Megakaryocyte Abnormalities in Thrombotic Thrombocytopenic Purpura
|
|
- Alaina Rose
- 6 years ago
- Views:
Transcription
1 Megakaryocyte Abnormalities in Thrombotic Thrombocytopenic Purpura LAWRENCE KASS, M.D. Department of Internal Medicine, Simpson Memorial Institute, The University of Michigan, Ann Arbor, Michigan ABSTRACT Kass, Lawrence: Megakaryocyte abnormalities in thrombotic thrombocytopenic purpura. Am. J. Clin. Pathol. 61: , Morphologic and enzymatic abnormalities were found in megakaryocytes obtained from bone marrow of four patients with thrombotic thrombocytopenic purpura. These abnormalities included large megakaryocytes resembling those in essential thrombocythemia, abnormalities in nuclear segmentation and "doughnut-hole" nuclei, multiple cytoplasmic vacuoles, erythrophagocytosis by megakaryocytes, small "reticuloid" megakaryocytes, and markedly increased activity of cytoplasmic LDH. These observations suggest the possibility of an intrinsic and perhaps neoplastic abnormality of megakaryocytes in thrombotic thrombocytopenic purpura. (Key words: Megakaryocyte; Purpura, thrombotic thrombocytopenic; Erythrophagocytosis; Lactic dehydrogenase.) THIS REPORT describes abnormalities of megakaryocytes in the bone marrow of four patients with thrombotic thrombocytopenic purpura (TTP). Materials and Methods Sternal or iliac bone marrow was obtained from four patients with the classic "triad" of thrombotic thrombocytopenic purpura comprised of hemolytic anemia, thrombocytopenia, and neurologic findings. All of these patients succumbed to the disorder, and at necropsy were found to have the typical capillary hyaline thrombotic lesions of TTP in various organs. Received September 17, 1973; received revised manuscript November 21, 1973; accepted for publication December 6, Supported by the Elizabeth Roodvoets Memorial Grant for Cancer Research of the American Cancer Society (CI-79), and by a grant from the National Cancer Institute (USPH CA ). Films of bone marrow flecks were made on methanol-cleaned glass coverslips and stained with Wright's stain for light microscopic examination. Other, unstained, coverslips were stained for lactic dehydrogenase (LDH) activity according to the method of Stuart and Skowron 10 and counterstained with nuclear fast red. 5 Control coverslips for LDH activity included marrows from three presumably normal individuals, three patients with agnogenic myeloid metaplasia, ten patients with idiopathic thrombocytopenic purpura (ITP), and four patients with essential thrombocythemia. Results In all of the TTP specimens, megakaryocytes were increased in number. Although some of the megakaryocytes appeared indistinguishable from normal 639
2 640 KASS A,J.C.P. Vol. 61 J FIG. 1. Unusually large megakaryocyte with multilobulated nucleus and abundant richly granular cytoplasm containing several sequestrations of granular material. Wright's stain, x 1,200. megakaryocytes, the majority of them appeared abnormal. The abnormalities were found in all the marrows examined, and seemed to be classifiable into several types. First, unusually large megakaryocytes were observed (Fig. 1). These megakaryocytes frequently contained multilobulated nuclei and voluminous, richly granular cytoplasm. Occasionally, the cytoplasm contained large areas of sequestered granules, as seen in Figure 1. A second type of abnormal megakaryocyte is illustrated in Figure 2, A and B. This megakaryocyte appeared normal in size, but the configuration of the nucleus was abnormal. Partially-disconnected nuclear lobes were seen, and numerous dense aggregates of chromatin appeared in the nucleus. This type of megakaryocyte frequently had a doughnut-shaped nucleus, with a small, central "hole," as illustrated in Figure 2, A and B. A third type of abnormal megakaryocyte is seen in Figure 2,C and D. This megakaryocyte had an eccentrically-located, coarsely-reticular appearing nucleus and its cytoplasm was filled with numerous vacuoles. Few granules were observed, and little evidence of platelet formation at the periphery of the megakaryocyte cytoplasm could be found. A fourth type of abnormal megakaryocyte appears in Figure 3, A, B, and C. This megakaryocyte had a dense-appearing nucleus, platelet pseudopodia at the peripheral boundaries of the cell, and scant hypogranular cytoplasm. The striking abnormality in these megakaryocytes was the finding of erythrophagocytosis of mature erythrocytes. These erythrocytes often appeared to be enclosed within a vacuolar structure in the cytoplasm, as seen in Figure 3, A, B and C. A fifth type of abnormal megakaryocyte is seen in Figure 4, A and B. This reticuloid megakaryocyte 3 was frequently smaller than the normal megakaryoblast, and demonstrated a finely-reticular nuclear chromatin network and scant, hypogranular cytoplasm. The cell was fre-
3 FIG. 2. A, megakaryocyte with numerous dense aggregates of nuclear chromatin and doughnut hole in center. The cytoplasm is scant and hypogranular. B, megakaryocyte with similar doughnut hole and several bulbous-appearing nuclear lobules. The cytoplasm is scant and contains few granules. C, megakaryocyte with eccentrically located nucleus and multiple cytoplasmic vacuoles. Abortive platelet formation can be seen at the periphery of the cell. D, megakaryocyte with similar eccentric nucleus and multiple cytoplasmic vacuoles of various sizes. Vacuole-filled pseudopodia are seen, and an area of granular cytoplasm is adjacent to the nucleus. Wright's stain, x 1,200. quently binucleate, and platelet formation at the periphery could be seen. A sixth group of megakaryocytes did not possess any common abnormality. Nevertheless, these megakaryocytes showed numerous individual aberrations, including abnormalities of nuclear segmentation and caliber of chromatin strands. These abnormalities are illustrated in Figure 5, A, B and C. A cytochemical stain for LDH activity in the megakaryocytes of the four marrow samples revealed dense cytoplasmic accumulations of formazan granules representing LDH activity (Fig. 6). The number of these granules was considerably greater than in normal or ITP megakaryocytes and resembled the LDH activity seen in essential thrombocythemia and agnogenic myeloid metaplasia. 8
4 KASS AJ.C.P. Vol. 61 FIG. 3. A, B, and C, megakaryocytes from three different patients with TTP illustrate erythrophagocytosis. Mature erythrocytes, some of which appear partially digested, are found in the cytoplasm (arrows). Wright's stain, x 1,200. FIG..4./4 andb, megakaryocytes from two patients. These small cells have finely reticular nuclear chromatin. Platelet formation can be seen at the periphery of the cell. These megakaryocytes are frequently binucleate. Wright's stain, x 1,200. FIG. 5. A, megakaryocyte with coarsely-fenestrated nuclear chromatin pattern and scant hypogranular cytoplasm. Lobulations are not seen. B, megakaryocyte with three separate nuclei, cytoplasmic vacuolation, and abortive platelet formation at the periphery. C, large young-appearing megakaryocyte^ megakaryoblast). Wrights stain, x 1,200.
