Wahed / Dasgupta / Dasgupta Ph. D Hematology and Coagulation

A Comprehensive Review for Board Preparation, Certification and Clinical Practice
1. Auflage 2015
ISBN: 978-0-12-800381-7
Verlag: Academic Press
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 324 Seiten, Format (B × H): 191 mm x 235 mm

Hematology and Coagulation is a clear and easy-to-read presentation of core topics and detailed case studies that illustrate the application of hematopathology knowledge to everyday patient care. In order to be successful, as well as to pass the American Board of Pathology examination, all pathology residents must have a good command of hematopathology, including the challenging topics of hematology and coagulation. Hematology and Coagulation meets this challenge head on. This basic primer offers practical examples of how things function in the hematopathology clinic as well as useful lists, sample questions, and a bullet-point format ideal for quick pre-board review. This book provides only the most clinically relevant examples designed to educate senior medical students, residents and fellows and 'refresh' the knowledge base, without overwhelming students, residents, and clinicians. - Takes a practical and easy-to-read approach to understanding hematology and coagulation at an appropriate level for both board preparation as well as a professional refresher course - Covers all important clinical information found in larger textbooks in a more succinct and easy-to-understand manner - Covers essential concepts in hematopathology in such a way that fellows and clinicians understand the methods without having to become specialists in the field

Amer Wahed is a graduate of Medicine, training initially in Internal Medicine at Royal Postgraduate Medical School, London, England. He subsequently trained in Anatomic and Clinical Pathology from the University of Texas-Houston Medical School. After working for several years in a private setting, he joined the Department of Pathology and Laboratory Medicine at the University of Texas-Houston Health Sciences Center. Currently he is an Assistant Professor of Pathology and Laboratory Medicine and Associate Director of Clinical Chemistry and Immunology at Memorial-Hermann Hospital at the Texas Medical Center. He is also the Associate Director of the Pathology Residency Program at the University of Texas-Houston Medical School. Dr. Wahed has a strong interest in teaching and is actively involved in the education of medical students, graduate students, residents, and fellows. He has been recognized for his teaching contributions through awards from his department, as well as the Office of the Dean. He is also active in mentoring pathology residents in research and has published multiple papers in peer-reviewed journals.

Autoren/Hrsg.

Wahed, Amer

Dasgupta, Amitava

Dasgupta Ph. D, Dabcc

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Hämatologie, Transfusionsmedizin

Inhaltsverzeichnis

1. Complete blood count (CBC) and peripheral blood smear examination
2. Bone marrow examination and interpretation
3. Red blood cell (RBC) disorders
4. Hemoglobinopathies, and thalassemias 
5. Benign white blood cell (WBC) and platelet disorders
6. Myeloid neoplasms
7. Monoclonal gammopathy and their detection
8. Application of flow cytometry in diagnosis of hematological disorders
9. Cytogenetics abnormalities and hematological neoplasa
10. Benign lymph nodes
11. B cell lymphomas
12. T cell and natural killer cell (NK) lymphomas
13. Hodgkin lymphoma
14. Lymphoproliferative Disorders Associated with Immune deficiencies, Histiocytic and Dendritic Cell Neoplasms
15. Essentials of coagulation
16. Thrombophilia and their detection
17. Sources of errors in hematology and coagulation

Leseproben

Chapter 2

Bone Marrow Examination and Interpretation

This chapter discusses the review of bone marrow slides, their interpretation, and common bone marrow findings in non-leukemia and non-lymphoma cases, including infections, storage disorders, and granulomatous diseases. Bone marrow examination is also important in the diagnosis of multiple myeloma.

