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S3B4 Pathology > Hematopoesis & Blood Cell Morphology > Flashcards

Hematopoesis & Blood Cell Morphology Flashcards

1
Q

What are the two main compartments involved in hematopoesis?

A
  • Myeloid
    • bone marrow & derived cells
  • Lymphoid
    • thymus, lymph nodes, spleen
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2
Q

How do we not run out of stem cells?

A

pluripotent hematopoietic stem cells self-renew

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3
Q

Cells from the “blast” stage and above express what marker?

This includes what types of cells?

A

CD34- stem-cell marker

hematopoietic stem cells

multilineage (multipotent) progenitor cells

progenitor cells

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4
Q

Where does hematopoiesis take place from 0-2 months gestation?

A

yolk sac

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5
Q

Where does hematopoiesis take place from 2-7 months gestation?

A

liver, spleen

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6
Q

Where does hematopoiesis take place from 5-9 months gestation?

A

bone marrow

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7
Q

How does the portion of marrow capable of hematopoiesis change as we age?

A
  • Infancy & childhood: all marrow is hematopoietic
  • Puberty & adulthood: restricted to central skeleton & proximal ends of femurs and humeri
  • Normal cellularity is ~ (100-age) +/- 20%
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8
Q

What cells are involved in hematopoiesis & what does each cell type give rise to?

A
  • Hematopoietic stem cells
    • self-renewal
    • produce multi-lineage progeny
  • Multi-lineage (multipotent) progenitor cells
    • single or limited lineage progenitor cells
  • Progenitor cells
    • irreversible lineage commitment
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9
Q

What is true about hematopoietic stem cells, multi-lineage progenitor cells & progenitor cells?

A

morphologically unrecognizable & express CD34

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10
Q

What is the first recognizable cell in lineage?

They have what specifics of lineage?

A

blast cell

mitotically active / variable expression CD34

immunophenotype or cytochemistry of lineage

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11
Q

After blasts cells, cells have what specifics of lineage?

A

immunophenotype & cytochemistry of lineage

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12
Q

What morphologic changes are associated with granulopoiesis?

A
  • cells & nuclei become smaller
  • nucleoli disappear
  • primary granules disappear
  • secondary granules appear
  • chromatin becomes more condensed
  • nuclei become segmented
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13
Q

Identify the cell stage of granulopoiesis shown in the provided images.

A
  • blast: not much in the way of granularity, multiple nucleoli
  • promyelocyte: pretty good size cell, with a lot of dark blue/purple granules, immature looking nuclear chromatin, can see nucleolus
  • metamyelocyte: nucleus starts to indent, when secondary granules start to appear & will see “dawn of neutrophilia” the zone of lighter color near adjacent to the nucleus (golgi)
  • band: nucleus is indented more than 50% of diameter but no nuclear lobes
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14
Q

How do you differentiate a neutrophilic band from a mature neutrophil?

A
  • neutrophilic band
    • non-segmented nucleus
    • granules are small, evenly distributed, and stain pink or pink and blue
  • mature neutophil
    • nucleus separated into distinct lobes connected by narrow filament
    • granules evenly distributed, light pink or pink-blue
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15
Q

Identify the mature leukocytes shown in the provided images

A
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16
Q

What is the largest of the peripheral blood leukocytes?

A

monocyte

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17
Q

What type of cell is shown in the provided images?

A

normal lymphocytes

  • small to large
  • variable mounts of pale blue/pink to dark blue cytoplasm
    • but do NOT have indented nucleus
  • +/- fine pink cytoplasmic granules
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17
Q

What type of cell is shown in the provided images?

A

normal lymphocytes

  • small to large
  • variable mounts of pale blue/pink to dark blue cytoplasm
    • but do NOT have indented nucleus
  • +/- fine pink cytoplasmic granules
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18
Q

What is the name of the precursor shown in the provided image?Erythroid Island

A
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18
Q

What is the name of the precursor shown in the provided image?

A
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19
Q

Identify the early, intermediate & late erythroblasts in this bone marrow aspirate.

A

chromatin will become more coarse & dense as the cells mature

nuclei remain round/oval & the cytoplasm becomes more orange

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20
Q

What type of cell is shown in the provided images?

