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Theo's Path > Haematology slides > Flashcards

Haematology slides Flashcards

1
Q

What does this film show?

A

Parvovirus B19 infection

  • Proerythroblasts with punched out clear nuclear inclusions
  • Cause of aplastic anaemia in SCD or hereditary spherocytosis and hydrops fetalis in pregnancy
  • Begins with fever, coryza, headache, nausea and vomiting

2-5 days later - malar rash with circumoral pallor (slap cheek), then lace like rash on trunk and limbs

Mx - supportive in fifth disease, transfusion in aplastic crisis

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2
Q

What does this slide show?

A

Hepatic siderosis

  • Hepatic siderosis caused by chronic transfusions and haemochromatosis
  • AR inherited mutation in HFE gene at 6p21.3
  • Increased iron absorption in gut –> deposition in organs (macrophages) leads to fibrosis
  • Fe deposits in liver with Prussian blue stain
  • Sx: bronzing, diabetes, Hmegaly, cardiomyopathy
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3
Q

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A

Hereditary spherocytosis

  • Spherocytes
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4
Q

What does this film show?

A

Hereditary elliptocytosis

  • Elliptocytes
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5
Q

What does this film show?

A

Hereditary pyropoikilocytosis

  • AR spectrin mutation/deficiency causing severe form of elliptocytosis
  • Severe haemolysis and anaemia in infancy that improves in later life
  • Mx - splenectomy if sequestration
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6
Q

What does this film show?

A

G6PD deficiency

  • Bite cells
  • Heinz bodies (blue deposits, oxidised Hb)
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7
Q

What does this film show?

A

Pyruvate Kinase deficiency (post-splenectomy)

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8
Q

What does this film show?

A

Cabot rings

  • Caused by inhibition of erythrocyte production secondary to B12 deficiency
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9
Q

What does this slide show?

A

Burkitt’s lymphoma (B cell acute lymphoblastic leukaemia)

  • “Starry sky” appearance
  • Tumour cells with minimal cytoplasm form the blue background, “sky”, while the macrophages appear white, “stars”.
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10
Q

What does this film show?

A

Hodgkin’s lymphoma

  • Reed-Sternberg cell, “owl-eyed”, binucleated/multinucleated cell with inclusion like nucleoli and surrounded by eosinophils
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11
Q

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A

Dacrocytes/ “Tear drop cells”

  • Found in bone marrow infiltration (by myelofibrosis, granulomatous inflammation, hematologic or metastatic malignancy), splenic abnormalities, megaloblastic anemia, and thalassemia.
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12
Q

What does this film show?

A

Blast cells

  • Acute leukaemia
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13
Q

What does this film show?

A

AML

  • Blast cells with fine granules and Auer rods (difficult to see, therefore further testing usually done to differentiate from ALL)
  • Would test postive with myeloperoxidase
  • Immunophenotyping confirms diagnosis and informs management

Ix - bone marrow biopsy

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14
Q

What does this slide show?

A

Bone marrow trephine in polycythaemia

  • Increased cellularity of bone marrow
  • JAK2 mutation present
  • Low serum erythropoetin
  • Sx: splenomegaly, plethora, erythomelalgia, thrombosis, retinal vein engorgement, gout
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15
Q

What does this slide show?

A

Bone marrow trephine showing megakaryocyte clustering

  • Essential thrombocythaemia
  • Clinical features: 50% incidental, or thrombosis, mucocutaneous bleeding, headaches, dizziness, visual disturbance
  • Peaks at 30 and 55 years
  • Sustained non-reactive thrombocytosis >600x10^9/L
  • JAK 2 V617F mutation
  • Mx: aspirin, anagrelide, hydroxycarbamide, alpha INF
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16
Q

What do these films show?

