HematologyHistological Slide Quiz - PowerPoint PPT Presentation

Title: HematologyHistological Slide Quiz


1
Hematology-Histological Slide Quiz

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• ANDY JONES

Tha Crocodile
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What is the WBC count, if this slide represents
the average number of WBC per field?
Use 40X objective and take the average number of
WBCs in 5 fields and multiply by 3,000. So 4
x 3,000 12,000 WBC per µL
3
Name the different cells.
Platelet
Eosinophil
Neutrophil (Band Cell)
Mature Neutrophil
Basophil
Monocyte
Lymphocyte
Red Blood Cell (Mature Erythrocyte)
4
What is the platelet count, if this slide
represents the average number of platelets per
field?
Use 100X oil objective and take the average of
platelets in 5 fields and multiply by
20,000. So 8 platelets per field (Avg.) x
20,000 160,000 platelets per µL (Reference
150,000 400,000 per µL)
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RBC Evaluation What type of RBC variation is
this?
1.
2.
1. Anisocytosis Variations in size
2. Poikylocytosis Variations in shape
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What is wrong with these RBCs, and under what
condition would you find cells like this?(Hint
MCV is less than 80)
Hypochromic, microcytic RBCs (note small size
of RBC in comparison to the nucleus of the
lymphocyteRBC diameter should be roughly the
size of the nucleus of lymphocyte) So Increased
central pallor (hypochromia) and decreased MCV
lt80 (microcytic anemia) Most commonly seen in
iron deficiency anemia
7
If you were to prepare a peripheral blood smear
that resulted in these two findings 1)What Blood
Cell abnormalities do you notice? 2)What is the
most likely diagnosis?
RBC Abnormalities Macrocytes and Ovalocytes
WBC Hypersegmented Neutrophil But
Normochromic Most likely diagnosis
Megaloblastic Anemia due to B12 or Folate
Deficiency (This deficiency results in the
normal development of cytosol in the blood
products, but a slower rate of nuclear
replication due to inhibited DNA synthesis aka
asynchrony of cytoplasm to nucleus
maturationleading to enlarged cells
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Judging from this peripheral blood smear, what is
the most likely diagnosis?
Basophilic Stippling

• RBCs Microcytic and
• look hypochromic
• Most have an MCV lt 70 fL
• Usually have a normal RDW
• RBC count usually gt 5 million
• Heterogeneous cell shapes

