HEMA Flashcards
Removes produced fibrins
plasmin
Cancer of blood
Leukemia
mimics the laboratory results of leukemia
Leukomoid reaction
High WBC count (↑ >50,000 ul)
INCREASE LAP
LEFT SHIFT ( young or blast cells instead of mature cells) PRESENCE OF DOHLE BODIES AND TOXIC GRANULES
ABSENCE OF AUER RODS AND PHILADELPHIA CHROMOSOME
Leukomoid reaction
A form of malignancy in blood (due to lifestyle or genetic)
CHRONIC MYELOGENOUS LEUKEMIA
High WBC count (malignant cells)
✓ DECREASE LAP
✓ LEFT SHIFT
✓ PRESENCE OF AUER BODIES
✓ PRESENCE OF PHILADELPHIA CHROMOSOME
CHRONIC MYELOGENOUS LEUKEMIA
Bone marrow test:
abnormal presence of
higher than normal number of immature cells
Leukemia
Bone marrow test:
normal number of
immature cells
Leukomoid reaction
Lymph node biopsy test:
abnormal presence of immature cells
Leukemia
Lymph node biopsy:
normal mature cells are present
Leukomoid reaction
NEUTROPHIL OR
LEUKOCYTE PHOSPHATASE TEST:
High score
Leukomoid reaction
Test: NEUTROPHIL OR
LEUKOCYTE PHOSPHATASE (low score)
Leukemia
enzyme produced by young granulocytes; seen in neutrophils from the metamyelocyte to segmented stage
Alkaline phosphatase
clonal proliferations of malignant leukocytes that arise initially in the bone marrow before disseminating to the peripheral blood, lymph nodes, and other organs
Leukemia
second line of defense
WBCs
first to recognize leukemia as a distinct clinical disorder between 1839 and 1845.
Virchow
Major symptoms of leukemia
fever, weight loss, and increased sweating
symptoms occurring more predominantly in chronic leukemias.
Enlargement of the liver, spleen and lymph nodes
General term for malignancy that starts in the lymph system, mainly the lymph nodes
Lymphoma
form of cancer of the plasma cells.
myeloma
Duration of acute leukemia
days to 6 months
Duration of subacute leukemia:
2-6 months
Duration of chronic leukemia
1 or 2 years or more
PBS: WBC ct. <15,000 cells/ul, no immature or abnormal WBC
ALEUKEMIC LEUKEMIA
PBS: WBC ct. < 15,000 cells/ul, with immature or abnormal WBC
Sub leukemic leukemia
PBS: WBC ct. >15,000 cells/ul, with immature and
abnormal form
Leukemic leukemia
TYPES OF WBC INVOLVED:
Leukemia with predominance of immature (blast) WBC
Acute leukemia
TYPES OF WBC INVOLVED:
predominance of mature/old WBC
chronic leukemia
Primarily a disease of childhood or adolescence, accounting for 25% of childhood cancers and up to 75% of childhood leukemia
Acute Lymphoblastic Leukemia
affected cells in common ALL
Early pre-B cell
represents only about 15% of pediatric ALL cases while 25% of adult cases
associated with large mass in the mediastinum (10-20%)
T-cell ALL
HALLMARK: Auer rods
Acute Myeloid Leukemia (AML)
most common leukemia in adults, and the incidence increases with age
Acute Myeloid Leukemia (AML)
Common abnormalities of AML
hyperuricemia, electrolytes (calcium, potassium, phosphate)
CELL MARKER: smudge cell
Chronic Lymphocytic Leukemia
Majority of cases of CLL appears to involve —- lymphocytes
B lymphocytes
Clinical signs are lymphadenopathy, fatigue, weight loss, splenomegaly, and hepatomegaly
Chronic Lymphocytic Leukemia (CLL)
