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    This document presents hematology practices and atlases for the recognition of abnormal cells in acute leukemias through blood count and smears. Instructs on the morphology of pathological blasts of myeloid and lymphoid lineages, as well as promyelocytes and promonocytes. It also covers myelogram, with emphasis on the analysis and differential counting of bone marrow cells to diagnose acute myeloid leukemias.

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    Activity 11

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    This document presents hematology practices and atlases for the recognition of abnormal cells in acute leukemias through blood count and smears. Instructs on the morphology of pathological blasts of myeloid and lymphoid lineages, as well as promyelocytes and promonocytes. It also covers myelogram, with emphasis on the analysis and differential counting of bone marrow cells to diagnose acute myeloid leukemias.

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    This document presents hematology practices and atlases for the recognition of abnormal cells in acute leukemias through blood count and smears. Instructs on the morphology of pathological blasts of myeloid and lymphoid lineages, as well as promyelocytes and promonocytes. It also covers myelogram, with emphasis on the analysis and differential counting of bone marrow cells to diagnose acute myeloid leukemias.

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    This document presents hematology practices and atlases for the recognition of abnormal cells in acute leukemias through blood count and smears. Instructs on the morphology of pathological blasts of myeloid and lymphoid lineages, as well as promyelocytes and promonocytes. It also covers myelogram, with emphasis on the analysis and differential counting of bone marrow cells to diagnose acute myeloid leukemias.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    7 views4 pages

    Activity 11

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    This document presents hematology practices and atlases for the recognition of abnormal cells in acute leukemias through blood count and smears. Instructs on the morphology of pathological blasts of myeloid and lymphoid lineages, as well as promyelocytes and promonocytes. It also covers myelogram, with emphasis on the analysis and differential counting of bone marrow cells to diagnose acute myeloid leukemias.

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    © All Rights Reserved
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    of 4

    Manual of Practice and Atlas of Hematology.

    2016
    ACTIVITY N° 11
    HEMOGRAM AND SPREAM IN ACUTE LEUKEMIAS

    GOALS:
    • Recognize the morphology of pathological blasts in acute hematological neoplasms.
    • Use the criteria and terms to describe anomalous elements (blasts).
    • Identify the morphological characteristics of abnormal promyelocytes (classic and variant
    promyelocytic acute leukemia) and promonocytes (monoblastic and monocytic acute
    leukemias).

    MATERIALS
    • Immersion oil and lens paper, isopropyl alcohol.
    • Microscopes with 40x lens and immersion.
    • Wright-stained blood smear, with leukocytosis due to acute leukemias.

    PROCEDURE
    • Find the reading area at the lowest magnification, add a drop of oil and observe with the
    immersion lens.
    • Search for the elements according to the images presented below:

    Blasts of myeloid lineage, distinguish the presence of nucleoli.


    - Ae —4855
    A distinctive feature of these cells are the " 0
    Auer bodies or composite “rods”
    of anomalous crystallized granules; the 2 — V“
    which are typical in Myeloid Leukemia.
    ce ~ n

    Lymphoid lineage blasts, very immature cells with large nuclei containing a nucleolus. These cells
    suggestive of Acute Lymphatic Leukemia are
    (ALL). Common disease in children, who
    respond better to treatment than adults.

    • Identify Auer bodies in various elements within the smear, explain the staining aspects.
    Discuss with the teacher the meaning and interpretation of said finding.

    • Likewise, once the anomalous elements are recognized, describe the main common
    characteristics and define the characteristic(s) that allow differentiation from other lineages.

    • Continue with the morphological analysis in equivalent blasts.

    School of Medicine. EAP of Medical Technology. Clinical Laboratory and Pathological


    Anatomy
    50
    Manual of Practice and Atlas of Hematology.
    2016
    PROMYELOCYTES

    PROMONOCYTES

    • Carry out the observation and identification, complete with the morphological description.

    MYELOGRAM

    INTRODUCTION:
    It corresponds to the differential count of cells in the bone marrow smear. It is important to have
    a clear knowledge of the quantitative morphological and hematological characteristics of the
    patient's peripheral blood. Take into account the age and physiological state of the person.
    The evaluation of spinal smears must follow an appropriate exploratory method. The myelogram
    is indicated only when preleukemic spinal cord symptoms are found (suspected myelodysplastic
    and/or myeloproliferative syndromes), acute leukemias, infiltration of lymphoid neoplasms or
    solid tumors, and also when chemotherapy results must be evaluated.

    GOALS:
    • Recognize the characteristics of the myelogram report.
    • Understand how spinal components are obtained and their usefulness in the diagnosis of
    acute myeloid leukemias.

