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cells, pathologies, labs, diagnostics

hematopoiesis

lymphatic system: map

LN region drainage

female GU LN

peau d'orange

indicates edema due to lymphatic obstruction

normal BM

HSC cells: fat 1:1 (50% cellularity: age-dept)
myeloid:erythroid 3:1
parts: cells, fat, sinusoids

RBC/erythroid maturation

mark: CD1a, 13/14/15, 33/34, 68, 117 c-Kit

granulocyte maturation

1o granules: promyelocytes
2o granules: myelocytes

megakaryocyte + platelet devo

eosinophil

basophil

basophilia: IgE-med allergy, CML

monocyte

MF precursor

erythroblast

15-30% BM cells
7d maturation

reticulocyte

2-3d in circulation
normal ct: 0.5-1.5%
stain: new Methylene blue, Wright stain

mature RBC

leukemoid reaction/ reactive neutrophilia = L-shift

poikilocyte/ SCD

T, NK maturation + markers

B cell maturation + makers

leukemoid reaction/ reactive neutrophilia = L-shift

leukocyte response to i2

cell-surface binding in i2

phagocytosis using FcR

phagocytosis: reactions

follicular hyperplasia v follicular lymphom

follicular hyperplasia: Bcl-2 (-)
follicular lymphoma: Bcl-2 (+), small cleaved LC

blood smear: normal

BM: normal

LN: normal

spleen: normal

note follicles = white pulp
vasculature + surrounding = red pulp

Hb types + Ddx

Hb genes + chains

B-thalassemia

target cell, basophilic stippling, HbA2, HbF

sideroblast

perinuclear mt accum Fe2+: MDS, congen

megaloblastic anemia

hemolysis chart

reticulocytosis

spherocytosis

hereditary, warm autoi2 hemolytic anemia

hereditary spherocytosis

G6PDH deficiency

cold autoi2 hemolytic anemia

schistocytes

macro/microangioPx trauma/hemolytic anemia:
DIC, TTP, thrombosis

acute blood loss anemia

slow drop in Hb, slow recovery RBC mass

MDS

ringed sideroblasts
mickey mouse myelocytes
bilobed neutrophils (not shown)

folic acid/Vit B9 + Vit B12: metabolic activity

synth: purine, pyridine, methionine

Vit B12 functions

also required to convert FA/Vit B9 to active form:
N5-methyltetrahydrofolate -> tetrahydrofolate

Chediak-Higashi syndrome

atypical lymphocytes

viral i2; CD8+, skirting cytoplasm

atypical LC v blast

atypical: skirting cytoplasm, ^chromatin condens

LN architecture: cartoon

reactive lymphadenoPx: compare

sinus histiocytosis

mixed cell LN hyperplasia

toxoplasmosis

myeloid + lymphoid neoplasia: chart

myeloproliferative neoplasms

PM: 1o myelofibrosis: histo

splenomegaly

PM

ET: essential thrombocytosis

mastocytosis

AML: acute promyelocytic leukemia: M3 t(15;17) PML-RARa

promyelocyte: butterfly nuc

Langerhans histiocytosis

Birbeck granules
coffee-bean nuc

CML: natural course: all ->AML

CLL/SLL

smudge cells, mature/small LC

CLL/SLL flow cytometry

CD5: usually T cell marker; (+) CD5, 19, sIg

hairy cell leukemia

follicular lymphoma

always consider follicular hyperplasia: Bcl-2(-)

DLBCL: diffuse large B-cell lymphoma

multiple myeloma: diagnostics

multiple myeloma: histo

Burkitt lymphoma

starry sky MF

mantle cell lymphoma

EMZL-MALToma

mycosis fungoides

convoluted nuc

adult T cell leukemia

flower-shaped nuc

anaplastic large cell lymphoma

hallmark cell: horseshoe-shaped

classical HL: Reed-Sternberg cells

bi-lobed nuc, each +huge nucleolus

HL: nodular sclerosing variant

HL: LC depletion variant

HL: mixed cellularity variant

B cell targets for therapy

others: CD52 (CD30 - usually T cell, but expressed in HL)

Brentuximab

Denileukin difitox

Campath/ Alemtuzumab

CLL, CTLC, T-cell lymphoma

chemotherapy targets

cell cycle: chemotherapy targets

hereditary hemorrhagic telangiectasia

Henoch-Schonlein purpura

TTP

hyaline microthrombi: plt only
schistocytes (helmet cell)

heparin-antithrombin III

thrombomodulin-Protein C-Protein S

coagulation cascade downreulation

thrombomodulin-prot C-prot S --| FVIII, FV
heparin-AT III --| FXI, FIX, FX, FVII, FII

PE: CT scans

pseudothrombocytopenia

smear + EDTA -> plt clumping

wet purpura

antiphospholipid Ab syndrome

HIT: heparin-induced thrombocytopenia

antiplatelet Rx

ticlopidine

thrombolytics

ABO groups: terminal saccharides

ABO gels: pt O

crossmatch - mini

blood components

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