bone marrow and peripheral blood films show small lymphoid cells with a characteristically coarse chromatin (“soccer-ball” pattern), absent or inconspicuous nucleoli, and scant cytoplasm
Chronic Lymphocytic Leukemia (CLL)
HALLMARK: Philadelphia chromosomes
Chronic Myelogenous Leukemia (CML)
Transfer of long arm of chromosome 22 to 9
Chronic Myelogenous Leukemia (CML)
All cases of CML are POSITIVE (+) for gene
BCR-ABL1
A myeloproliferative disorder characterized by pancytosis
Chronic Myelogenous Leukemia (CML)
90% of cases are positive for Philadelphia chromosome t(9:22)
Chronic Myelogenous Leukemia (CML)
Chemicals predisposing factors for developing leukemia and lymphoma
Benzene, Hydrocarbons, hair dyes (organic
materials)
Environmental predisposing factors for developing leukemia and lymphoma
Ionizing radiation, insecticides, herbicides, and
fungicides
Drugs predisposing factors for developing leukemia and lymphoma
Alkylating agents, chloramphenicol
Viruses predisposing factors for developing leukemia and lymphoma
EBV, HIV, HTLV
Genetic syndrome predisposing factors for developing leukemia and lymphoma
Down syndrome, Fanconi anemia
Classified acute leukemia as presence of ≥30% blast in the peripheral blood and bone marrow
French American British (FAB)
FAB - SUBDIVIDE LEUKEMIA ACCORDING TO:
- Cellular morphology
- Cytochemical staining results.
Widely used to classify leukemia. It is now the standard classification in diagnosing leukemia
World Health Organization
defines acute leukemia as ≥ 20% peripheral blood and bone marrow blasts
World Health Organization
WHO - SUBDIVIDE LEUKEMIA ACCORDING TO:
- Cellular morphology
- Cytochemical stains(cytochemistry)
- Immunophenotyping (Flow cytometry)
- Cytogenetics abnormalities
- Clinical syndrome
Devoted to the laboratory study of visible chromosome abnormalities, such as deletions, translocations, and aneuploidy
Cytogenetic Analysis (Karyotyping)
Use of specialized stains to detect cellular enzymes and other chemicals in peripheral blood films and bone marrow aspirate smears. Used to differentiate hematologic diseases, especially leukemias.
Cytochemistry
Used to identify cells on the basis of the types of markers or antigens present on the cell’s surface, nucleus, or cytoplasm
IMMUNOPHENO TYPING (FLOW CYTOMETRY)
Anemia caused by bleeding and replacement of normal marrow elements by leukemic blasts
Acute Leukemias
Peripheral blood and bone marrow smear: more immature cells and blast cells
Acute Leukemias
ACUTE MYELOID LEKUEMIA (AML) is also called
Acute Myelogenous Leukemia; Acute Non-Lymphocytic Leukemia
WHO classification of AML not otherwise categorized; Undifferentiated blasts, AML— not otherwise categorized
Minimal differentiation
M0 (Myeloid)
Blasts and promyelocytes predominate without further maturation of myeloid cells
In other cases, the blasts resemble LYMPHOBLASTS, from which they
are differentiated by positivity to myeloperoxidase stains or Sudan black in
at least 3% of blast cells
M1 (myeloid)/ acute myeloblastic leukemia without maturation
demonstrate maturation beyond the blast and promyelocyte stage
Blasts may show azurophilic granules and Auer rods, and evidence of maturation is present
M2 (myeloid)/ acute myeloblastic leukemia with maturation.