5 May 1974 MEGAKARYOCYTES IN TTP 643 Discussion Although the clinical manifestations of thrombotic thrombocytopenic purpura have been well characterized since its description by Moschowitz in 1925, 7 the etiology of the disorder is still unknown. 1 The results of the present study suggest that the thrombocytopenia of TTP may have at least part of its origin in morphologically abnormal megakaryocytes. The first, or large, type of megakaryocyte resembles those seen in essential thrombocythemia. Increased activity of LDH enzyme has been found in the megakaryocytes of essential thrombocythemia. 5 Since increased activities of glycolytic enzymes are found in neoplastic cells, 9 it has been suggested that the abnormal-appearing megakaryocytes of essential thrombocythemia may be neoplastic. 5 FIG. 6. Megakaryocyte, TTP, LDH stain and nuclear fast red counterstain, showing numerous dark formazan granules representing LDH activity, x 1,200. The present study illustrates such megakaryocytes containing phagocytized erythrocytes. Erythrophagocytosis by reticulum cells is commonly observed in TTP The second type of megakaryocyte, containing dense chromatin aggregates and a "doughnut-hole" nucleus, may also indicate an intrinsic megakaryocyte abnormality. marrows, 6 and may account in part for Although this is speculative, the anemia. It is difficult to assess the the dense chromatin aggregates may be contribution of megakaryocytic erythrophagocytosis caused in part by collections of nucleohistones. These focal collections of histones could repress certain types of genetic information, leading to cytoplasmic hypogranuiarity and decreased platelet formation. The "doughnut-hole" may represent a defect in nuclear division. The third to the development of the anemia of TTP, but perhaps it may play a minor role. The factor(s) making the erythrocyte susceptible to engulfment by the megakaryocyte and the factor(s) which may lead to increased activity of the megakaryocytic cell membrane, causing it to type of megakaryocyte, with an eccentric behave as a phagocyte in TTP, are largely nucleus and multiple cytoplasmic vacuoles, unknown. The fifth, or "reticuloid," group resembles some of the megakaryocytes of megakaryocytes strongly resembles observed in idiopathic thrombocytopenic those seen in myeloproliferative disorders, purpura. 2,3 Such megakaryocytes in the particularly chronic granulocytic leukemia, latter condition are believed to be vacuolated agnogenic myeloid metaplasia, and acute because of "toxic" influences. It is and chronic erythremic myelosis. 3 The iso uncertain whether this is the case in TTP lated nuclear segmentation and chromatin since a "toxin" has not yet been identified. abnormalities in TTP resemble those Although fibrin strands surrounding found in both acute leukemias 3 and idiopathic and penetrating megakaryocytes have been thrombocytopenic purpura. 2,3 observed in TTP, 8 erythrophagocytosis Recent cytochemical studies of proerythroblasts by megakaryocytes has not been described. in TTP 6 have shown that the
6 644 KASS AJ.C.P. Vol. 61 proerythroblasts contain punctate deposits of arginine-rich histone in a speckled pattern. Among a variety of anemias, only proerythroblasts in the DiGuglielmo syndrome (acute and chronic erythremic myelosis and erythroleukemia) and in TTP were found to have this speckling. 4,6 A megaloblastoid type of erythroid chromatin pattern such as that found in the DiGuglielmo syndrome is also found in the erythroid precursors of TTP. 6 The cytochemical and morphologic similarities between the erythroid precursors of TTP and the DiGuglielmo syndrome suggested the possibility of an intrinsic and perhaps neoplastic erythroid abnormality in TTP. 6 In the present study, most TTP megakaryocytes were found to have markedly elevated LDH activities. Because LDH elevations of this magnitude are commonly found in neoplastic cells, 9 the possibility is raised that the megakaryocytes in TTP may also be neoplastic, and perhaps part of a wider panmyelotic disturbance. The suggestion that TTP may be a neoplastic disorder contrasts with a more widely-accepted belief 1 that TTP may be a type of disseminated intravascular coagulation. According to this consumptivecoagulopathy theory of TTP, the bizarre changes in the megakaryocytes may be the result of the same catastrophic event that has occurred in the microvasculature. References 1. Amorosi EL, Ultmann JE: Thrombotic thrombocytopenic