Thrombocytopenias Due to Reduced Cell Production

Causes Thrombocytopenia Adults

In this condition, blood contains few, usually small, pyknotic old thrombocytes. Only a very few megakaryocytes are found in the bone marrow, and these have a normal appearance. Chronic alcoholism. There may be some overlap with increased turnover and folic acid deficiency. Chemical and radiological noxae. Cytostatics naturally lead directly to a dose-dependent reduction in megakaryocyte counts. A large therapeutic radiation burden in the area of blood-producing bone marrow has the same result,...

Thrombocytopenias Due to Increased Demand High Turnover

Etiology Thrombocytopenia

A characteristic sign of this pathology can be that among the few throm-bocytes seen in the blood smear, there is an increased presence of larger, i.e., less mature cell forms. The bone marrow in these thrombocytopenias shows raised or at least normal megakaryocyte counts. Here too, there may be an increased presence of less mature forms with one or two nuclei Figs. 60,61 . Drug-induced immunothrombocytopenia As in drug-induced agranulo-cytosis, the process starts with an antibody response to a...

Essential Thrombocythemia

Polycythemia Vera Blood Smear

Essential thrombocythemia, by contrast, is a myeloproliferative disease see p. 114 in which the main feature of increased thrombocytes is accompanied by other signs of this group of diseases that may vary in severity, such as leukocytosis and an enlarged spleen. Severe thrombocythemia may also be seen in osteomyelosclerosis, polycythemia vera, and chronic myeloid leukemia, and for this reason the following specific diagnostic criteria have been suggested Diagnostic criteria for essential...

Polycythemia Vera Erythremic Polycythemia and Erythrocytosis

Polycythemia Vera

Increases in erythrocytes, hemoglobin, and hematocrit above the normal range due to causes unrelated to hematopoiesis i.e., the majority of cases are referred to as secondary erythrocytosis or secondary polycythemia. However, it should be remembered that the normal range of values is quite wide, especially for men, in whom the normal range can be as much as 55 of the hematocrit Table 28 Causes of secondary erythrocytosis Table 28 Causes of secondary erythrocytosis - Carboxyhemoglobin formation...

Cytology of Cerebrospinal Fluid

Cerebrospinal Fluid Analysis Imagines

The first step in all hemato-oncological and neurological diagnostic assessments of cerebrospinal fluid is the quantitative and qualitative analysis of the cell composition Table 32 . Table 32 Emergency diagnostics of the liquor according to Felgenhauer in Thomas 1998 v Cell count Fuchs-Rosenthal chamber v Smear or cytocentrifuge preparation - to analyze the cell differentiation and - to search for bacteria and roughly determine their types and prevalence gt An additional determination of...

Reactive Lymph Node Hyperplasia and Lymphogranulomatosis Hodgkin Disease

Lymph Node Cytology

Reactive lymph node hyperplasia of whatever etiology is characterized by a confused mixture of small, middle-sized, and large lymphocytes. When the latter have a nuclear diameter at least three times the size of the predominating small lymphocytes and have a fair width of basophilic cytoplasm, they are called immunoblasts lymphoblasts . Cells with deeply basophilic, eccentric cytoplasm and dense nuclei are called plasmablasts, and cells with a narrow cytoplasmic seam are centroblasts....

Sarcoidosis and Tuberculosis

Cytology Pics Sacoidosis

The material of cell biopsies taken from indolent, nonirritated enlarged lymph nodes in the neck or axilla that have developed with little in the way of clinical symptoms, or from subcutaneous infiltration in various regions, can be quite homogeneous. With their thin, very long, ovoid nucleus four to five times the size of lymphocytes , delicate reticular chro-matin structure, and extensive layer of cytoplasm that may occasionally appear confluent with that of other cells, they are reminiscent...

Bone Marrow Carcinosis and Other Space Occupying Processes

Peripheral Blood Film Metastasis

Anemia resulting from bone marrow infiltration by growing, space-occupying tumor metastases can in principle be normochromic. However, under the indirect influence of the underlying disease, it tends more often to be hypochromic secondary anemia . Normoblasts in the differential blood analysis Fig. 9a, p. 33 particularly suggest the possibility of bone marrow carcinosis, because their presence implies destruction of the bone marrow-blood barrier. Usually, bone marrow carcinosis leads eventually...