Promyelocytes predominate in the bone marrow; DIC - most common cause of death
Highest number of Auer rods, collectively named as Faggot cells/Firewood
cells seen in bundles
M3 (promyelomonocytic)
AML associated with chromosomal translocation of 15:17
M3 (promyelomonocytic)
Monoblasts are large cells with round containing one or more prominent nuclei and abundant basophilic cytoplasm, sometimes with fine azurophilic granules, vacuoles, and PSEUDOPOD FORMATION
referred to as Naegeli type monocytic leukemia
acute myelomonocytic leukemia (M4)
AML characterized by large blasts in bone marrow and peripheral blood (common in young adults)
FAB M5a/ acute monoblastic leukemia
AML differentiated type by monoblasts, promonocytes, and monocytes (common during middle age)
FAB M5b/acute monocytic leukemia
SCHILLING’S TYPE leukemia WHO classification
Acute monoblastic and acute monocytic leukemia (M5a, M5b)
Abnormal proliferation of both erythroid and granulocytic precursors; may include abnormal megakaryocytic and monocytic proliferations
Erythroleukemia/Erythemic Myelosis or Di Guglielmo syndrome
Large and small megakaryoblasts with a high nuclear cytoplasmic ratio; pale, agranular cytoplasm
Dysplastic platelets may be visible in the blood, as may be circulating micromegakaryocytes and megakaryocyte fragments
M7 (megakaryocytic)/acute megakaryoblastic leukemia
Constitute 5% of AML
✓ At least 50% of the nucleated cells in the bone marrow is are erythroid
✓ At least of 20% of nonerythroid cells are myeloblast – the myeloblast are
similar to those in AML with and without maturation (M1 and M2)
Acute erythroid leukemia (M6a)
✓ Cases are very rare
✓ >80% of the marrow cells are erythroid
✓ The erythroblast has deeply basophilic, often agranular, cytoplasm that
may contain poorly delineated vacuoles
✓ The round nuclei have fine chromatin and one or more nuclei
M6(b): Pure Erythroid Leukemia
Positive control for MPO staining
AML minimally differentiated
mature granulocyte
Positive control for MPO staining in AML without maturation
Myelocyte
Classification of AML in four general groups according to WHO
- AML not otherwise categorized
- AML with recurrent genetic abnormalities
- AML with multilineage dysplasia
- AML and myelodsplastic syndromes, therapy-related
✓ 5%-10% of AML cases
✓ Predominantly younger patients
✓ Blasts – typically large, with abundant basophilic cytoplasm, often with
Auer rods and numerous, sometimes very large azurophilic granules
AML with t(8;21) (q22;q22)
✓ 10% of AML cases
✓ Primarily in younger patients
✓ The bone marrow usually has elements of both granulocytic and
monocytic differentiation combined with abnormal eosinophils
✓ M4eo in FAB classification or acute myelomonocytic leukemia with
abnormal eosinophils
✓ Eosinophil precursors contain abnormally large purple granules that can
be sufficiently numerous to obscure the nuclei
AML with inv (16) (p13q22) or t(16;16) (p13;q22)
✓ 5% of AML
✓ Acute promyelocytic leukemia
✓ Abnormal promyelocytes are present, either hypergranular or
hypogranular (microgranular)
✓ M3 or M3v in FAB classification
✓ In the hypergranular form, the cytoplasm is packed with pink, red, or
purple granules that are usually large, but may be fine.
✓ Bundles of Auer rods are present in most cases; the nuclei, which may be
bilobed, are irregular in size and variable in shape and maybe reniform
(kidney-shaped)
AML with t(15;17) (q22;q12) or acute promyelocytic leukemia
✓ 5% of AML cases
✓ Occurs at any age,but more common among children
✓ Monocytic differentiation, with monoblasts and promonocytes
predominating, is the most common morphologic pattern
✓ Patients may have gum infiltration, and DIC
✓ Monoblasts are large cells with round nuclei that usually contain lacy
chromatin and large prominent nucleoli
✓ The abundant basophilic and sometimes vacuolated cytoplasm may form
pseudopods and contain scattered, fine azurophilic granules.