purpura: Report of 16 cases and review of the literature. Medicine 45: , Dameshek W, Miller EB: Megakaryocytes in idiopathic thrombocytopenic purpura; a form of hypersplenism. Blood 1:27-36, Kass L: Bone Marrow Interpretation. Springfield, 111., Charles C Thomas, Kass L: Demonstration of histones in proerythroblasts in pernicious anemia and the Di Guglielmo syndrome. J Histochem Cytochem 20: , Kass L: Enzymatic abnormalities in megakaryocytes. Acta Haematol 49: , Kass L: Nuclear "speckling" in thrombotic thrombocytopenic purpura proerythroblasts. Am J Clin Pathol 59: , Moschowitz E: An acute febrile pleiochromic anemia with hyaline thrombosis of the terminal arterioles and capillaries. An undescribed disease. Arch Intern Med 36:89-93, Rebuck JW, Boyd CB, Monto RW: Morphologic evaluation of megakaryocytes, The Blood Platelets. Baltimore, Williams and Wilkins, 1971, pp Shonk CE, Arison RN, Koven BJ, et al: Enzyme patterns in human tissues. III. Glycolytic enzymes in normal and malignant tissues of the colon and rectum. Cancer Res 25: , Stuart J, Skowron PN: A cytochemical study of marrow enzymes in megaloblastic anaemia. Br J Haematol 15: , 1968
Blood Cell Identification Graded
Blood Cell Identification Graded Case History The patient was a five-day-old girl with an elevated unconjugated bilirubin and a weakly positive direct antiglobulin test (DAT). Her CBC showed: WBC = 11.0
More informationHematology Unit Lab 2 Review Material
Objectives Hematology Unit Lab 2 Review Material - 2018 Laboratory Instructors: 1. Assist students during lab session Students: 1. Review the introductory material 2. Study the case histories provided
More informationMegakaryocyte or Precursor, Normal
Precursor, Normal SYNONYMS none VITAL STATISTICS size...20-160 µm in diameter N:C ratio...varible, depending on maturation of cell; early forms have a high N:C rato which decreases as cell matures and
More informationParticipants Identification No. % Evaluation. Mitotic figure Educational Erythrocyte precursor, abnormal 1 0.
Cell Identification Mitotic figure 212 99.5 Educational Erythrocyte precursor, abnormal BMD-02 The arrowed cell is a mitotic figure. It was correctly identified by 99.5% of the participants. A cell containing
More informationHematopathology Lab. Third year medical students
Hematopathology Lab Third year medical students Objectives Identify the lesion Know the specific name of the lesion Know associated disease Know relevant pathologic background Spherocytes: appear small,
More informationEDUCATIONAL COMMENTARY DISTINGUISHING MORPHOLOGIC LOOK-ALIKES
EDUCATIONAL COMMENTARY DISTINGUISHING MORPHOLOGIC LOOK-ALIKES Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationEDUCATIONAL COMMENTARY MORPHOLOGIC ABNORMALITIES IN LEUKOCYTES
EDUCATIONAL COMMENTARY MORPHOLOGIC ABNORMALITIES IN LEUKOCYTES Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationBlood Cell Identification Graded
BCP-21 Blood Cell Identification Graded Case History The patient is a 37-year-old female with a history of multiple sickle cell crises. She now presents with avascular necrosis of the left hip. Laboratory
More informationEDUCATIONAL COMMENTARY BLOOD CELL IDENTIFICATION
EDUCATIONAL COMMENTARY BLOOD CELL IDENTIFICATION Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click
More informationEDUCATIONAL COMMENTARY DIFFERENTIATING IMMATURE PERIPHERAL BLOOD CELLS
Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click on Continuing Education on the left side of the
More informationHEMATOLOGIC MORPHOLOGY- AECOM HEMATOLOGY COURSE
Log Out Help current login :lcytryn@montefiore.org HEMATOLOGIC MORPHOLOGY- AECOM HEMATOLOGY COURSE Lawrence Cytryn, M.D. - Course Director 1998 Edward Burns, M.D. Images used by permission within AECOM
More informationParticipants Identification No. % Evaluation. Mitotic figure Educational Erythrocyte precursor, abnormal/
Cell Identification BMD-09 Participants Identification No. % Evaluation Mitotic figure 233 96.7 Educational Erythrocyte precursor, abnormal/ 4 1.7 Educational dysplastic nuclear features Erythrocyte precursor
More informationLymphoma Tumor Board Quiz! Laboratory Hematology: Basic Cell Morphology
Lymphoma Tumor Board Quiz! Laboratory Hematology: Basic Cell Morphology CABOT RINGS Cabot rings in a patient with hemolytic anemia. Cabot ring (red arrow) and Howell-Jolly body (blue arrow). Observed in
More informationMegakaryoblastic Leukemia in a Dog A. Hillström 1, H. Tvedten 1, M. Kiupel 2.
