• History strongly indicative of Hodgkin lymphoma: weight loss, fever, night sweats, lassitude, pruritis, and enlarged cervical nodes. Sometimes accompanied by pain in one or more sites almost immediately after ingestion of alcohol. Extranodal involvement is very rare.
• Histologically/cytologically presence of RS cells is diagnostic of Hodgkin lymphoma.
Case No. 21
History: A 33-year-old female complains of low-grade fevers, 6 kg weight loss, night sweats, and generalized malaise for the past 3 months. On physical examination, she has non-tender right cervical and supraclavicular lymphadenopathy.
Inference (case No. 21):
non-tender
lympadenoapthy, low-grade fever, weight loss, night sweats and presence of characteristic Reed-Sternberg cells is diagnostic of Hodgkin lymphoma.
Investigation: Fine needle aspiration followed by a biopsy of cervical lymph node is performed. On microscopic examination, the lymph node showed loss of architecture and characteristic cell that confirmed the clinical diagnosis. He was admitted to the oncology ward for further management.
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Bibliography
Different stages of hematopoiesis.
Abbreviation: BFU, bursa forming unit, CFU, colony forming unit
Rapid Review of Hematology 128
Stages of erythropoiesis
Variations in color of RBCs and associated conditions
Variations in shape of RBCs and associated conditions
Rapid Review of Hematology 130
Inclusions in RBCs and associated conditions
Rouleaux formation and associated conditions
Stages of megakaryopoiesis
Variations in size of RBCs and associated conditions
Rapid Review of Hematology 132
Stages of myelopoiesis
HEMOPARASITES
Hemoparasites 1. Malarial parasites:
Most common are Plasmodium vivax and falciparum
2. Microfilaria 3. Trypanosomes 4. Leishmania donovani 5. Babesiosis.
Peripheral blood smear showing microfilaria
Peripheral blood smear A. Plasmodium vivax ring form, B and C Plasmodium vivax schizont and D. Plasmodium falciparum gametocyte
A B C D
A
Abdominal discomfort 125 Abnormal localization of immature precursors 61
Abnormalities of
coagulation/clotting factor 105 globin production 22
platelet 100
Abnormally large megakaryocytes 66 ABO
hemolytic disease of newborn 39 incompatibility 37
Achlorhydria 12 Acquired
clonal stem cell disorders 60 coagulation disorders 105, 109 disorders 52, 100
hypercoagulable states 114 mutations 41
myeloproliferative neoplasm 63 Activated
partial thromboplastin time 107 protein C resistance 114 Acute
abdominal pain 32
bacterial and fungal infections 46 blood loss 41
chest syndrome 32 erythroid leukemia 54
immune thrombocytopenic purpura 102, 123
leukemia 52, 52t, 53, 55, 72 lymphoblastic
leukemia 49, 52, 53, 55, 56f, 124 lymphoma 55
lymphoid leukemias 55t megakaryoblastic leukemia 54 monoblastic leukemia 54 monocytic leukemia 49, 54 myeloblastic leukemia 52, 53, 124 myelocytic leukemia 49, 53 myelogenous leukemia 53, 57 myeloid leukemia 53, 54
myelomonocytic leukemia 48, 49, 54
Index
Page numbers followed by f refer to figure and t refer to table
promyelocytic leukemia 54 Adult T cell
leukemia 49, 81 lymphoma 49, 81 Agranulocytosis 47 Aleukemic leukemia 52 Alimentary system 12 Allergic rhinitis 48
Alloimmune hemolytic anemia 36 Amyloidosis 79, 80
Anaplastic large cell lymphoma 81 Anemia 3, 19, 36, 65f
of blood loss 41 of chronic disorders 8