Keywords

Bone marrow; multiple myeloma; leukemia; lymphoma; storage disorders

Contents

2.1 Introduction 15

2.2 Fundamentals of Bone Marrow Examination 16

2.2.1 Dry Tap 17

2.2.2 Granulopoiesis 17

2.2.3 Erythropoiesis 18

2.2.4 Monopoiesis, Megakaryopoiesis, Thrombopoiesis, and Other Cells in Bone Marrow 19

2.3 Bone Marrow Examination Findings and Bone Marrow Failure 19

2.3.1 Disorders of Erythropoiesis, Granulopoiesis, and Thrombopoiesis 21

2.3.2 Infections 22

2.3.3 Granulomatous Changes 23

2.3.4 Storage Disorders 23

2.3.5 Metabolic Bone Diseases 24

2.3.6 Metastatic Tumors 24

2.3.7 Hemophagocytic Syndrome 24

2.3.8 Bone Marrow Necrosis/Infarction 24

2.3.9 Serous Atrophy 25

2.3.10 Bone Marrow Fibrosis 25

2.3.11 Reactive Lymphoid Aggregate 25

2.3.12 Bone Marrow Infiltration in Lymphoproliferative Disorders 25

2.3.13 Amyloidosis 26

Key Points 26

References 29

2.1 Introduction

Complete blood count (CBC), examination of peripheral blood smear, and other routine laboratory tests may not provide enough information for unambiguous diagnosis of hematological or nonhematological disease in certain patients. For these patients, direct microscopic examination of the bone marrow is required for a proper diagnosis. The bone marrow, which is disseminated within the intertrabecular and medullary spaces of bone, is a complex organ with dynamic hematopoietic and immunological functions. The role of bone marrow in hematopoiesis was first described by Neumann in 1868; since then, methods for bone marrow procedures have undergone many improvements. Following the development of newer techniques and equipment, bone marrow aspiration and bone marrow biopsy have become important medical procedures for diagnosis of hematological malignancies and other diseases and also for follow-up evaluation of patients undergoing chemotherapy, bone marrow transplantation, and other forms of therapy [1]. Bone marrow trephine biopsy should be carried out by a trained health care professional, and bone marrow aspirate should be collected during the same procedure. Because a diagnostic specimen is a small representation of the total marrow, it is important that material be adequate and representative of the entire marrow. The specimen must also be of high technical quality. Cytochemical analysis and various other diagnostic procedures can be performed on the liquid bone marrow aspirate, and bone marrow biopsy material can be stained using immunoperoxidase and other stains. The recent development of bone marrow biopsy needles with specially sharpened cutting edges and core-securing devices has reduced the discomfort of the procedure and improved the quality of the specimen obtained [2]. Today, bone marrow examination is considered an important and effective way to diagnose and evaluate primary hematological and metastatic neoplasm as well as nonhematological disorders [3]. Common indications for performing bone marrow examination are listed in Box 2.1.

Box 2.1

Common Indications for Bone Marrow Examination

Diagnosis of Diseases

 Acute or chronic unexplained anemia including hypoplastic or aplastic anemia

 Differentiating megaloblastic anemia from normoblastic maturation

 Unexplained leukopenia

 Unexplained thrombocytopenia, pancytopenia

 Myelodysplastic syndrome

 Myeloproliferative disease

 Plasma cell dyscrasia

 Hodgkin and non-Hodgkin lymphoma

 Suspected leukemia

 Disseminated granulomatous disease

 Primary amyloidosis

 Metabolic bone disease

 Suspected multiple myeloma

 Suspected storage diseases (e.g., Gaucher’s disease)

 Fever of unknown origin

 Confirmation of normal marrow in a potential allogeneic donor

Follow-Up of Medical Treatment

 Chemotherapy/bone marrow transplant follow-up

 Treatment of isolated cytopenia

2.2 Fundamentals of Bone Marrow Examination

Prior to a bone marrow examination, the relevant history of the patient, CBC, and the report from the peripheral blood smear examination must be reviewed [4]. During a routine bone marrow examination, slides obtained from the aspirate, slides from the clot sections, slides from the trephine biopsy, touch preparation slides obtained from the trephine biopsy, and iron strains must be carefully examined for proper interpretation of results. Occasionally, examination of a well-prepared aspirate slide, core biopsy specimen, and iron strain by a well-trained professional may be adequate for arriving at a diagnosis [1]. However, additional tests, such as flow cytometry and cytogenetics studies, may be needed in other cases. Additional steps that may be performed during bone marrow examination are listed in Box 2.2.

Box 2.2

Additional Steps That May Be Performed as Part of a Bone Marrow Examination

 Immunophenotyping by flow cytometry (performed on the aspirate specimen)

 Immunophenotyping by immunohistochemistry (performed on the biopsy or clot section slides)

 Special stains—for example, acid fast bacilli (AFB), Grocott’s methenamine silver (GMS), reticulin, trichrome, Wright–Giemsa stain, Prussian blue stain

 Cytogenetic studies

 Molecular studies—for example, polymerase chain reaction (PCR), fluorescence hybridization (FISH)

 Electron microscopy

The aspirate slides are typically used to assess morphology by performing a differential count and thus obtaining the myeloid:erythroid (M:E) ratio. If the aspirate lacks particulates or is unsatisfactory, morphology may be assessed from the touch prep slides.