Megakaryoblastic Leukemia in a Dog A. Hillström 1, H. Tvedten 1, M. Kiupel 2. 1 University Animal Hospital, Swedish University of Agricultural Sciences and Strömsholm Referral Animal Hospital, Sweden 2
More informationApproccio morfologico alle microangiopatie trombotiche
Approccio morfologico alle microangiopatie trombotiche Gina Zini Polo Oncologia e Ematologia Policlinico A. Gemelli Università Cattolica S. Cuore - Roma 1 Thrombotic microangiopathies Occlusive microangiopathic
More informationVETERINARY HEMATOLOGY ATLAS OF COMMON DOMESTIC AND NON-DOMESTIC SPECIES COPYRIGHTED MATERIAL SECOND EDITION
VETERINARY HEMATOLOGY ATLAS OF COMMON DOMESTIC AND NON-DOMESTIC SPECIES SECOND EDITION COPYRIGHTED MATERIAL CHAPTER ONE HEMATOPOIESIS GENERAL FEATURES All blood cells have a finite life span, but in normal
More informationMyelodysplastic syndrome (MDS) & Myeloproliferative neoplasms
Myelodysplastic syndrome (MDS) & Myeloproliferative neoplasms Myelodysplastic syndrome (MDS) A multipotent stem cell that can differentiate into any of the myeloid lineage cells (RBCs, granulocytes, megakaryocytes)
More informationTHROMBOTIC MICROANGIOPATHY. Jun-Ki Park 7/19/11
THROMBOTIC MICROANGIOPATHY Jun-Ki Park 7/19/11 TMAs are microvascular occlusive disorders characterized by systemic or intrarenal aggregation of platelets, thrombocytopenia, and mechanical injury to erythrocytes.
More informationHISTOLOGY VIRTUAL LABORATORY BLOOD AND LYMPHATICS SYSTEM
HISTOLOGY VIRTUAL LABORATORY BLOOD AND LYMPHATICS SYSTEM Login: http://histopath.westernu.edu Histology Atlas AND Virtual Histology links. I. HEMATOLOGY - PERIPHERAL BLOOD Purpose: To be able to identify
More informationFaculty of Medicine Dr. Tariq Aladily
Iron deficiency anemia The most common anemia worldwide Only 10% of ingested iron is absorbed Most dietary iron occurs in meat products Absorbed in duodenum Hepcidin By inhibiting ferroportin, hepcidin
More informationCoagulation Disorders. Dr. Muhammad Shamim Assistant Professor, BMU
Coagulation Disorders Dr. Muhammad Shamim Assistant Professor, BMU 1 Introduction Local Vs. General Hematoma & Joint bleed Coagulation Skin/Mucosal Petechiae & Purpura PLT wound / surgical bleeding Immediate
More informationLaboratory diagnosis of parasitic diseases. (Amoebiasis)
Laboratory diagnosis of parasitic diseases (Amoebiasis) Sarah Alharbi Clinical Laboratory department Collage of Applied Medical Sciences King Saud University This document contains materials modified or
More informationMORPHOLOGY OF BONE MARROW ASPIRATES. Dr.Prasanna N Kumar Head Department of Pathology, Oman Medical College, Oman
MORPHOLOGY OF BONE MARROW ASPIRATES Dr.Prasanna N Kumar Head Department of Pathology, Oman Medical College, Oman BONE MARROW ASPIRATION Sites Sternum Anterior or posterior iliac spines Aspiration from
More informationBone marrow aspiration as the initial diagnostic tool in the diagnosis of leukemia - A case study
Original Research Article Bone marrow aspiration as the initial diagnostic tool in the diagnosis of leukemia - A case study Priyanka Poonam 1*, N.K. Bariar 2 1 Tutor, Department of Pathology, Patna Medical
More informationHemopoiesis and Blood
Hemopoiesis and Blood Blood Cells o o o Erythrocytes Leukocytes Thrombocytes Function o Transport nutrients and wastes throughout the bloodstream, fight foreign antigens and blood coagulation. Location
More informationEDUCATIONAL COMMENTARY MORPHOLOGIC CHANGES IN PERIPHERAL BLOOD CELLS
EDUCATIONAL COMMENTARY MORPHOLOGIC CHANGES IN PERIPHERAL BLOOD CELLS Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
More informationHENATOLYMPHOID SYSTEM THIRD YEAR MEDICAL STUDENTS- UNIVERSITY OF JORDAN AHMAD T. MANSOUR, MD. Part 4 MYELOID NEOPLASMS
HENATOLYMPHOID SYSTEM THIRD YEAR MEDICAL STUDENTS- UNIVERSITY OF JORDAN AHMAD T. MANSOUR, MD Part 4 MYELOID NEOPLASMS Introduction: o Myeloid neoplasms are divided into three major categories: o Acute
More informationMyelodysplastic Syndromes Myeloproliferative Disorders
Myelodysplastic Syndromes Myeloproliferative Disorders Myelodysplastic Syndromes characterized by maturation defects that are associated with ineffective hematopoiesis and a high risk of transformation
More informationYear 2003 Paper two: Questions supplied by Tricia
QUESTION 65 A 36-year-old man presents in a post-ictal state after an observed generalised seizure. Full blood investigation shows: haemoglobin 0 g/l [128-175] mean corpuscular volume (MCV) 106 fl [80-7]
More informationHEME 10 Bleeding Disorders
HEME 10 Bleeding Disorders When injury occurs, three mechanisms occur Blood vessels Primary hemostasis Secondary hemostasis Diseases of the blood vessels Platelet disorders Thrombocytopenia Functional
More informationBlood & Blood Formation
Module IB Blood & Blood Formation Histology and Embryology Martin Špaček, MD (m.spacek@centrum.cz) http://www.lf3.cuni.cz/histologie Approximately 7% of a person's weight is blood (about 5 L) Blood consists
More informationFormation of Blood Cells
Hematopoiesis Lecture Objectives Name organs responsible for hematopoiesis in the fetus. List the developmental stages of hematopoiesis both prenatally and postnatally. Outline the major steps of post
