Preparation of slides
- centrifugated (in Dutch: gespind) +: equal distribution -: need a lot of work
- smear -: not equal distribution (overestimation neutrophils, underestimation lymphocytes).
- Standard stain: Grunwald
Workflow
- fluorescense identification of the blood cells, automated flagging system using (for example using Cell Dyne Sapphire, Abbott).
- reactive cells: zone between lymphocytes and monytes
- smear
Two types
- bone marrow: various stadia
- peripheral
Morphology of the cells
- immature granulocytes: myelocyte, metamyelocyte
- monocytes: granular
- reactive neutrophils: large granulocytes, vacuolisation, a lot of young
- eosinophils: orange
- lymphocytes: empty cytoplasm,
- B/T cells: reactive vs. malignant
- atypical lymphocytes (reactive, not malignant)
for example in mononucleosis
- plasma cells --> plasmocytes
- blue border
- large nucleus: not yet turned into plasma cells
- erythrocytes
- erythroblasts: nucleated red blood cells, blue (polychromasie: rest of DNA)
- cold vs. warm agglutination. Mostly cold. (vs. Cryoglubulinel: humoral).
- thrombocytes
- ITP: few megakaryocytes, platelets are as big as RBCs
- trombocytes aggregation: problem with blood withdrawal (fibrin can be also seen), EDTA tube problem (less with citrate).
Morphology of the diseases
Anemia
- Microcytaire hympchrom anemia
- small erythrobalsts
- also in chronic infection
- Pernicious
- big oval RBC (macrocytes)
- not too many RBCs
- also: hypersegmentation neutrophils,
- problem with DNA production
- Thalassemia
- mostly Beta minor in Belgium
- poikilocytosis (pear like), target cells, basophilic stippling (also in lead poisoning).
- Sickle cell (SCD)
- homozygotes mutation that produces HbS (can be seen on electrophoresis), 30% in SCD
- target cells, Howell Jolly body RBCs (cluster DNA remnants, indicates spleen damage)
- also: large platelets
- G6PD
- can be triggered by medication for example antimalarial
- unstable hb
- blister cells (bite cells)
- increased hemolysis
- small RBCs with hole, normal Hb, increased MCHC
- autoimmune hemolysis
- spherocytes, polychromasie, increased reticulocytes (young RBCs).
- microangiopathic hemolysis (HUS, TTP)
- Von Willebrand factor deficiency
- helmet cells/ schistocytes (small part of RBCs is 'bitten'): mechanical breakdown against fibrine.
Helmet cells are better visualized using smeared using Grunwald stain than spinned
- low platelets
- increased ureum
- HUS: bloody diarrhea
Malignanacy
- the diagnosis is in bone marrow
- myelopriliferative (still functional) vs. myelodysplasia (not functional, a lost of blasts)
- Chronic myeloid leukemia
- not a precise term, actually is not a leukemia, it is myeloproliferative
- granulocytes proliferation
- polycythemia vera (Vaquez disease)
- 5 to 10% RBCs
- Essential trombocytosis
- 1 to 10% peripheral thrombocytes
- Myelofibrosis
- Fibroblasts, erythroblasts, tear drop, immature granulocytes, empty bone marrow,
- extramedullair take it over: enlarge liver and spleen
- Myelodysplastic
- refractaire anemia with ringed sideroblasts --> precursor of leukemia
- unilineage RBC (with sideroblasts), multilineage
- hypogranulation
- Leukemia
- blasts proliferation
- monoclonal
- lymphatic or myeloid
- emergency (on call)
- AML
- myeloblasts (fine granulocytes)
- Auers rods (in AML, primary granulocytes fused, peroxidase stain)
- AML: M1 to M7 using FAB classification
- ALL
- no peroxidase, cleavage, no cytoplasm, vacuoles
- perform phenotyping
- red sign: trombocytopenia, and pancytopenia
- Myelomas
- monoclonal plasma cells
- plasma cells leukemia when it is peripheral
- RBCs train: heavy protein, increased ESR (due to fibrinogen, versus reactive plasma cells)
- Lymphomas
- Non Hodgkin
- mostly B cells
- monoclonal
- CLL
- lymphocytosis
- mature B cells from blood as origin (vs. lymph node in NHL)
- atypical lymphocytes (can also be reactive)
- T cells > B cells
- centrocytes, cleaved, like paint on the ground
- Hairy cell leukemia
- is visualized better in smeared not spinned
- from the milt
- centrifugated (in Dutch: gespind) +: equal distribution -: need a lot of work
- smear -: not equal distribution (overestimation neutrophils, underestimation lymphocytes).