A

Chronic idiopathic myelofibrosis

  • Leucoerythroblastic picture with tear drop poikilocytes, giant plts and circulating megakaryoctytes
  • “Dry tap” bone marrow aspirate
  • 2o to PV or ET
  • Sx - cytopaenia, thrombocytosis, HSmegaly, hypermetabolic state
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17
Q

What does this slide show?

A

Bone marrow trephine showing myelofibrosis

  • Increased reticulin/collage fibrosis
  • Prominent megakaryocyte hyperplasia with clustering
  • New bone formation
18
Q

What does this film show?

A

Leucoerythroblastic film

  • Tear drop poikilocytes
  • Nucleated RBC
  • Myelocyte
  • Dx: bone marrow infiltration e.g. cancer, TB, severe fungal infection, myelofibrosis
19
Q

What does this film show?

A

MAHA

  • Schistocytes (RBC fragments)
  • Thrombocytopaenia
  • Anaemia, reticulytosis, raised uncongugated Bi, raised LDH, reduced haptoglobins
  • DAT -ve
  • 2o to HUS, TTP, DIC, PET
  • Mx: plasma exchange
20
Q

What does this film show?

(Patient has raised WCC)

A

Chronic myeloid leukaemia

  • Neutrophilia (50-500), basophilia, immature myelocytes
  • Splenomegaly (often massive)
  • Middle aged (40-60yo)
  • Ph chromosome +ve (80%) translocation (9;22)
  • PCR for BCR-ABL fusion gene
  • Mx indolent dx (<5% blasts) with imatinib (BCR-ABL tyrosine kinase inhibitor)
21
Q

What does this film show?

A

CLL
- Small lymphocytes and smear cells

  • Elderly (65-70yo)
  • Sx: asymptomatic/incidental, symmetrical painless LNpathy, BM failure, FLAWS
  • Ix: high WBC with lymphocytosis, low serum Ig
  • Mx: watchful waiting if asymptomatic, alemtuzumab in p53 deletion or clinical trial or chlorambucil
22
Q

What does this film show?

A

Multiple myeloma (neoplasia of plasma cells)

  • Rouleaux (RBC stacking), normocytic and normochromic anaemia,
  • Thrombocytopaenia and neutropaenia
  • Bence-Jones protein in urine, v high ESR, >10% plasma cells in BM
  • CRAB (hypercalc, renal failure, anaemia, bone lesions)
  • Mostly IgG (66%)
  • Mx: supportive (bisphosphonates), auto-SCT (younger), Bortezomib + low dose dexamethasone + thalidomide/lenalidomide
23
Q

What does this film show?

A

Normal neutrophils

  • Most abundant WBC and granulocyte
  • Innate immunity
  • Type of polymorphonuclear cell, others are basophils and eosinophil
  • Segmented nuclei (2-5 lobes) and stain pink (H&E)
  • Basophils: bean-shaped nuclei and stain dark blue (H&E)
  • Eosinophils: bilobed nucleus and stain bright red (H&E)
24
Q

What does this film show?

A

Pelger-Huet anomaly

  • Bilobed neutrophil with lobes connected with a thin strand (arrow) and reduced granulation
  • Found in MDS and may be inherited
  • Other morphology of MDS: dysgranulopoiesis of neutrophils, dyserythropoiesis of red cells, dysplastic megakaryocites, increased blasts in BM
25
Q

What does this film show?

A

Dysgranulopoeisis of neutrophil

Other morphology of MDS: Pelger-Huet anomaly, dyserythropoiesis of red cells, dysplastic megakaryocites, increased blasts in BM

26
Q

What does this film show?

A

Myelokathexis

  • Increased number of mature and hypersegmented neutrophils
  • Characterised by lengthening and thinning of intrasegmented filaments and vacuoules
  • Leads to retention of neutrophils in BM

NB// rare congenital disorder unlikely to come up

27
Q

What does this film show?

A

Dyserythropoeisis

Other morphology of MDS: Pelger-Huet anomaly, dysgranulopoeisis of neutrophils, dysplastic megakaryocites, increased blasts in BM

28
Q

What does this film show?

