hematopoietic lecture ppt 2015 - bloomington...
TRANSCRIPT
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Fluorescent in situ hybridization for chromosomal translocation
HematopoiesisHematopoiesis: Red and white marrow
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Bone marrow aspirate and core biopsy
Gartner, Color Textbook of Histology, 3rd Edition
reticulocytes elliptocytes schistocytes
spheroctyes target cells acanthocytes
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Basophilic stippling Howell Jolly bodies Pappenheimer bodies
Ribosomal RNALead
ThalassemiaMyelodysplasia
DNA remnant,splenectomy
Inorganic iron granules,iron stain
Rouleaux
Paraproteinemia
Anemias classified by MCV
Hereditary spherocytosis
Figure 11‐1
Figure 11‐2
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Osmotic fragility test
Normal
Spherocytes
Sickle cell disease
Hemoglobin electrophoresis Hemoglobin electrophoresis
AdultFetal Hb SHb C
1 = Control2 = Hb A3 = HBA and Hb F4 = Hb S disease
5 = Control6 = Hb S and Hb A trait7 = HB S and Hb C8 = Hb S and Hb A trait
Hemoglobin High Performance Liquid Chromatography
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Hemoglobin HPLCHemoglobin electrophoresesβ‐globin mutations in β‐thalassemias
Glucose‐6‐phosphate dehydrogenase deficiencyParoxysmal nocturnal hemoglobinuria
Anopheles mosquito
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Hephaestus captures Aphrodite and Ares
Figure 11‐9
Iron regulation
Bone marrow iron stains Hepatic hemochromatosis
Figure 15‐25
Figure 11‐10
Microcytic hypochromic anemia
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Sideroblastic anemia
EtOH
Pyroxidine (B6)deficiencywith Isoniazid use
Myelodysplasia
Mitochondrial ironin erythroid precursors
Marrow megaloblasts
Giantmetamyelocytes
Hyperlobatedneutrophils
Megaloblastic anemia
Aplastic anemia
Myelophthisic marrow,metastatic carcinoma
Peripheral bloodLeukoerythroblastosis
Epstein Barr Virus
MonospotHeterophile antibody test
Hodgkin lymphomaBurkitt lymphomaNasopharyngeal
carcinoma
Epstein‐Barr VirusNormal Lymph Node
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Acute nonspecific lymphadenitis
Follicular hyperplasia Paracortical hyperplasia Sinus histiocytosis
Bartonella henselae
Stellate necrotizinggranulomata
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CD5+, CD19+, CD20+, CD23‐
Kappa light chain restricted
Cyclin D1 positive
t(11;14)
CD5 ‐, CD19 +, CD20+, CD23‐
Kappa/lambda light chain 2:1
Cyclin D1 negative
Negative for t(11;14)
Mantle cell lymphomaReactive lymph node
2 light chains + 2 heavy chains → Immunoglobulin(cell surface antigen receptor or secreted Ig)
Heavy chain protein production
Light chain protein production
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Monoclonal IgG kappa →
PCR assay for clonality:VDJ gene rearrangement
PCR assay of VDJ gene rearrangement Fluorescent in situ hybridization for chromosomal translocation
Most lymphomas resemble some stage of B or T cell differentiation
Figure 11‐13
B cell germinal center somatic hypermutation
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ALL: Acute lymphoblastic leukemia/lymphoma
Chronic lymphocytic leukemia/small lymphocytic lymphoma
Smudge cells Diffuse nodal effacement Nodular marrow involvement
Follicular lymphomat(14;18) BCL2/IgH
BCL2 follicular lymphoma
BCL2 normal memory cells
Mantle cell lymphomat(11;14) cyclin D1 overexpression
Cyclin D1 stain
Lymphomatoid polyposis
Figure 11‐17
Diffuse large B cell lymphoma
BCL6CD19, CD20, CD10
Burkitt lymphoma
t(8;14)t(2;8)t(8;22)
Starry sky pattern
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Multiple Myeloma
Rouleaux formation Renal tubular protein casts
Lytic lesionsAtypical plasma cells,
Mott cell
Henry Bence Jones
Prof Jan Waldenström at New York Hospital, Cornell University, New York, NY, 1963.
Left: Before plasmapheresis optic disc edema (arrowheads), central retinal hemorrhages (bold arrows), and venous “sausaging” (thin arrows) were observed. Right: After plasmapheresis disc edema and retinal hemorrhages improved. Venous sausaging disappeared.
Lymphoplasmacytic Lymphoma
Waldenström MacroglobulinemiaHyperviscosity Syndrome
Hodgkin lymphoma
Reed Sternberg cell
Figure 11‐23Figure 11‐20
Thomas Hodgkin
Hodgkin lymphoma,nodular sclerosis subtype
Nodular sclerosing pattern Lacunar cell
Figure 11‐22 Figure 11‐21
Extranodal marginal zone lymphomaNormal splenic marginal zone Gastric MALToma
Hairy cell leukemia
TRAP positive(outdated test)
Splenomegaly
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Mycosis FungoidesCutaneous T‐Cell Lymphoma
Pautrier microabscess(Lymphocyte epidermotropism)
Sezary syndrome(exfoliative erythroderma)
Circulating Sezary cells
Myelodysplasia
Abnormal erythroblasts Ring sideroblasts (iron stain)
Hypolobated, hypogranulated neutrophils
Abnormal megakaryocytes
Figure 11‐25
Acute myelogenous leukemias
Auer rods
ALL AML
Acute Promyelocytic LeukemiaFAB M3
Acute Myelomonocytic LeukemiaFAB M4
Gingival infiltration
Figure 11‐26
Chronic myelogenous leukemia
Splenomegaly
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Erythromelalgia
Splenomegaly
Myelofibrosis
Dacryocytes (teardrops ), nucleated red cells ( ) Marrow fibrosis
Essential thrombocythemia
Peripheral blood with thrombosis, giant platelets Marrow with increased megakaryocytes
Langerhans cell is a type of dermal dendritic cell
Birbeck granuleCD1a
HemostasisBetween Scylla and Charybdis
Figure 3‐7
Primary hemostasis
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Secondary hemostasis
Figure 3‐8
Figure 3‐5
Platelet plug Coagulation clot
Figure 3‐6
Antithrombotic mechanisms
Figure 3‐11
Fibrinolytic system
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Platelet function analyzer Platelet aggregation studies
http://www.platelet‐research.org/3/pfa.htm
Russell venom viper testfor lupus anticoagulant
Reptilase testfor heparin
Thrombotic Thrombocytopenia Purpura
SchistocytesHyaline thrombi
Hemolytic uremic syndrome
E. Coli O157:H7
Von Willebrandmultimer analysis
vWF functionFigure 11‐29
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Disseminated intravascular coagulopathy
Figure 11‐28
St. George and the dragon