A

Normal Erythrocytes

“central zone of pallor”

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21
Q

Why is the biconcave disc an idea shape for red blood cells?

A

can carry plenty of hemoglobin

makes them very deformable but not fragile

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22
Q

Megakaryocytes have what type of genetic material?

A

polyploid

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23
Q

How do megakaryeocytes mature?

A

by a series of nuclear replications with a common cytoplasm, leading to multi-lobed, polyploid nuclei

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24
Q

What process is shown in the provided image?

A

megakaryopoiesis

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25
Q

What are the indications for receiving a bone marrow biopsy & aspiration?

A
  • Diagnosis / follow-up of hematolymphoid neoplasms
  • staging of lymphomas, some solid tumors
  • investigation of unexplained blood abnormality
  • fever of unknown origin, suspected bone marrow infection
  • unexplained radiographic findigns
  • pre-transplantation work up
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26
Q

What are the contraindications for receiving a bone marrow biopsy & aspiration?

A

not meeting the criteria of having one done

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27
Q

What is the most common site for bone marrow aspiration & biopsy?

A

posterior iliac crests

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28
Q

What is a bone marrow biopsy used for?

A

biopsy of trabecular bone

  • to determine architectural relationships
    • cellularity
    • myeloid:erythroid estimation
    • cell distribution
    • fibrosis and other marrow infiltrating processes
    • bony and vascular abnormalities
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29
Q

Bone marrow aspirate is better when looking at what feature as compared to a bone marrow biopsy?

A

cytological details

growing cultures

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30
Q

What structure is shown in the provided images?

A

core biopsy from the patient & on the slide

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31
Q

What are two procedures commonly preformed on the core biopsy?

A
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32
Q

What are bone marrow aspirates most commonly used for?

A

cell counts

cytologic evaluations

special studies

33
Q

What are two special features that are performed on the bone marrow aspirate?

A
34
Q

What substances in shown in the provided image?

A

bone marrow

35
Q

When looking at a peripheral slide, what RBC abnormalities are you looking out for?

A

size

shape

inclusions

miscellaneous

36
Q

What is the normal size of a RBC?

A

7-8 microns in diameter

37
Q

What characteristics determine a small RBC? What is its name?

A

< 80 fL and pale

zone of central pallor is > ⅓ the diameter of the cell

microcyte

38
Q

Microcytes are seen in what conditions?

A
  • iron deficiency
  • chronic disease
  • sideroblastic anemia
  • heavy metal poisoning
  • thalassemia
39
Q

What condition is shown in the provided image?

A

MIcrocytic Hypochromic

  • pale / small RBC
  • larger “area of central pallor”
40
Q

What characteristics determine a small RBC? What is its name?

A

>100 fL, ell hemoglobanized RBC

often oval in shape

Macrocytes

41
Q

Macrocytes are seen in what conditions?

A
  • vitamin B12 deficiency
  • folate deficiency
  • medication / toxin effect
  • myeloid neoplasms
42
Q

What condition is shown in the provided image?

A

Macrocytic erythrocytes

43
Q

What defect leads to microcytic cells? What does this mean for hemoglobin content?

A

cytoplasmic defect - small amounts of hemoglobin

44
Q

What defect leads to macrocytic erythrocytes? What does this mean for hemoglobin content?

A

nuclear defect - normal amount of hemoglobin

45
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Spherocytes

cells are spherical & lose bioconcave disk shape– due to loss of membrane w/o loss of cytosol

46
Q

What aspect of spherocytes makes them pathological?

A

much less deformable

47
Q

Spherocytes are seen in what pathologies?

A

immune hemolytic anemia

hereditary spherocytosis

burns

transfusion

48
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Elliptocytosis / ovalocytosis

abnormalities of cytoskeletal proteins

49
Q

Elliptocytosis / ovalocytosis is seen in what conditions?

A

Hereditary forms

acquired forms:

thalassemia

iron deficiency

myelofibrosis

myelodysplasia

50
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Target Cell -

redundant membrane in relation to the volume of the cell

51
Q

What aspect of target cells makes them pathological?