More informationChronic Idiopathic Myelofibrosis (CIMF)
Chronic Idiopathic Myelofibrosis (CIMF) CIMF Synonyms Agnogenic myeloid metaplasia Myelosclerosis with myeloid metaplasia Chronic granulocytic-megakaryocytic myelosis CIMF Megakaryocytic proliferation
More informationBone marrow histopathology in Ph - CMPDs. - the new WHO classification - Juergen Thiele Cologne, Germany
Bone marrow histopathology in Ph - CMPDs - the new WHO classification - Juergen Thiele Cologne, Germany Current issues in MPNs concerning morphology 1.Prodromal stages of disease 2.Impact of histopathology
More information12 Dynamic Interactions between Hematopoietic Stem and Progenitor Cells and the Bone Marrow: Current Biology of Stem Cell Homing and Mobilization
Table of Contents: PART I: Molecular and Cellular Basis of Hematology 1 Anatomy and Pathophysiology of the Gene 2 Genomic Approaches to Hematology 3 Regulation of Gene Expression, Transcription, Splicing,
More informationBlood Cell Identification Graded
Blood Cell Identification Graded Case History The patient is a 20-year-old female with sickle cell disease who presents with bilateral leg pain for 3 days. She is scheduled to have bilateral hip and leg
More informationA CASE ORIENTED APPROACH Alan H. Rebar, DVM, PhD, DACVP
RED CELL RESPONSES IN DISEASE: A CASE ORIENTED APPROACH Alan H. Rebar, DVM, PhD, DACVP CLINICAL PATHOLOGY Introduction Anemia is one of the most common disease syndromes in domestic animals and may be
More informationMYELODYSPLASTIC SYNDROMES
MYELODYSPLASTIC SYNDROMES Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra university hospital, Isfahan university of medical sciences Key Features ESSENTIALS OF DIAGNOSIS Cytopenias
More informationDone By : WESSEN ADNAN BUTHAINAH AL-MASAEED
Done By : WESSEN ADNAN BUTHAINAH AL-MASAEED Acute Myeloid Leukemia Firstly we ll start with this introduction then enter the title of the lecture, so be ready and let s begin by the name of Allah : We
More informationBone Marrow Mast Cell Morphologic Features and Hematopoietic Dyspoiesis in Systemic Mast Cell Disease
Hematopathology / SYSTEMIC MAST CELL DISEASE Bone Marrow Mast Cell Morphologic Features and Hematopoietic Dyspoiesis in Systemic Mast Cell Disease Eric C. Stevens, MD, and Nancy S. Rosenthal, MD Key Words:
More informationCase # year old man with a 2 cm right kidney mass
Case # 4. 52 year old man with a 2 cm right kidney mass Figure 1 Figure 2 Figure 3 Figure 4 Diagnosis: Negative/Non-diagnostic Normal kidney tissue Fine needle aspiration (FNA) of the kidney is performed
More informationBy Dr. Mohamed Saad Daoud
By Dr. Mohamed Saad Daoud Part I Introduction Types of White Blood Cells Genesis of the White Blood Cells Life Span of the White Blood Cells Dr. Mohamed Saad Daoud 2 Leucocytes Introduction: Infectious
More informationSUFFERING FROM RETINOBLASTOMA*t
Brit. J. Ophthal. (1968) 52, 388 BONE MARROW APPEARANCES IN CHILDREN SUFFERING FROM RETINOBLASTOMA*t BY A. J. SALSBURY, M. A. BEDFORD, AND J. H. DOBREE St. Bartholomew's Hospital, London RETINOBLASTOMA
More informationStudy of etiopathogenesis of thrombocytopenia in a tertiary health centre: A prospective study
2017; 3(5): 187-191 ISSN Print: 2394-7500 ISSN Online: 2394-5869 Impact Factor: 5.2 IJAR 2017; 3(5): 187-191 www.allresearchjournal.com Received: 21-03-2017 Accepted: 22-04-2017 Dr. Jayanta Kumar Das Dr.
More informationVPBS-02 Participants Identification No. % Evaluation
Cell Identification VPBS-02 nrbc, norm/abn morphology 833 85.5 Educational Lymphocyte 118 12.1 Educational Lymphocyte, reactive 19 2.0 Educational The image is that of a nucleated RBC, as correctly identified
More informationPrelab #4 BLOOD; BONE MARROW; RESPIRATORY; INTEGUEMENT Page 1
Prelab #4 BLOOD; BONE MARROW; RESPIRATORY; INTEGUEMENT Page 1 Blood Slide 101 This a classic slide of blood cells using a Wright stain. Inspect red blood cells and their appearance. Note the approximate
More informationHeme 9 Myeloid neoplasms
Heme 9 Myeloid neoplasms The minimum number of blasts to diagnose acute myeloid leukemia is 5% 10% 20% 50% 80% AML with the best prognosis is AML with recurrent cytogenetic abnormality AML with myelodysplasia
More informationMegakaryocyte morphometry in chronic myeloid leukaemia and thrombocytopenic purpura
Megakaryocyte morphometry in chronic myeloid leukaemia and thrombocytopenic purpura Author(s): Surya Vasishta Tatapudi, Debdatta Basu Vol. 16, No. 2 (2005-05 - 2005-08) Biomedical Research 2005, 16 (2):
More informationBone marrow morphology in reactive conditions. Kaaren K. Reichard, MD Mayo Clinic Rochester
Bone marrow morphology in reactive conditions Kaaren K. Reichard, MD Mayo Clinic Rochester reichard.kaaren@mayo.edu Nothing to disclose Conflict of Interest Outline of Presentation Brief introduction General
More informationCase 3. Ann T. Moriarty,MD
Case 3 Ann T. Moriarty,MD Case 3 59 year old male with asymptomatic cervical lymphadenopathy. These images are from a fine needle biopsy of a left cervical lymph node. Image 1 Papanicolaou Stained smear,100x.