Lab Values RBC 5.5 (normal) MCV - 50 fL
(low) RDW 12.5 (normal)
Diagnosis Thalassemia Gene mutation or
deletion that causes decreased rate of synthesis
of the globin chain Homozygous mutation
(severe hemolytic anemia) or heterozygous
mutation (asymptomatic or mild problems)
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Case 65 y/o plumber presents with anemia and
fatigue. After looking at his peripheral blood
smear you notice some abnormalities in his blood.
You ask about his occupational hazards and
discover he has worked with lead solder for 25
years. What is the most likely cause of this
mans anemia?
Blood picture MCV may vary depending on RBC
population May have normal RBCs with
microcytic, hypochromic RBCs Basophilic
stippling, polychromasia, teardrops, aniso,
poik, increased RDW Siderocytes or Pappenheimer
bodies (due to build-up of Fe in
mitochondria) Ringed Sideroblasts in bone marrow
biopsy
DIAGNOSIS Sideroblastic Anemia Normal iron
uptake, but cant use the iron due to enzyme
problem. Congenital or acquired. Acquired
caused by other diseases (hemolytic or
inflammatory), exposure to drugs or agents
(alcohol, lead, Chloramphenicol)
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What type of cell is this, and when would you see
these cells in a peripheral blood smear? What
test could you order to confirm your suspicions?
Atypical lymphocyte (note cytoplasm is pushed in
by RBCs) This is seen in patients with EBV
mono. To confirm an infectious mono you could
order a heterophile Antibody test (monospot test).
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This is a peripheral blood smear and bone marrow
aspirate from a 10 y/o boy that presents with a
three week history of malaise, fever and night
sweats. Upon physical exam you note
lymphadenopathy and hepatosplenomegaly. What is
the most likely diagnosis? (Click once for hint)
Peripheral Blood Smear
Bone Marrow Aspirate
Hint Note the size of the blast cells as
compared to the RBCs in the peripheral
blood smear. What one type of cell predominants
in the bone marrow aspirate?
Acute Lymphocytic (Lymphoblastic) Leukemia. This
is the most common malignant disease of children
(80 of childhood leukemias). This patient is
experiencing fatigue and malaise from anemia,
since all of his cells in the bone marrow have
been displaced by proliferating lymphoblasts.
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Refer to the last questionif the peripheral
blood smear of the patient looked like the one
presented below, how would you narrow your
diagnosis?
In this case you have a different morphology that
resembles a Burkitts Lymphoma (Medium to large
cells, moderate very basophilic cytoplasm,
prominent cytoplasmic vacuoles) The diagnosis
would be Acute Lymphoblastic Leukemia- FAB L3
13
Based on the peripheral blood smear of this
patient with a WBC count of 85,000 anemia, fever
and nauseawhat is the most likely cause of this
patients luekemia?
Auer Rod
Diagnosis Acute Myeloblastic Leukemia (AML).
Note the Auer Rods, this rules out Acute
Lymphoblastic Leukemia (ALL). These are
azurophilic granules lined up in a rod
shape. Remember, if auer rods are present with
balsts then it means 100 of the time you are
looking at AML (From Dr. Turnbill)
14
What are the cells present at the arrows? What
condition causes these cells to have this
appearance?
Cells Smudge cells. Cells in peripheral blood
that are fragile, and become disrupted by the
slide preparation. Condition This is seen in
Chronic Lymphocytic Leukemia
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When would you see a cell like this, and in what
part of the body? What cellular surface markers
would be present on this cell to confirm the
diagnosis? What is the diagnosis?
Reed-Sternberg cells in a reactive background (T
cells surrounding). This sample is probably
taken for a lymph node biopsy from a cervical or
an axillary lymph node. (Dr. Ramalingam) To
confirm your suspected diagnosis, cell surface
markers CD30 and CD15 would most likely be
present. Leukocyte common antigen (LCA) would be
negative
Diagnosis Mixed Cellularity Hodgkins Lymphoma
16
A 28 yo male presents with painless adenopathy of
the cervical lymph nodes. Upon inspection of his
chest x-ray, ordered for his shortness of breath,
you notice a mediastinal mass. What is the most
likely diagnosis?
Classical Reed-Sternberg cells are rare, But you
do see lacunar cell (little lakes) variants in
the lymph node biopsy
Capsular thickening, broad collagen bands
traverse the node
Diagnosis this is probably the most common
subtype of Hodgkins disease, Nodular Sclerosis
Hodgkins Disease since 80 of patients present
with a Cervical lymphadenopathy and a
mediastinal mass.
17
You are treating a young boy for an abdominal
mass. After surgical resection of the mass, the
pathologist (Dr. Falls) calls you to come look at
his findings. After examining the slides under
low and high power, what is the most likely
cytogenetic change in these cells? What
mechanism causes this change?(Click once for
hint)
Low Power
High Power
Cytoplasmic vacuoles
Starry Sky appearance
So the diagnosis would be Burkitts Lymphoma with
our favorite t(814) translocation. Remember the
translocation of the c-myc gene from chromosome 8
to the region of chromosome 14 (bcl-2) that
contains a promoter for an immunoglobulin gene.
This causes the over expression of c-myc (which
normally a promotes cell proliferation and
growth). The unchecked expression causes B cell
proliferation and cancer. Many times, this has
been associated with Epstein Barr Virus infection
(esp. in Africa).
18
You are seeing a 68 yo male patient, who presents
to you for a routine physical. You notice as you
begin you chest lung exam, he has some lesions
on his skin. A dermatologist performs a skin
biopsy and discovers the following results. What
is your diagnosis?
Epidermotrophic inflitrates
Skin plaques and patches
Diagnosis Mycosis Fungoides Sezary Syndrome
Most common cutaneous lymphoma Seen in
Adults/elderly Limited to skin patches
plaques Dissemination to peripheral blood,
lymph nodes, spleen (Sezary syndrome) Bone
marrow involvement is rare
19
A 32 yo male presents to your clinic with fatigue
and skin lesions. Upon physical examination you
note generalized lymphadenopathy. Your results
from a CBC arrive moments later, with an elevated
WBC count. Blood chemistry reveals
hypercalcemia. What is you diagnosis, and what
prognosis can you give your patient?
The presence of circulating flower cells can
give a clue to the diagnosis.
Diagnosis Adult T cell Luekemia/Lymphoma. This
is associated with skin lesions and
hypercalcemia (From Dr. Ramalingam) and
especially the HTLV-1 (Human T Cell Lymphoma
Virus-1). The prognosis for this disease would
be poor, since this is a very aggressive form of
leukemia/lymphoma. Median survival rate is only
8 months!