AML with 11q23 abnormalities
Abnormal erythropoiesis is characterized by ringed sideroblasts, vacuolated cytoplasm, and nuclei that are multiple, fragmented, or megaloblastic
AML with multilineage dysplasia
Abnormal megakaryocytes are small or have single-lobed or multiple, discrete
nuclei
AML with multilineage dysplasia
AML and myelodsplastic syndromes, therapy-related occurs after theraphy with
topoisomerase II inhibitors (etoposide and doxorubicin)
3 stages of CML according to WHO
- Chronic phase (CML-CP )
- Accelerated phase (CML-AP )
- Blast phase (CML-BP )
CML PHASE: Basophils are universally increased
Eosinophilia is common
Serum LDH and uric acid - increased
Chronic Phase
CML Phase:
- Increasing white count and spleen size despite therapy
- Persistent thrombocytopenia (<100 x109/L) or thrombocytosis ( >1000 x 109/L ) despite treatment
- Blast making up 10% to 19% of bone marrow or peripheral wbc
- Peripheral blood basophilia of more than or equal to 20%
- Evidence of clonal evolution
Accelerated phase
Blast phase: Large aggregates of blasts occurs in
Bone marrow
WHO DIAGNOSTIC CRITERIA FOR CML:
- Persistent monocytosis in the peripheral blood ( > 1x109/L)
- No Philadelphia chromosome on BCR/ABR fusion gene
- < 20% blasts (including myeloblasts, monoblast, or promonocyte) in the peripheral blood or bone marrow.
- Dysplasia in one or more myeloid lines.
Characterized by hypercellular marrow, erythrocytosis, granulocytosis, and thrombocytosis, Myelofibrosis
Chronic Myeloproliferative Disorders
gene that provides instructions in making a protein
for the promotion and development of cells
JAK2
oncogene for Polycythemia vera, Chronic idiopathic myelofibrosis,
Essential thrombocythemia
JAK2 ONCOGENE
Hallmark of Polycythemia Vera
Plethora
Malignant hyperplasia of the multipotential myeloid stem cell causes
increase in all cell lines particularly the RBC and possible WBC and
platelets
Polycythemia Vera (PV)
High blood viscosity
There is the possibility that ESR is low. Because the blood is viscous thus
the ESR rate is low
Polycythemia Vera (PV)
Presents with proliferation of granulocytes
Chronic Myelogenous Leukemia (CML)
Bone marrow ratio in chronic myelogenous leukemia
25:1
Normal M:E ratio
3:1 or 4:1
LAP is low
Philadelphia chromosome t(9;22)
Blast crisis
CHRONIC MYELOGENOUS LEUKEMIA
Characterized by proliferation of megakaryocytes
Platelets >1000 x 109/L (Giant forms, platelet function abnormalities)
Essential Thrombocythemia (ET)
A.K.A Primary Myelofibrosis
CHRONIC IDIOPATHIC MYELOFIBROSIS
Myeloid stem cell disorder characterized by proliferation of erythroid, granulocytic, and megakaryocytic precursors in marrow with dyspoiesis
CHRONIC IDIOPATHIC MYELOFIBROSIS
The LEAST COMMON BUT THE MOST AGGRESSIVE OF THE MPNS.
Teardrop cells (RBC)
CHRONIC IDIOPATHIC MYELOFIBROSIS
Group of acquired clonal disorders affecting the pluripotential stem cells
MYELODYSPLASTIC SYNDROMES (MSDs)
Characterized by progressive blood cytopenias (lower production of cells) despite bone marrow hyperplasia (increase production of cells)
MYELODYSPLASTIC SYNDROMES (MSDs)
Anemia that is refractory (not responsive) to therapy
Bone marrow blasts <5% and peripheral blasts <1%
Refractory anemia
Ringed sideroblasts comprise more than 15% of bone marrow nucleated cells
Dimorphic erythrocytes
Refractory anemia with ringed sideroblasts (RARS)
✓ Presents with leukocytosis
✓ Bone marrow blasts 5-20% and peripheral blood blasts <5%
✓ Absolute monocytosis >1.0 x 109/L
Chronic myelomonocytic leukemia (CMML)
✓ Trilineage cytopenias ( decrease RBC, WBC, & platelets)
✓ Bone marrow and peripheral blood blasts are the same as with CMML, but there is no absolute monocytosis
Refractory anemia with excess blasts (RAEB)
✓ Bone marrow blast >20% but less than 30%; peripheral blood blasts >5%
✓ WHO classification reassigns RAEB-t as an acute leukemia instead of a myelodysplastic syndrome
Refractory anemia with excess blasts in transformation (RAEB-t)
Hallmark of Hodgkins Lymphoma (HL)
Reed-Sternberg cells
the most common cancer in children, representing 23% of cancer diagnoses among children younger than 15 years of age.
ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)
Higher survival rate than lymphoma
Hodkins Lymphoma (HL)
ALL: Lymphoblast is small and homogenous (same shape) having a nucleus and scanty cytoplasm (children below 15 years old)
L1
Lymphoblast is large and heterogeneous in PBS having cleft nuclei (older children and adults)
L2
ALL:
Lymphoblast is still large and homogenous with prominent vacuolation (white holes) and deeply basophilic in PBS
Epstein Barr virus (EBV) is seen (patients with leukemia secondary to Burkitts`s lymphoma)
L3
ACUTE LYMPHOBLASTIC LEUKEMIA (FAB CLASSIFICATION):
✓Lymphoblasts are small and homogenous, varies little in size
✓ Scanty cytoplasm and inconspicuous nucleoli; nucleus is round and irregular/indistinct in shape;
✓ Most common CHILDHOOD ALL with best prognosis
ALL L1
ACUTE LYMPHOBLASTIC LEUKEMIA (FAB CLASSIFICATION): ✓ Lymphoblasts are large and heterogenous, variable in size
✓ Abundant, basophilic cytoplasm, and the nuclei are often
clefted with nucleoli present
✓ Adult type ALL
ALL L2
ACUTE LYMPHOBLASTIC LEUKEMIA (FAB CLASSIFICATION)
✓ Burkitt-Type
✓ Lymphoblasts are large, homogenous and vacuolated
✓ Rarest subclass, can be found in both children and adult
✓ poor prognosis
ALL L3
✓ about 75% of cases occur in children younger than 6 years old
✓ About 85% of ALL are this type
PRECURSOR BCELL ACUTE LYMPHOBLASTIC
LEUKEMIA
ALL:
(+): enlarged lymph nodes, liver, and spleen
✓ Leukocyte count: variable
PRECURSOR BCELL ACUTE LYMPHOBLASTIC
LEUKEMIA
✓ Lymphoblasts are pleomorphic and vary from
small to large with nuclei having prominent or
inconspicuous nucleoli, compact or dispersed
chromatin
✓ The blue or blue-gray cytoplasm is usually scant
(but may be abundant)
PRECURSOR BCELL ACUTE LYMPHOBLASTIC
LEUKEMIA
✓ Coarse azurophilic granules may be present
✓ neoplasm of lymphoblasts committed to the B-cell lineage
PRECURSOR BCELL ACUTE LYMPHOBLASTIC
LEUKEMIA
✓ accounts for about 15% of childhood ALL
✓ about 25% of adult ALL
✓ leukocyte count is often markedly elevated
PRECURSOR TCELL ACUTE LYMPHOBLASTIC
LEUKEMIA
✓ lymphoblasts are similar to those in precursor
B-cell ALL with a wide variation in morphology
✓ neoplasm of lymphoblasts committed to the
T-cell lineage
PRECURSOR TCELL ACUTE LYMPHOBLASTIC
LEUKEMIA
Genetic translocations of FAB L3/ Burkitt lymphoma
t(8;14)
Genetic translocations of Pre-B cell ALL
t(19;22)
Genetic translocations of B cell ALL
t(4;11)
Genetic translocations of T cell ALL
t(7;11)
CD marker characteristics: ✓ CD19, CD34, TdT
(+)
✓ CD10 (CALLA) (-)
Progenitor B cells
CD marker characteristics: ✓ CD10 (CALLA), CD19, CD34, TdT (+)
Early pre-B cells ALL
CD marker characteristics: ✓ CD10 (CALLA), CD19, CD20, TdT (+)
Pre-B cells ALL
CD marker characteristics: ✓ CD19, CD20
(+)
✓ TdT (-)
B cells ALL
CD marker characteristics : CD2, CD3, CD5, CD7 (pan T cell markers)
T cell lineage
TdT result is positive for —–
immature T cells
T cell ALL common finding
mediastinal mass
TRAP stain POSITIVE
Hairy cell leukemia
Monoclonal gammopathy causes B cell production of excessive IgG or IgA
Multiple Myeloma
Monoclonal gammopathy causes B cell production of excessive IgM (macroglobulin) and decreased production of the other immunoglobulins
WALDENSTROM MACROGLOBULINEMIA