More informationYEREVAN STATE MEDICAL UNIVERSITY DEPARTMENT OF HEMATOLOGY COURSE DESCRIPTION HEMATOLOGY
1. Module/unit Code II. 1.2. 2. Module/unit Title Hematology 3. Subject Field Internal Diseases Group 4. Faculty/Department General Medicine, Department of Hematology 5. Programme(s) to which the Doctor
More informationNotes for the 2 nd histology lab
Notes for the 2 nd histology lab Note : Please refer to the slides and see the morphological characteristics of each cell, as the practical exam will be in the form of figures. SLIDE #2 Erythropoiesis
More informationDr. Rai Muhammad Asghar Associate Professor Head of Pediatric Department Rawalpindi Medical College
Dr. Rai Muhammad Asghar Associate Professor Head of Pediatric Department Rawalpindi Medical College AN APPROACH TO BLEEDING DISORDERS NORMAL HEMOSTASIS After injury, 3 processes halt bleeding Vasoconstriction
More informationPlatelet Disorders. By : Saja Al-Oran
Platelet Disorders By : Saja Al-Oran Introduction The platelet arise from the fragmentation of the cytoplasm of megakaryocyte in the bone marrow. circulate in the blood as disc-shaped anucleate particles
More informationBlood Cells. Dr. Sami Zaqout. Dr. Sami Zaqout Faculty of Medicine IUG
Blood Cells Dr. Sami Zaqout Blood Blood Blood cells (45%) Erythrocytes Platelets Leukocytes Plasma (55%) Hematocrit tubes with blood Composition of Plasma Plasma Aqueous solution (90%) Substances (10%)
More informationBlood: Functions. Liquid connective tissue 3 general functions 1. Transportation. 2. Regulation. 3. Protection
Blood Elements Lecture Objectives List blood components. Classify formed elements of blood. Discuss the scientific basis of the above classification. Describe the basic structure of erythrocytes and criteria
More informationNew aspect of hepatic nuclear glycogenosis
J. clin. Path. (1968), 21, 19 New aspect of hepatic nuclear glycogenosis in diabetes1 F. CARAMIA, F. G. GHERGO, C. BRANCIARI, AND G. MENGHINI From the Institute of General Pathology, University of Rome,
More informationDETERMINATION OF A LYMPHOID PROCESS
Chapter 2 Applications of Touch Preparation Cytology to Intraoperative Consultations: Lymph Nodes and Extranodal Tissues for Evaluation of Hematolymphoid Disorders INTRODUCTION As discussed in Chap. 1,
More informationAverage adult = 8-10 pints of blood. Functions:
Average adult = 8-10 pints of blood Functions: Transports nutrients, oxygen, cellular waste products, and hormones Aids in distribution of heat Regulates acid-base balance Helps protect against infection
More informationDoes Morphology Matter in 2017
Does Morphology Matter in 2017 ISLH May 2017 Kathryn Foucar Distinguished Professor Emerita kfoucar@salud.unm.edu Objectives Recognize unique RBC and WBC abnormalities in non-neoplastic disorders Learn
More informationV.N. KARAZIN KHARKOV NATIONAL UNIVERSITY
V.N. KARAZIN KHARKOV NATIONAL UNIVERSITY Kharkov Regional Centre of Cardiovascular surgery V.N. Karazin Kharkov National University Department of Internal Medicine Immune thrombocytopenic purpura Abduyeva
More informationThings to never miss in the office. Brett Houston MD FRCPC (PYG-5, hematology) Leonard Minuk MD FRCPC
Things to never miss in the office Brett Houston MD FRCPC (PYG-5, hematology) Leonard Minuk MD FRCPC Presenter Disclosure Faculty / Speaker s name: Brett Houston / Leonard Minuk Relationships with commercial
More informationNon-immune acquired haemolytic anaemias. Dr.Maysem
Non-immune acquired haemolytic anaemias Dr.Maysem Causes of Non-immune acquired haemolytic anaemias. Infections Infections can cause haemolysis in a variety of ways: -They may precipitate an acute haemolytic
More informationMyelodysplastic Syndromes: Everyday Challenges and Pitfalls
Myelodysplastic Syndromes: Everyday Challenges and Pitfalls Kathryn Foucar, MD kfoucar@salud.unm.edu Henry Moon lecture May 2007 Outline Definition Conceptual overview; pathophysiologic mechanisms Incidence,
More informationMost Common Hemostasis Consults: Thrombocytopenia
Most Common Hemostasis Consults: Thrombocytopenia Cindy Neunert, MS MSCS Assistant Professor, Pediatrics CUMC Columbia University TSHNA Meeting, April 15, 2016 Financial Disclosures No relevant financial
More informationPrimary myelofibrosis
- It s a bone marrow fibrosis Primary myelofibrosis - It's type of myeloproliferative disease i.e. neoplastic proliferation of mature cell of myloid linage. - Its similar to chronic myloid leukemia (CML).