The architecture of the bone marrow is best assessed from the trephine biopsy slides. Infiltrates (e.g., granulomas, lymphomatous infiltrates, and metastatic tumors), if any, and their distribution can also be assessed from the biopsy slides. The cellularity of the bone marrow is usually assessed from the biopsy slides. In addition, reticulin or collagen fibrosis is also assessed from the biopsy slides. Bone marrow stroma and the bone itself are assessed from the biopsy slides. In the absence of a good trephine biopsy specimen, the slides from the clot section may be used as an alternate means of assessment.

2.2.1 Dry Tap

Causes of dry tap while performing a bone marrow procedure include the following:

 Faulty technique

 Packed marrow (e.g., with leukemia)

 Fibrotic marrow (e.g., myelofibrosis)

 Hairy cell leukemia.

In cases of dry tap, one must improvise to obtain the greatest possible amount of information. One way of achieving this is to obtain two trephine biopsies and to submit the first for flow cytometry and the other for cytogenetic studies. Good touch preps from the second biopsy should provide adequate morphological and architectural information.

2.2.2 Granulopoiesis

Granulopoiesis involves maturation of myeloblasts into mature polymorphonuclear neutrophils, basophils, and eosinophils. The steps include the transformation of myeloblasts to promyelocytes to myelocytes to metamyelocytes to bands to mature granulocytes.

Myeloblasts are large cells with a high nuclear to cytoplasmic (N:C) ratio, moderately blue cytoplasm (less blue than the cytoplasm of an erythroblast), and prominent nucleoli. Promyelocytes are larger cells compared to myeloblasts and have prominent nucleoli, a Golgi hof, and granules. These granules are primary granules and appear reddish-purple. The promyelocytes of the three granulocytic lineages cannot be differentiated by routine light microscopy. Myelocytes no longer have nucleoli but continue to have granules. However, these granules are secondary and specific granules. Thus, cells of the three granulocytic lineages can now be distinguished. Myeloblasts, promyelocytes, and myelocytes are all capable of cell division. Metamyelocytes have indented nuclei and cannot undergo cell division. The nucleus of bands is “U” shaped. Granulopoiesis in a normal marrow is seen adjacent to the bony trabecular surface (as a layer two or three cells thick) and to arterioles.

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Über Autor(innen)

Dasgupta, Amitava
Amitava Dasgupta received his PhD degree in Chemistry from the Stanford University and his fellowship training in Clinical Chemistry from the Laboratory Medicine Department of the University of Washington School of Medicine at Seattle. He is a tenured Full Professor of Pathology and Laboratory Medicine at the University of Texas Health Sciences Center located at the Texas Medical Center at Houston. Dr. Dasgupta has published 210 scientific papers, wrote many invited review articles, and edited, co-edited or wrote 15 books. He is on the Editorial Board of five major medical journals including American Journal of Clinical Pathology, Archives of Pathology and Laboratory Medicine, Therapeutic Drug Monitoring, Clinica Chimica Acta and Journal of Clinical Laboratory Analysis.

Wahed, Amer
Amer Wahed is a graduate of Medicine, training initially in Internal Medicine at Royal Postgraduate Medical School, London, England. He subsequently trained in Anatomic and Clinical Pathology from the University of Texas-Houston Medical School. After working for several years in a private setting, he joined the Department of Pathology and Laboratory Medicine at the University of Texas-Houston Health Science Center. Currently he is an Assistant Professor of Pathology and Laboratory Medicine and Associate Director of Clinical Chemistry and Immunology at Memorial-Hermann Hospital at the Texas Medical Center. He is also the Associate Director of the Pathology Residency Program at the University of Texas-Houston Medical School. Dr. Wahed has a strong interest in teaching and is actively involved in the education of medical students, graduate students, residents and fellows. He has been recognized for his teaching contributions through awards from his department as well as the Office of the Dean. He is also active in mentoring pathology residents in research and has published multiple papers in peer-reviewed journals.