Multiple myeloma identification on serum protein electrophoresis
M:-spike in gamma-globulin region
Protein seen in multiple myeloma
Bence Jones
✓ a form of multiple myeloma
✓ increased (↑) numbers of plasma cells are found in the blood rather in the
BM
Plasma Cell Leukemia
Heavy chain disease is characterized by the production of ——– of Ig
gamma, alpha, or mu
Most common heavy chain disease
Alpha chain disease
Franklin’s disease is associated with what Immunoglobulin
Gamma
Rarest heavy chain disease
Mu chain
WHO classification considers CLL and — as one entity with different clinical presentations
Small Lymphocytic Leukemia (SLL)
Proliferation of malignant cells in solid lymphatic tissues
Lymphomas
includes the various forms of leukemias and malignant lymphomas that are of lymphoreticular origin
Lymphoproliferative disorder
group of closely related disorders that are characterized by the overproliferation of one or more types of cells of the lymphoid system such as lymphoreticular stem cells, lymphocytes, reticular cells and histiocytes
Lymphomas
a deviation from the diploid number of chromosomes (can be increased or decreased)
Aneuploidy
Normal number of chromosomes
46
Trisonomy chromosome number
47
Monosomy chromosome number
45
Chromosomes with recurring numerical abnormality
1,2,5,12,21
Most frequent type of NHL
diffuse large B-cell lymphoma
✓ 40% lymphomas
✓ Associated with Epstein-Barr virus
✓ REED-STERNBERG cells (RS)
✓ B cell lineage
Hodgkin Lymphoma
✓ 60%
lymphomas
✓ B cell neoplasms:
a. Mantle cell
b. Follicular
c. Burkitt
Non-Hodgkin Lymphoma
✓ Causes skin itching leading to ulcerative tumors
✓ Sezary syndrome
✓ CD2, CD3, and CD4 positive.
MYCOSIS FUNGOIDES
(Cutaneous T cell lymphoma)
leukemic phase of cutaneous T-cell lymphoma
Sezary Syndrome
typically the size of a small lymphocyte and has a dark-staining, clumped, nuclear chromatin pattern
SEZARY CELL
Preferred specimen for diagnosing leukemia
Smears and imprints (BM, Lymph nodes, spleen, preipheral blood)
Stains for non-enzymatic smears
Periodic acid schiff (PAS); Sudan black
CBC reference value for leukocyte count
3.4 – 9.7 X 10^9/L
LEUKOCYTOPENIA value
< 3 X 10^9/L
LEUKOCYTOSIS value
> 10 X 10^9/L
Too light pressure effect on smear
thick smear
Too heavy pressure on smear effect
thin smear
enzyme found in the myeloid cells
myeloperoxidase
Peroxidase is present in primary granules of
neutrophils, granules of eosinophils and monocytes
Positive reaction of myeloperoxidase
yellow-brown stain
Anticoagulant that inhibits peroxidase reaction
EDTA
Stain specific for lipids
Sudan black B
Sudan black B stains type of lipids
Neutral fat, phospholipids, sterols
Cytochemical reaction that allows distinction between cells of monocyte lineage and cells of neutrophil lineage
esterases
most suitable identifying monoblastic types of leukemia
1-naphthyl-acetate-esterase
Positive result for esterases
brightly red-brown or black-brown precipitate
Two substrate esters commonly used
a-napthyl acetate; a-napthyl butyrate
Specific estarase
a-Naphthyl AS-d chloroacetate esterase
Nonspecific esterases react best at ph
6.0 - 6.3
inhibits the monocyte, megakaryocyte, platelets and plasma cells but not that in granulocyte and lymphocytes.