More informationOrdering Physician CLIENT,CLIENT. Collected REVISED REPORT
HPWET Hematopathology Consultation, MML Embed Client Hematopathology Consult REVISED INAL DIAGNOSIS Interpretation Peripheral blood, bone marrow aspirate and biopsies, bilateral iliac crests: 1. Normocellular
More informationThe Power of Peripheral Blood Smears: Apparent Diagnostic Clues (Part 1) (Wednesday, October 19, 2011)
The Power of Peripheral Blood Smears: Apparent Diagnostic Clues (Part 1) (Wednesday, October 19, 2011) By Gene Gulati, Ph.D., SH(ASCP) Conflict of Interest None Plan for the Course Review blood smears,
More informationSome renal vascular disorders
Some renal vascular disorders Introduction Nearly all diseases of the kidney involve the renal blood vessels secondarily We will discuss: -Hypertension (arterionephrosclerosis in benign HTN & hyperplastic
More informationCHAPTER:4 LEUKEMIA. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY 8/12/2009
LEUKEMIA CHAPTER:4 1 BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Leukemia A group of malignant disorders affecting the blood and blood-forming tissues of
More informationGroup of malignant disorders of the hematopoietic tissues characteristically associated with increased numbers of white cells in the bone marrow and
Group of malignant disorders of the hematopoietic tissues characteristically associated with increased numbers of white cells in the bone marrow and / or peripheral blood Classified based on cell type
More informationAnemia (3).ms4.25.Oct.15 Hemolytic Anemia. Abdallah Abbadi
Anemia (3).ms4.25.Oct.15 Hemolytic Anemia Abdallah Abbadi Case 3 24 yr old female presented with anemia syndrome and jaundice. She was found to have splenomegaly. Hb 8, wbc 12k, Plt 212k, retics 12%, LDH
More informationBone marrow examination in cases of pancytopenia
International Journal of Research in Medical Sciences Shah P et al. Int J Res Med Sci. 2017 Apr;5(4):1494-1498 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171253
More informationHematology Case Conference 11/26/02
Hematology Case Conference 11/26/02 Clinical History A 28-year-old man with a history of alcohol and intravenous drug use presented with delirium tremens, fever, and progressive anemia. Physical examination
More informationHemostatic System - general information
PLATELET DISORDERS Hemostatic System - general information Normal hemostatic system vessel wall circulating blood platelets blood coagulation and fibrynolysis Bleeding Diathesis inherited or acquired defects
More informationThe primary medical content categories of the blueprint are shown below, with the percentage assigned to each for a typical exam:
Hematology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified hematologist
More informationCHAPTER 1. The Blood Film and Count
CHAPTER 1 The Blood Film and Count Blood Blood is a life sustaining fluid that circulates through the heart and blood vessels. It carries oxygen and nutrients to the tissues and waste products to the lungs,
More informationThe importance of thrombocytopenia and its causes
SYSMEX EDUCATIONAL ENHANCEMENT AND DEVELOPMENT NO 4 2017 SEED HAEMATOLOGY The importance of thrombocytopenia and its causes Key words: Thrombocytopenia, thrombocytopenic, low levels of platelets What is
More informationDRUG NAME: Eculizumab Brand(s): Soliris DOSAGE FORM/ STRENGTH: 10 mg/ml (300 mg per vial)
Preamble: A confirmed diagnosis of atypical hemolytic uremic syndrome (ahus) is required for eculizumab funding. The information below is to provide clinicians with context for how a diagnosis of ahus
More informationCD34 positive dysplastic giant platelets masquerading as blasts on flow cytometry
CD34+ Giant Platelets Hematopathology - September 2016 Case Study CD34 positive dysplastic giant platelets masquerading as blasts on flow cytometry Anmaar Abdul-Nabi 1,*, Yvette Reese 2, Susan Treese 2,
More informationSpermatogenesis in Man
Spermatogenesis in Man I. Nuclear Morphology During Spermatogenesis in Man BRUNETTO CHIARELLI, PH.D., ARTHUR FALEK, PH.D., KAREN J. BACK, B.S., and C. THOMAS COWART, M.D. THE SEQUENCE of transformations
More informationChapter 13 The Blood
Chapter 13 The Blood Copyright 2015 Wolters Kluwer Health Lippincott Williams & Wilkins Overview Key Terms agglutination erythrocyte lymphocyte albumin fibrin megakaryocyte anemia hematocrit monocyte antigen
More informationnumber Done by Corrected by Doctor Maha Shomaf
number 16 Done by Waseem Abo-Obeida Corrected by Zeina Assaf Doctor Maha Shomaf MALIGNANT NEOPLASMS The four fundamental features by which benign and malignant tumors can be distinguished are: 1- differentiation
More informationMyeloid neoplasms. Early arrest in the blast cell or immature cell "we call it acute leukemia" Myoid neoplasm divided in to 3 major categories:
Myeloid neoplasms Note: Early arrest in the blast cell or immature cell "we call it acute leukemia" Myoid neoplasm divided in to 3 major categories: 1. AML : Acute myeloid leukemia(stem cell with myeloid
More informationBone Marrow Pathology. Part 1. R.S. Riley, M.D., Ph.D.