A

too floppy, which makes them too fragile

52
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Acanthocytes

irregularly sized & irregularly distributed pointed projections from the cell surface

53
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

echinocytes

short, numerous projections all around the cell, fairly even in size

54
Q

How are the spicules seen in acanthocytes different from those seen in echinocytes?

A
  • Acanthocytes
    • unevenly distributed over RBC surface
    • unequal length
  • Echinocytes
    • evenly distributed over RBC surface
    • short, blunt
55
Q

Acanthocytes are seen in what pathological states?

A
  • liver disease
  • myelodysplastic neoplasms
  • malnutrition
  • abetalipoproteinia
56
Q

Echinocytes are seen in what pathological states?

A
  • liver or renal disease
  • shortage artifact
  • inherited enzyme deficiency
57
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Stomatocytes

cup-shaped

57
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Stomatocytes

cup-shaped

58
Q

Stomatocytes are most commonly seen in what condition?

A

alcohol abuse syndromes

59
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Schistocyte

red cell fragments - RBC basically get clothes-lined on a fibrin strand or a strandform of platelet aggregates

60
Q

Schistocytes can be commonly mistaken for what other misshapen RBC? What is the differentiating factor?

A

Sickle Cells – NOT cell fragments

schistocytes ARE fragments

61
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Sickle-cells

point mutation on beta chain of hemoglobin

sickle in conditions of hypoxia / dehydration

62
Q

What condition is depicted by the provided blood smear? What types of RBC deformations are seen in the slide?

A

Hemoglobin C Disease

63
Q

What is the name for the type of cell depicted by the black arrow? They are seen in what condition?

A

Bit Cell (Degmacyte)

or G6PD deficiency

64
Q

How are “bite cells” formed?

A

When denatured hemoglobin aggregates (Heinz bodies) are removed from RBC by the spleen

65
Q

What type of RBC shape abnormality is shown in the provided image? Underlying cause?

A

Teardrop Cells (Dacrocytes)

due to mechanical distortion of the cell

66
Q

Teardrop Cells are most commonly seen in what conditions?

A
  • primary (idiopathic myelofibrosis)
  • secondary (reaction to myeloma, solid tumors, therapy)
66
Q

Teardrop Cells are most commonly seen in what conditions?

A
  • primary (idiopathic myelofibrosis)
  • secondary (reaction to myeloma, solid tumors, therapy)
67
Q

What type of pathological RBC condition is shown in the provided image?

A

Polychromasia

  • blue-gray color of immature RBCs due to residual cytopplasmic ribosomal material
  • immature RBCs are larger than mature RBCs
68
Q

Polychromasia is most commonly seen in what conditions?

A

reticulocytosis - hemolytic anemias & regenerating marrow

69
Q

What is reticulocytosis?

A

premature release of immature cells from marrow in times of increased RBC turnover

70
Q

What is the name of the cells with the dark blue inclusions?

A

Reticulocytes (blue = RNA aggregates)

71
Q

What type of RBC inclusion is shown on the provided slide? What are they?

A

Howell-Jolly Bodies

small nuclear remnant, typically single & round

72
Q

Howell-Jolly Bodies are commonly seen in what conditions?

A

post-splenectomy states

hemolytic anemias

megaloblastic ane

73
Q

What type of RBC inclusion is shown on the provided slide? What are they?

A

Pappenheimer Bodies / Granules

iron-containing mitochondrial remnants

occur in small clusters near periphery of cell

74
Q

Pappenheimer Bodies/Granules are most commonly associated with what pathology?

A

seen in sideroblastic anemia & post-splenectomy states

75
Q

What type of RBC inclusion is shown on the provided slide? What are they?

A

Basophilic stippling

RNA, aggregates of ribosomes

76
Q

What are the usual causes of coarse basophilic stippling?

A

lead intoxication

thalassemia

77
Q

What are the usual causes of fine basophilic stippling?

A

many anemias

78
Q

What pathology is shown in the provided image?

A

cold agglutinins

immune-mediated agglutintion

79
Q

What pathology is shown in the provided image?

A

Rouleaux

NOT immune-mediated

caused by high protein level that messes with negative charges on the surface of RBC

S3B4 Pathology (6 decks)

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