Hyperchromic Anemias

Vacuolization Alcohol Erythroblasts

In patients with clear signs of anemia, e.g., a sickly pallor, atrophic lingual mucosa, and sometimes also neurological signs of bathyanesthesia loss of deep sensibility , even just a cursory examination of the blood smear may indicate the diagnosis. Marked poikilocytosis and anisocytosis are seen, and the large size of the erythrocytes is particularly conspicuous in comparison with the lymphocytes, whose diameter they exceed mega-locytes . These are the hallmarks of macrocytic, and, with...

Normochromic Renal Anemia

Sometimes Hypochromic or Hyperchromic Normochromic anemia should also suggest the possibility of renal insufficiency, which will always lead to anemia within a few weeks. In cases of chronic renal insufficiency it is always present and may reach Hb values as low as 6 g dl. The anemia is caused by changes in the synthesis of erythropoietin, the hormone regulating erythropoiesis measurement of serum erythropoietin is an important diagnostic tool. Erythrocyte life span is also slightly reduced....

Diseases of the Lymphatic System Non Hodgkin Lymphomas

Slvl Lymphoma

Malignant diseases of the lymphatic system are further classified as Hodg-kin and non-Hodgkin lymphomas NHL . NHL will be discussed here because most NHLs can be diagnosed on the blood analysis. gt Non-Hodgkin lymphomas arise mostly from small or blastic B-cells. gt Small-cell NHL cells are usually leukemic and relatively indolent, of the type of chronic lymphocytic leukemia and its variants. gt Blastic NHL precursor lymphoma is not usually leukemic. An exception is the lymphoblastic lymphoma,...

Elevated Eosinophil and Basophil Counts

Reactive Bronchial Cells

In accordance with their physiological role, an increase in eosinophils gt 400 1, i.e. for a leukocyte count of 6000, more than 8 in the differential blood analysis is usually due to parasitic attack p. 5 . In the Western hemisphere, parasitic infestations are investigated on the basis of stool samples and serology. Strongyloides stercoralis in particular causes strong, sometimes extreme, elevation of eosinophils may be up to 50 . However, eosinophilia of variable degree is also seen in ameba...

Normochromic Hemolytic Anemias

Polychromatic Erythrocyte

Hemolytic anemias result from a shortened erythrocyte life span with insufficient compensation from increased erythrocyte production Table 24 . H Usually, hematopoiesis in the bone marrow is increased in compensation, and, depending on the course of the disease, may make up for the accelerated cell degradation for all or some of the time by recycling the iron as it becomes free. Accordingly, counts of the young, newly emerged erythrocytes reticulocytes are always raised, and usually sporadic...

Relative Lymphocytosis Associated with Granulocytopenia Neutropenia and Agranulocytosis

Agranulocytosis

Neutropenia is defined by a decrease in the number of neutrophilic granulocytes with segmented nuclei to less than 1500 1 1.5 x 109 l . A neutrophil count of less than 500 l 0.5 x 109 l constitutes agranulocytosis. Absolute granulocytopenias with benign cause develop into relative lymphocytoses. In the most common clinical picture, drug-induced acute agranulocytosis, the bone marrow is either poor in cells or lacks granulopoietic precursor cells aplastic state , or shows a maturation block at...

Acute Leukemias

Myelodysplasia Bone Marrow Smear

Acute leukemias are described in this place for morphological reasons, because they involve a predominance of mononuclear cells p. 63 . Although or perhaps because the term leukemia is relatively imprecise, an overview seems required Table 13 . The cellular phenomenon common to the different forms of leukemia is the rapidly progressive reduction in numbers of mature granulocytes, thrombocytes, and erythrocytes. Simultaneously, the leukocyte count usually increases due to the occurrence of...

Hypochromic Anemias Iron Deficiency Anemia

Iron Deficiency Anemia Ferritin Below

Their usual cause is iron deficiency from various causes Fig.44 . To distinguish quickly between real iron deficiency and an iron distribution disorder, iron and ferritin levels should be determined. Fig. 44 The most important reasons for iron deficiency according to Begemann Fig. 44 The most important reasons for iron deficiency according to Begemann Table 22 Diagnostic findings and work-up for the most important disorders of the red cell series Table 22...

