Morphology Flashcards
(28 cards)
T-PLL
- Usually marked lymphocytosis.
- Atypical lymphoid cells with clumped chromatin
- Single, indistinct nucleolus – may be more apparent at lower magnification.
- Cytoplasmic blebbing is common.
- Minimal basophilic, agranular, cytoplasm.
T PLL
Prolymphocytes
Larger than CLL cells with prominent nucleoli and abundant cytoplasm.
Prolymphocytes
Medium sized
Abundant cytoplasm
Prominent nucleoli
Sezary syndrome
- Medium-large size
- Convoluted, cerebriform nuclei with tightly intertwined nuclear lobes
- Scanty cytoplasm
- May be vacuolated
- Nuclear groove may be present
- No nucleoli
Sezary cells immunophenotype
CD3+/4+
CD8-/7-/26-
PD1+
Follicular lymphoma
- Small, mature, atypical lymphoid cells
- Lymphocytosis may be minimal or marked
- Size ranges from smaller than CLL to larger with less condensed cytoplasm
- Characteristically have deep, narrow clefts - BUMs
- Scanty, basophillic cytoplasm
- Smudge cells are not a feature, in contrast to CLL
Can have a nodular, paratrabeculae or diffuse infiltrate
Adult T cell leukemia/lymphoma
May be quite pleomorphic, with several described variants:
Pleomorphic small / medium / large
Anaplastic
AITL-like (rare)
Morphology
Medium-large atypical lymphoid cells
Pronounced nuclear pleomorphism with multiple lobes –“flower cells“
Mature chromatin with distinct, sometimes prominent nucleoli
Variable proportions of blast-like cells
A minority of cells may resemble Sezary cells
+/- eosinophilia
Lymphoid vs myeloid blast
(no hard and fast rules, flow is king)
Lymphoid
- more ploemorphic
- higher NC ratio
- agranular
- deeply basophilc cytoplasm
- vacuolation
- prominent nucleoli
- absence of Auer rods
- may have smear cells
- if finding it difficult to diff between
lymphocytes vs large lymphs = likely lymphoid
Marginal Zone lymphoma
Small atypical lymphoid cells
Lacks uniform appearance of CLL (mildly pleomorphic)
Mature nuclei, sometimes may have inconspicious nucloeli
INCONSPICIOUS nucleoli are
Scanty, weakly basophilic cytoplasm
Occasional lymphocytes may appear lymphoplasmacytoid
SMZL - polar villous
Hairy cell leukemia
Immunophenotype:
20++/11c+/25+/103+/123+
Annexin A1 positive
BRAF positive
Monocytopaenia
Pancytopaenia
Splenic B-cell lymphoma/leukemia with prominent nucleoli
Monomorphic medium to large cells with cytoplasmic projections, variable cytoplasmic basophilia, and typically a prominent single nucleolus.
20+/11c+/103+/25-/123-
UNLIKE in HCL - may have normal counts and usually a marked lymphocytosis
Alpha trait -
Single or two gene deletions (aa/-a), (aa/–) or
(-a/-a)
Microcytosis and occasional target cells.
In single gene - Hb is normal
In two gene deletion - may have mild anaemia
HbH
MARKED hypochromic microcytic anaemia
Hb 60-100
Anisopoikolocytosis with TARGET cells, tear drop cells and fragments
Basophilic stippling
Polychromasia
*ABSENT nRBC
HbH
Alkaline gel - HbH is FAST
Acid gel - HbH runs with A
HPLC - very short retention time!
Beta thalassaemia trait
NORMAL Hb or mild anaemia 100-110
MARKED microcytosis
Blood film features:
Quite bland
Occasional target cells
Basophilic stippling
Polychromasia
Mild increase in A2
ddx - co-existing iron def and alpha thal trait
Beta thalassaemia intermedia
defect may be the presence of** two alleles** for** mild β+ thalassaemia**, β thalassaemia/HbE
Mod severe microcytic anaemia.
Not usually transfusion dependent
Blood film inbetween trait and major
- target cells
- anisopoikilocytosis
- basophilic stippling/pappenheimer bodies
- nRBC (which may varry)
- poly
LOOK for
- hyposplenic changes
- dimorphic picture (recent tx)
Beta thalassaemia major
Homozygosity or compound heterozygosity
for β thalassaemia –> severel lack of synthesis of β globin chains = no HbA
Blood film fx:
- SEVERE anaemia (unless transfused)
>DIMORPHIC if transfused
- MARKED anisopoikilocytosis
- Target cells
- Basophilic stippling
- Pappenheimer bodies
- NUMEROUS nRBCs
- look for HYPOSPLENISM
Sickle cell anaemia
βSβS
Homozygouse HbS
Hb wide range, usually 70-80
Anisocytosis
NORMOCYTIC
Sickle cells (may be very rare)
Boat-shaped cells
Target cells
Polychromasia
Anisocytosis
Basophilic stippling
Some spheros/contracted red cells
nRBCs
Also look for
- hyposplenism
- dimorphic picture (recent tx)
Ddx
- Sickle cell/haemoglobin C disease
- Sickle cell/β thalassaemia
Sickle cell/B+ or 0 vs Sickle anaemia
Sickle cell/β° thalassaemia cannot
be distinguished from sickle cell anaemia on HPLC or HPEPG as there is no HbA in either
- distinction made on fam hx AND LOW MCV/MCH in compound heterozygotes
Sickle cell/
β+ thalassaemia - may show a less abnormal blood count and blood film than sickle cell anaemia, depending on amount of HbA present
Image of a sickle cell/B0
Sickle cell trait
ββS
NORMAL blood film, NO true sickle cells.
> may have microcytosis
or target cells
No clinical significance –> but of genetic importance
Hb SC disease
Sickling disorder from haemoglobin S and haemoglobin C (ßsßc) characterised by SC poikilocytes
Varying presentations
May have higher Hb than sickle anaemia
+/- microcytosis
Mild-moderate microcytic, hypochromic anaemia
SC poikilocytes - unusual
Haemoglobin SC crystals
Numerous BOAT cells and TARGET cells
LESS Polychromasia
FEWER sickle cells
FEWER nRBCs
May have features of hyposplenism
Look for features of hydroxyurea therapy also
Congenital Dyserythropoietic Anaemia
SUPER RARE , inherited dyserytrhopoietic anaemia - ineffetcive erythropoiesis and intramedullary haemolysis.
AR
usually normocytic/macrocytic
Blood film features:
- MARKED anisopoikilocytosis
- dimorphic
- macrocytes, most cells normocytic
- Teardrop cells
- Basophilic stippling
- nRBCs may be seen, especially after splenectomy (look for features of splenectomy)
Other cell lines lack dyserythropoietic features
- NO poly
Type I = mutation in CDAN1,
Type II = mutation in SEC23B
Type III = mutation in KIF23
Hereditary Spherocytosis
AD, majority of mutations in ankyrin and B-spectrin genes –> destabilised membrane and spherocytosis
Most patients have compensated haemolysis with normal Hb concentration but reticulocytosis.
Anaemia (or normal if compensated)
Spherocytosis
Polychromasia
+/- hyposplenic changes