    MATERIALS:
    • Bone marrow smear stained with Wright or Giemsa.
    • Microscope with immersion lens.
    • Immersion oil.

    PROCEDURE:
    • Verify the presence of spicules in bone marrow smears.

    • Perform observation at lower magnification looking for quantitative and/or qualitative


    changes in cellular elements.

    School of Medicine. EAP of Medical Technology. Clinical Laboratory and Pathological


    Anatomy
    51
    Manual of Practice and Atlas of Hematology.
    2016
    • Once the spicule is located, start the count concentrically with it. Complete 500 cells, during
    counting, use cytomorphological identification characteristics.
    • Normally, 3 leukocytes are seen for each nucleated red cell, which gives a leukoerythroid ratio
    of 2/1.
    • Take into account the maturation index, that is, the proportion that exists between mature
    and immature cells in each series. For white it is 1 to 2 and for red it is 1 to 4.
    • We observe bone marrow mesenchymal cells, such as endothelial cells, osteoblasts,
    osteoclasts, but these are not considered in the count.
    • The search for possible intracellular and extracellular parasites ends.
    • According to the percentages of the different hematopoietic lines we will evaluate the
    normality and abnormality of the bone marrow.

    REFERENCE INTERVALS
    MYELOGRAM
    LEUKOCYTE SERIES
    • blasts 0.3 – 5%
    • Promyelocytes 1 – 8%
    • myelocytes 5 – 19 %
    • Metamyelocytes 9 – 24 %
    • Neutrophils 13 – 32 %
    • Eosinophils 0.5 – 4 %
    • Basophils 0.2 – 0.7 %
    • Lymphocytes 3 – 17%
    • Plasma cells 0 – 2%
    RED SERIES •• reticular cells
    Pronormoblasts
    0.1 – 2%
    1–8%
    • Basophilic normoblates 7 – 32 %
    • Orthochromatic normoblast0.4 – 5%
    • Polychromatic normoblast 17 – 29%
    MYELO:ERYTHROID RATIO 0.6 – 2.7 %
    DESCRIPTION
    Spikes Sample (with, without) spicules of medullary tissue, (hypo
    to hypercellular) , with a heterogeneous/homogeneous
    Myelo:erythroid ratio M/E ratio ( increased, normal, decreased ) .
    Erythroid Series
    With ( increase or decrease ) percentage of its elements.
    Granulocytic Series With precursors at limits (upper, normal and lower) of
    mature elements.
    Megakaryocytic series (present/absent) with characteristics (normal,
    dysplastic) and in proportion (increased, normal or
    decreased).
    Maturation With (hyperplasia, dyshemopoiesis) , ( mild, moderate,
    intense).

    • With the teacher's guidance, perform the analysis of cellular components and their application
    as part of the morphological diagnosis of acute myeloid leukemias.

    School of Medicine. EAP of Medical Technology. Clinical Laboratory and Pathological


    Anatomy
    52
    Manual of Practice and Atlas of Hematology.
    2016
    CELLULAR COMPONONENTS IN THE MORPHOLOGICAL DIAGNOSIS OF ACUTE LEUKEMIAS

    blasts blasts
    Promyelocytes
    Myelocytes 'Promyelocytes
    Metamyelocytes Component Myelocytes
    Neutrophils Granulocytic Metamyelocytes
    Eosinophils Neutrophils
    Non-Erythroid Component Eosinophils
    Basophils
    Lymphocytes .Basophiles
    Plasmocytes
    Monocytes Reticular Component
    cells Megakaryocytes Monocytic {Monocytes
    Erythroblasts
    Normoblasts Megakaryocytes
    _________-__________
    Erythroid Component

    • Calculate the cellular components for the following examples:


    Case A Case B Case C Interv. Reference
    Blast 25 1 39 0.3 – 5
    Promyelocyte 5 84 3 1.8 – 5
    myelocyte 14 1 4 5.0 - 20
    Metamyelocyte 6 3 7.0 – 30
    Neutrophils 33 4 8 13 – 32
    Eosinophils 1 0.5 – 4
    Basophils 1 0 – 0.7
    Lymphocytes 8 5 2 03 – 17
    Plasmocytes 1 2 0–3
    Monocytes 3 17 0.5 – 5
    Megakaryocytes 0.2 – 2
    Erythroblasts 1 1 01 – 8
    Normoblasts 3 2 23 07 - 32
    • Record and discuss your findings.

    School of Medicine. EAP of Medical Technology. Clinical Laboratory and Pathological


    Anatomy
    53

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