- Standard stain: Grunwald
Workflow
- fluorescense identification of the blood cells, automated flagging system using (for example using Cell Dyne Sapphire, Abbott).
- reactive cells: zone between lymphocytes and monytes
- smear
Two types
- bone marrow: various stadia
- peripheral
Morphology of the cells
- immature granulocytes: myelocyte, metamyelocyte
- monocytes: granular
- reactive neutrophils: large granulocytes, vacuolisation, a lot of young
- eosinophils: orange
- lymphocytes: empty cytoplasm,
- B/T cells: reactive vs. malignant
- atypical lymphocytes (reactive, not malignant)
for example in mononucleosis
- plasma cells --> plasmocytes
- blue border
- large nucleus: not yet turned into plasma cells
- erythrocytes
- erythroblasts: nucleated red blood cells, blue (polychromasie: rest of DNA)
- cold vs. warm agglutination. Mostly cold. (vs. Cryoglubulinel: humoral).
- thrombocytes
- ITP: few megakaryocytes, platelets are as big as RBCs
- trombocytes aggregation: problem with blood withdrawal (fibrin can be also seen), EDTA tube problem (less with citrate).
Morphology of the diseases
Anemia
- Microcytaire hympchrom anemia
- small erythrobalsts
- also in chronic infection
- Pernicious
- big oval RBC (macrocytes)
- not too many RBCs
- also: hypersegmentation neutrophils,
- problem with DNA production
- Thalassemia
- mostly Beta minor in Belgium
- poikilocytosis (pear like), target cells, basophilic stippling (also in lead poisoning).
- Sickle cell (SCD)
- homozygotes mutation that produces HbS (can be seen on electrophoresis), 30% in SCD
- target cells, Howell Jolly body RBCs (cluster DNA remnants, indicates spleen damage)
- also: large platelets
- G6PD
- can be triggered by medication for example antimalarial
- unstable hb
- blister cells (bite cells)
- increased hemolysis
- small RBCs with hole, normal Hb, increased MCHC
- autoimmune hemolysis
- spherocytes, polychromasie, increased reticulocytes (young RBCs).
- microangiopathic hemolysis (HUS, TTP)
- Von Willebrand factor deficiency
- helmet cells/ schistocytes (small part of RBCs is 'bitten'): mechanical breakdown against fibrine.
Helmet cells are better visualized using smeared using Grunwald stain than spinned
- low platelets
- increased ureum
- HUS: bloody diarrhea
Malignanacy
- the diagnosis is in bone marrow
- myelopriliferative (still functional) vs. myelodysplasia (not functional, a lost of blasts)
- Chronic myeloid leukemia
- not a precise term, actually is not a leukemia, it is myeloproliferative
- granulocytes proliferation
- polycythemia vera (Vaquez disease)
- 5 to 10% RBCs
- Essential trombocytosis
- 1 to 10% peripheral thrombocytes
- Myelofibrosis
- Fibroblasts, erythroblasts, tear drop, immature granulocytes, empty bone marrow,
- extramedullair take it over: enlarge liver and spleen
- Myelodysplastic
- refractaire anemia with ringed sideroblasts --> precursor of leukemia
- unilineage RBC (with sideroblasts), multilineage
- hypogranulation
- Leukemia
- blasts proliferation
- monoclonal
- lymphatic or myeloid
- emergency (on call)
- AML
- myeloblasts (fine granulocytes)
- Auers rods (in AML, primary granulocytes fused, peroxidase stain)
- AML: M1 to M7 using FAB classification
- ALL
- no peroxidase, cleavage, no cytoplasm, vacuoles
- perform phenotyping
- red sign: trombocytopenia, and pancytopenia
- Myelomas
- monoclonal plasma cells
- plasma cells leukemia when it is peripheral
- RBCs train: heavy protein, increased ESR (due to fibrinogen, versus reactive plasma cells)
- Lymphomas
- Non Hodgkin
- mostly B cells
- monoclonal
- CLL
- lymphocytosis
- mature B cells from blood as origin (vs. lymph node in NHL)
- atypical lymphocytes (can also be reactive)
- T cells > B cells
- centrocytes, cleaved, like paint on the ground
- Hairy cell leukemia
- is visualized better in smeared not spinned
- from the milt
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