Surgery Clerkship > Hematopathology > Flashcards

Hematopathology Flashcards

(62 cards)

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1
Q

Differential for non-megaloblastic macrocytosis

A
  • Liver disease
  • Reticulocytosis (due to retics)
  • Myelodysplastic syndrome
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2
Q

What does a finding of rouleaux on hematopathology represent?

A

High concentration of protein, usually fibrinogen or immunoglobulins

However! There is always rouleaux on the location a drop of blood is placed on the slide initially. So, make sure you look at the whole slide before calling rouleaux.

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3
Q

Agglutination

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4
Q

Stomatocytes

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5
Q

Acanthocytes

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6
Q

Echinocytes

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7
Q

When you see dacryocytes, you need to check. . .

A

. . . if they are all facing the same direction

If so, it is likely an artifact

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8
Q

Blister cells

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9
Q

Hemoglobin C disease

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10
Q

Hb SC disease

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11
Q

Howell-Jolly bodies

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12
Q

Pappenheimer bodies

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13
Q

Basophilic stippling

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14
Q

Heinz bodies

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Note: These are usually visualized with a methylene blue stain

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15
Q

Cabot ring

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16
Q

Ways to differentiate babesia from malaria

A
  1. Maltese cross formation is always babesia
  2. Babesia will have mostly rings and rarely maltese crosses, but no other intracellular forms – malaria can take a few shapes
  3. Babesia may live extracellularly, so you may catch some parasites outside red cells. Malaria is obligate intracellular.
  4. Travel history! Babesia is common in the US and some parts of Europe. Malaria is across tropical areas, but especially tropical Africa and Asia
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17
Q

Active CD8+ T cells

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18
Q

Toxic granulation

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19
Q

Dohle bodies

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20
Q

Alder-Reilly anomaly

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21
Q

Pelger Huet anomaly

A
  • “Dumbell neutrophils”
  • Acquired form is “pseudo-Pelger-Huet”, which may be in association with myelodysplasia
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22
Q

Chediak Higashi syndrome

A

Visualization of these cells on the smear is diagnostic of the condition

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23
Q

Histoplasmosis

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24
Q

Anaplasmosis / Ehrlichosis

A

Note: Usually only present during the first week of infection

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25
Large platelet syndromes
26
Platelet clumping and satelliting
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Gelatinous transformation
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Parvovirus B19 in bone marrow
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Hemophagocytosis
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Macrophages in lipid storage diseases
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Lymph node medulla
Cords: Contain T cells, plasma cells, and macrophages Sinuses: Contiguous with the efferent lymphatics. Contain a large number of monocytes which filter incoming material.
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Structure of a secondary follicle
Note: Occasionally there is a marginal zone between the mantle and germinal center. This is most common in the spleen. This area houses mature lymphocytes with moderate amounts of pale cytoplasm, including marginal zone B cells.
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Differentiating cells by nuclei in a germinal center
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Centroblast vs centrocyte
* B cells within a germinal center * Centroblast: The replicating B cells with euchromatin, contained within the dark zone * Centrocyte: The progeny of the replicating B cells, which migrate to the light zone of the germinal center following division. Here, they interact with DCs and T cells in the light zone to determine if their affinity is sufficient to migrate back to the dark zone and become centroblasts or to become memory B cells.
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Germinal B cell markers
* Bcl6 * CD10
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Follicular DC markers
* CD23 * CD35 * CD21 * CD11b/CD18
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Follicular helper T cell markers
* CD4 * CD57 * PD-1 * Bcl6
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Proliferation marker for germinal centers
Ki67
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BCL2 in germinal centers
BCL2 is an anti-apoptotic protein found in mature lymphocytes. It is not present in a benign secondary germinal centers except very scarcely. Mature lymphocytes in the mantle zone will be BCL2 positive. However, primary germinal centers *will* express BCL2, as they do not contain any replicating B cells. As such, **malignant follicles may have BCL2 expression AND be positive for B cell markers like CD20, CD10**
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Follicular pattern of lymphoid hyperplasia
* Increase in # and size of LN follicles. Germinal centers may be large and irregularly shaped, but maintain features of benign germinal centers (polarization into light and dark zones, preserved mantle zones, tingible body macrophages. * Occurs with: * Idiopathic Follicular hyperplasia * Syphilis * HIV lymphadenopathy * Castlemann disease * Progressive transformation of germinal centers
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Sinus pattern of lymphoid hyperlasia
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Tingible body macrophages
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Partacortical hyperplasia
* Expansion of the paracortical space between follicles. Heterogeneous population of small lymphocytes, larger immunoblasts, and immunoblasts is present. * Can be seen in: * **EBV lymphadenitis** * **HSV lymphadenitis** * **Granulomatous lymphadenitis** * **Dermatopathic lymphadenopathy** * **Drug reaction** * **Toxoplasmosis**
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CD10
* Function: Cell membrane metalloprinteinase * In T cells and B cells: Marker of a follicular cell. Can help identify TfH and follicular B cells * Mature neutrophils (but not immature)
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Progressive transformation of germinal centers
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Follicular lysis
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Paracortical hyperplasia
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Sinus histiocytosis
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Bartonella hensleae lymphadenitis OR lymphogranulosum venereum (L1-3 serotype chlamydia) lymphadenitis
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Bacillary angioatosis
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Syphilis lymphadenitis
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Toxoplasma lymphadenitis
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Epithelioid histiocytes
Look like islands of epithelial tissue in a lymph node, marrow, or stroma, but then when you look closer they are macrophages
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Progression of HIV lymphadenitis
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Birbeck granules
* Tennis-racket-shaped granules found only in Langerhans cells * Visualized by electron microscopy
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Secondary HLH
* Commonly associated with hematologic malignancies, in particular **NK/T cell neoplasms.** It is only rarely reported in association with other cancers. * **Acute HIV infection** has been implicated in the development of HLH, but typically **in the setting of other acute infections** or **HIV associated lymphomas**, especially **EBV related lymphoproliferative processes** * May be seen in **up to 60% of patients with sepsis**
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Virus most associated with hemophagocytic lymphohistiocytosis?
* Epstien-Barr virus
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Reed Sternberg (classical and non-classical) immunophenotype
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Richter syndrome / Richter transformation
A transformation of B cell chronic lymphocytic leukemia (CLL) or hairy cell leukemia into a fast-growing diffuse large B cell lymphoma
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Oncocytic morphology
An oncocyte is an **epithelial cell** characterized by an **excessive number of mitochondria**, resulting in an **abundant eosinophilic, granular cytoplasm**
61
CLL hereditary risk
VERY strong hereditary prevalence of CLL
62
Why is it not uncommon to see minor thrombocytosis in anemia?
EPO has some activity at the TPO receptor as well
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