A

Ringed sideroblasts (Prussian blue)

  • Refractory anaemia with ringed sideroblasts (one of the MDS)
  • MDS: progressive disorder featuring ineffective proliferation and differentiation of myeloid stem cells
  • Seen in elderly, sx develop over weeks/months: BM failure
  • Ix: by definition <20% blasts, hypercellular BM
  • MX: supportive (transfusion, EPO, G-CSF, abx), immunosuppression (lenalidomide), chemo (like AML), allogenic SCT
29
Q

What does this film show?

A

Myeloblasts with Auer rods (AML)

  • AML: acute neoplastic disease of BM and blood (>20% blasts)
  • Subtypes: M3 associated with DIC, M4+5 associated with skin/gum infiltration and hypokalaemia
  • Sx: BM failure, organ infiltration e.g. HSmegaly, LNpathy, pain etc.
  • Ix: morphology +/- cytochemistry, flow cytometry (CD34, MPO) genetics
  • Mx: chemo, ATRA for M3, supportive
30
Q

What does this slide show?

A

Normal bone marrow

31
Q

What does this slide show?

A

Aplastic bone marrow

  • Aplastic anaemia
  • Bimodal age incidence: 15-24 and over 60
  • Majority idiopathic (70-80%)
  • Inherited: Fanconi anaemia, dyskertatosis congenita, Schwachman-Diamond syndrome
  • Secondary to radiation, drugs (cytotixic, chloramphenicol, NSAIDs), hepatitis, SLE
32
Q

What does this film show?

A

Thalassemia trait

  • Target cells, hypochromic, microcytic RBC, nucleated RBC
33
Q

What does this film show?

A

Basophilic stippling

  • Small dots on periphery (rRNA)
  • Due to accelerated red cell production or defective Hb synthesis
  • Dx: lead poisoning, megaloblastic anaemia, myelodysplasia, liver disease, haemoglobinopathy, thalassemia
34
Q

What does this film show?

A

Acanthocytes

  • RBCs show many spicules
  • Abetaliproproteinaemia (congenital lack of apoliproteins, fat malabsorption), liver disease, hyposplenism
35
Q

What does this film show?

A

Echinocyte

  • Irregular shaped cells (“Burr” or “Sea urchin”)
  • Uraemia, GI bleed, stomach carcinoma
36
Q

What does this film show?

A

Howell-Jolly bodies

  • Basophilic (purple spot) remnants in RBC
  • Post splenectomy or hyposplenism e.g. SCD, coeliac, congenital, IBD, myeloproliferative, amyloid
  • Megaloblastic anaemia
  • Hereditary spherocytosis
37
Q

What does this film show?

A

Polychromasia

  • RBCs of multiple colours, particularly blue due to varying levels of Hb
  • Premature release from BM (sign of reticulocytosis)
38
Q

What does this film show?

A

Right-shift (hypersegmented neutrophils)

  • Megaloblastic anaemia, uraemia, liver dx
39
Q

What does this film show?

A

Stomatocytes (“smiling faces”)

  • Central pallor in rod shape
  • Hereditary, etOH xs, liver dx
40
Q

What does this film show?

A

Target cells

  • Central pallor
  • Liver dx, hyposplenism, thalassemia, IDA
41
Q

What does this film show?

A

Sickle cell disease

  • AR haemoglobinopathy (Glu -> Val at codon 6 of B chain)
  • Sickle cell anaemia (HbSS) - severe, manifests at 3-6 months as HbF decreases
  • Sickle cell trait (HbAS) asymptomatic unless under stress e.g. exercise

Others: HbSC, HbS/B

42
Q

What does this film show?

A

Pyruvate kinase deficiency

  • AR recessive most common
  • Sx: severe neonatal jaundice, splenomegaly, haemolytic anaemia
  • Mx: most dont need it, can be transfusion or splenectomy

Theo's Path (9 decks)

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