Bone Marrow Pathology Part 1 R.S. Riley, M.D., Ph.D. Bone Marrow Pathology Bone marrow basics Red cell diseases White cell diseases Other diseases Bone Marrow Pathology Bone marrow basics Hematopoiesis
More informationStudy of diagnostic features of bone marrow in aplastic anaemia
Original article: Study of diagnostic features of bone marrow in aplastic anaemia 1Dr. Poonam Nanwani, 2 Dr. Sativan Khatri* 1MD Pathologist, Assistant Professor, Department of Pathology, M.G.M. Medical
More informationADx Bone Marrow Report. Patient Information Referring Physician Specimen Information
ADx Bone Marrow Report Patient Information Referring Physician Specimen Information Patient Name: Specimen: Bone Marrow Site: Left iliac Physician: Accession #: ID#: Reported: 08/19/2014 - CHRONIC MYELOGENOUS
More informationBleeding Disorders: (Hemorrhagic Diatheses) Tests used to evaluate different aspects of hemostasis are the following:
Bleeding Disorders: (Hemorrhagic Diatheses) Excessive bleeding can result from: 1. Increased fragility of vessels. 2. Platelet deficiency or dysfunction. 3. Derangement of coagulation. 4. Combinations
More informationr). SUPPLEMENTARY/SECOND OPPORTUNITY EXAMINATION PAPER nnmlbih UNIVERSITY Sophia Blaauw INSTRUCTIONS FACULTY OF HEALTH AND APPLIED SCIENCES
r). nnmlbih UNIVERSITY OF SCIEFICE nnd TECHNOLOGY FACULTY OF HEALTH AND APPLIED SCIENCES DEPARTMENT OF HEALTH SCIENCES QUALIFICATION: BACHELOR OF MEDICAL LABORATORY SCIENCES QUALIFICATION CODE: 08BMLS
More informationAcute Lymphoblastic Leukaemia
Acute Lymphoblastic Leukaemia Terri Boyer 17 th October 2006 Overview Disease information: Aetiology of ALL proposed theory, contributing factors Symptoms Complications Diagnostic approaches - morphology
More informationHaemostasis & Coagulation disorders Objectives:
Haematology Lec. 1 د.ميسم مؤيد علوش Haemostasis & Coagulation disorders Objectives: - Define haemostasis and what are the major components involved in haemostasis? - How to assess the coagulation status?
More informationHEMOTOLOGY. B. Helps stabilize body temperature -heats up and cools down slowly which moderates body temp
I. Body H 2 O = HEMOTOLOGY A. Variable quantities 1. sweating and urination ( ) decreases H 2 O 2. drinking H 2 O increases B. Water is found in two compartments 1. contains 2/3 of all water in your body
More informationCHANGES IN BUCCAL CELLS IN THE ANAEMIAS
J. clin. Path. (1959), 12, 222. CHANGES IN BUCCAL CELLS IN THE ANAEMIAS BY M. M. BODDINGTON From the Department of Pathology, Churchill Hospital, Headington, Oxford (RECEIVED FOR PUBLICATION DECEMBER 19,
More informationOriginal article Study of bone marrow aspiration in cases of pancytopenia, one year study
Original article Study of bone marrow aspiration in cases of pancytopenia, one year study Dr. Chetal Suva, Dr. Alpesh Chavada, Dr. Yagnik Chhotala, Dr. Nikunja Chavada,Dr. Shamim Sheikh Pathology Department,
More informationDifferentiation of Renal Tubular Epithelium in Renal Transplantation Cytology
Differentiation of Renal Tubular Epithelium in Renal Transplantation Cytology G. BERRY SCHUMANN, M.D., LAWRENCE J. PALMIERI, B.S., C.T.(ASCP), AND DAVID B. JONES, M.D. Schumann, G. Berry, Palmieri, Lawrence
More informationBlood and Haemopoiesis
Blood and Haemopoiesis Li Shulei lishulei@tom.com Department of Histology & Embryology Connective Tissue Connective tissue proper Connective tissue with special properties Loose connective tissue Dense
More informationChapter 21 Outline. General Composition and Functions of Blood Blood Plasma Formed Elements in the Blood Hemopoiesis: Production of Formed Elements
Chapter 21 Outline General Composition and Functions of Blood Blood Plasma Formed Elements in the Blood Hemopoiesis: Production of Formed Elements Introduction Blood serves many functions. Some examples
More informationYear 2004 Paper one: Questions supplied by Megan
QUESTION 53 Endothelial cell pathology on renal biopsy is most characteristic of which one of the following diagnoses? A. Pre-eclampsia B. Haemolytic uraemic syndrome C. Lupus nephritis D. Immunoglobulin
More informationCase Report Immune Thrombocytopenia and JAK2V617F Positive Essential Thrombocythemia: Literature Review and Case Report
Hindawi Case Reports in Hematology Volume 2017, Article ID 3725089, 4 pages https://doi.org/10.1155/2017/3725089 Case Report Immune Thrombocytopenia and JAK2V617F Positive Essential Thrombocythemia: Literature
More informationChapter 06 Lecture Outline. See separate PowerPoint slides for all figures and tables preinserted into PowerPoint without notes.
Chapter 06 Lecture Outline See separate PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright 2016 McGraw-Hill Education. 2012 Pearson Permission Education,
More information