Reactive Left Shift

Hematology Shift Left

A relative left shift in the granulocyte series means less mature forms in excess of 5 band neutrophils the preceding, less differentiated cell forms are included and all transitional forms are taken into account. This left shift almost always indicates an increase in new cell production in this cell series. In most cases, it is associated with a raised total leukocyte count. However, since total leukocyte counts are subject to various interfering factors that can also alter the cell...

Steps in the Diagnosis of Chronic Myeloid Leukemia

Cloud Like Megakaryocyte

Left-shift leukocytosis in conjunction with usually low-grade anemia, thrombocytopenia or thrombocytosis which often correlates with the migration of small megakaryocyte nuclei into the blood stream , and clinical splenomegaly is typical of CML. LDH and uric acid concentrations are elevated as a result of the increased cell turnover. The average typical cell composition is as follows in a series analyzed by Spiers about 2 myeloblasts, 3 promyelocytes, 24 myelocytes, 8 metamyelocytes, 57 band...

Bone Marrow Cell Composition and Principles of Analysis

Mice Bone Marrow Smears

As indicated above, and as will be shown below, almost all disorders of the hematopoietic system can be diagnosed using clinical findings, blood analysis, and humoral data. There is no mystery about bone marrow diagnostics. The basic categories are summarized here to give an understanding of how specific diagnostic information is achieved photomicrographs will show the appearance of specific diseases. Once the individual cell types, as given in the preceding pages, are recognized, it becomes...

Hypochromic Infectious or Toxic Anemia Secondary Anemia

Skin Infection Cytology Image

Among the various causes of lack of iron for erythropoiesis see Fig.44, p. 129 , a special situation is represented by the internal iron shift caused by iron pull of the reticuloendothelial system RES during infections, toxic processes, autoimmune diseases, and tumors. Since this anemia results from another disorder, it is also called secondary anemia. The MCH is hypochromic, or in rare instances, normochromic, and therefore erythro-cyte morphology is particularly important to diagnosis. In...

Monocytosis

Autoimmune Endocarditis Lenta

If mononuclear cells stand out in showing an unusually elaborate nuclear structure with ridges and lobes and a wider cytoplasmic layer with very delicate granules for characteristics see p. 46, for cell function, see p. 6 , and this is in the context of relative gt 10 or absolute monocytosis cell count gt 900 l , a series of possible triggers must be considered Table 12 . If the morphology does not clearly identify the cells as monocytes, then esterase assays should be done in a hematological...

Bone Marrow Medullary Stroma Cells

Bone Marrow Osteoblasts Blood Film

gt Fibroblastic reticular cells form a firm but elastic matrix in which the blood-forming cells reside, and are therefore rarely found in the bone marrow aspirate or cytological smear. When present, they are most likely to appear as dense cell groups with long fiber-forming cytoplasmic processes and small nuclei. Iron staining shows them up as a group of reticular cells which, like macrophages, have the potential to store iron. If they become the prominent cell population in the bone marrow,...

Reactive Lymphocytosis

Lymphocytes Blasts

Lymphatic cells show wide variability and transform easily. This is usually seen as enlarged nuclei, a moderately loose, coarse chromatin structure, and a marked widening of the basophilic cytoplasmic layer. Clinical findings, which include acute fever symptoms, enlarged lymph nodes, and sometimes exanthema, help to identify a lymphatic reactive state. Unlike the case in acute leukemias, erythrocyte and thrombocyte counts are not significantly reduced. Although the granulocyte count is...

The Individual Cells of Hematopoiesis

Promyelocytes Myelocytes Metamyelocytes

Immature Red Cell Precursors Proerythroblasts and Basophilic Erythroblasts Proerythroblasts are the earliest, least mature cells in the erythrocyte-forming series erythropoiesis . Proerythroblasts are characterized by their size about 20 m , and by having a very dense nuclear structure with a narrow layer of cytoplasm, homogeneous in appearance, with a lighter zone at the center they stain deep blue after Romanowsky staining. These attributes allow proerythroblasts to be distinguished from...

Stepby Step Diagnostic Sequence

On the basis of what has been said so far, the following guidelines for the diagnostic workup of hematological changes may be formulated 1. The first step is quantitative determination of leukocytes L , erythrocytes E and thrombocytes T . Because the normal range can vary so widely in individual cases Table 2 , the following rule of thumb should be observed A complete blood count CBC should be included in the baseline data, like blood pressure. 2. All quantitative changes in L E T call for a...