sodium fluorides
Alpha-naphthyl acetate esterase is strongest in
monocytes, macrophages, megakaryocytes, and platelets
Positive result for a-Naphthyl AS-d
red granules
Reaction that stains polysaccharides
Periodic acid schiff
Stains most carbohydrates in all red cells except PRONORMOBLAST
Periodic acid schiff
Positive result for PAS
magenta or purple
Leukocyte Alkaline Phosphatase is used to differentiate
chronic myelogenous leukemia from a leukemoid reaction
indicated by red granular precipitate and is demonstrable in most cells of the hematopoietic system
Acid phosphatase
Intense activity of acid phosphatase is seen in
osteoclasts and some macrophages
Anticoagulant for flow cytometry
heparin or EDTA
To test the specimen viability for trypan blue exclusion or flow cytometry, specimen is stained with
propidium iodide
After cytocentrifugation, sample for flow cytometry is stained with
a cocktail of fluorochrome-conjugated monoclonal antibodies
study of chromosomes, their structure, and their inheritance
cytogenetics
h kill cells that are moving through the cell cycle, regardless of whether the cells are G1,G2,S,or M phase
Cycle-specific agents
kill nondividing cells or cells in the resting state
Cycle-nonspecific agents
mechanism: ionize within cells, forming highly reactive free radicals that damage DNA
Alkylating agents
Agents of plant alkaloids
vincristine and vinblastine
Commonly used tumor antibiotics include
daunonubicin and doxorubicin (Adriamycin)
Antimetabolites affects what cell phase
S phase
producing unstable ions that damage the DNA and may cause instant or delayed death of the cell
radiation theraphy
most affected during radiation theraphy
hematopoietic system, the GIT, and the skin
found in 95% of PV patients and contributes to the pathogenesis of the disease.
JAK2 V617F mutation
characterized by small B lymphocytes with abundant cytoplasm and fine cytoplasmic projections.
Hairy Cell leukemia
include a strong acid phosphatase reaction that is not inhibited by tartaric acid or tartrate resistant acid phosphatase (TRAP) stain.
Hairy Cell leukemia
lymphoproliferative disorder characterized by medium-sized lymphoid cells with irregular nuclear outlines
derived from the follicular mantle zone
Mantle Cell Lymphoma
Follicular lymphoma originates from
germinal center B cells
characterized by medium- sized, highly proliferating lymphoid cells with basophilic vacuolated cytoplasm
Burkitt Lymphoma
Lymphoid proliferation shows prominent starry sky pattern
Burkitt Lymphoma
most common cutaneous lymphoma affecting T lymphocytes
Mycosis fungoides &
Sezary Syndrome
Morphologic evidence:
✓ Oval macrocytes
✓ Hypochromic microcytes
✓ Dimorphic red blood cell (RBC) population
✓ RBC precursors with more than one nucleus
✓ RBC precursors with abnormal nuclear shapes
✓ RBC precursors with uneven cytoplasmic staining
✓ Ring sideroblasts
Dyserythropoiesis
Morphologic evidence:
✓ Persistent basophilic cytoplasm
✓ Abnormal granulation
✓ Abnormal nuclear shapes
✓ Uneven cytoplasmic staining
Dysmyelopoiesis
Morphologic evidence:
✓ Giant platelets
✓ Platelets with abnormal granulation
✓ Circulating micromegakaryocytes
✓ Large mononuclear megakaryocytes
✓ Micromegakaryocytes or micromegakaryoblasts or both
✓ Abnormal nuclear shapes in the megakaryocytes/megakaryoblasts
Dysmegakaryopoiesis