of impaired red cell production 3 Angioimmunoblastic T cell lymphoma 81 Angular stomatitis and glossitis 7 Anisopoikilocytosis 33
Antiglobulin test 38, 39 Anti-intrinsic factor antibody 12
Antiphospholipid antibody syndrome 114 Antiplatelet autoantibodies 102
Antithrombin III deficiency 114 Aplastic
anemia 13, 15, 46, 48, 50 crises 20, 33
Appearance of
neoplastic lymphoid cells 84 typical thalassemic facies 25f Arterial oxygen saturation 65 Asthma 48
Asynchrony of nuclear and cytoplasmic maturation 10
Atherosclerosis 13 Atrophic
gastritis 121 glossitis 7, 12 Atrophy of glands 12 Atypical lymphocytosis 51 Autoimmune
diseases 49 disorder 102
hemolytic anemia 36, 39, 40
Autosomal dominant
disorder 17, 108 trait 19
recessive hereditary disorder 22 Autosplenectomy 33
B
B cell
neoplasms 76
prolymphocytic leukemia 81 Basophilia 49
Bence Jones proteins 76, 78 Benign leukocytic proliferation 47 Bernard-Soulier syndrome 100, 104 Biochemical tests for megaloblastic anemia 11
Black tarry stool 120 Bleeding
disorders 99, 100, 105 tendency 80
time 103, 107
Blockage of microcirculation 32 Blood
brain barrier 38 loss 4
trephine biopsy 61 pain 56
and tenderness 56 Brucellosis 49
Budd-Chiari syndrome 63 Burkitt lymphoma 81, 83, 84f, 85f
C
Carcinoma 15 Causes of
aplastic anemia 14t
eosinophilia 48t hemolytic anemia 16t
hemorrhagic/bleeding diathesis 111 hypercoagulability state 113 iron
deficiency anemia 5t overload 24
leukocytosis 45t leukopenia 46t lymphocytopenia 50t lymphocytosis 49t megaloblastic anemia 8t
microcytic hypochromic anemia 8 monocytosis 49t
neutropenia 48t neutrophilia 46 pancytopenia 15t
thrombocytopenia 101, 101t thrombocytosis 104t Central nervous system 7, 12, 38 Cervical lymph nodes 56 Chickenpox 49
Christmas disease 108 Chronic
antigenic stimulation 77 atrophic gastritis 7, 12 blood loss 5, 42, 121 eosinophilic leukemia 62 hemolytic anemia 32 hypoxia 32
immune thrombocytopenic purpura 102
infections 49 leukemia 53
lymphocytic leukemia 45, 48, 49, 53, 73, 74f, 81, 125
myelogenous leukemia 62, 68, 125 myeloid leukemia 45, 47t, 48, 53, 70,
72f, 104
myelomonocytic leukemia 49 myeloproliferative neoplasm 65 neutrophilic leukemia 62 organ damage 33
Classical Hodgkin lymphoma 81, 87, 88 Classification of
acute myelogenous leukemia 57 anemia 3, 4t
bleeding disorders 100, 100t coagulation disorders 105, 105t disorders of hemostasis 100t hemolytic anemias 16 hemostatic disorders 99
hereditary defects in hemoglobin 22 immunohemolytic anemias 36, 36t
lymphoid neoplasms 81 plasma cell neoplasms 76, 76t platelet
disorders 100, 101t functional disorders 104t sickle cell disease 29, 29t Clonal
hematopoietic stem cell disorders 62 proliferative disorder 95
Combined vitamin B12 9
Common hereditary X-linked recessive disease 106
Complement-mediated intravascular hemolysis 41
Confirmatory test 112, 115 Congestive heart failure 7, 50 Consequences of
ineffective erythropoiesis 23 thrombi formation 111 Coombs test 38, 38f, 39 Crohn disease 49
Cutaneous T cell lymphoma 86 Cyclic neutropenia 48
Cytochemistry of lymphoblasts 57 myeloblasts 58
D
Defective
DNA synthesis 4 heme synthesis 5 hemoglobin synthesis 4 Deficiency of
antithrombotic factors 113, 114 intrinsic factor 11
Degeneration of dorsal and lateral tracts 13
Degree of hemoglobinization 3 Dehydration 31
Delayed maturation of nucleus 8
Demonstration of heterophile antibodies 51
Demyelination of spinal cord 13 Deoxyuridine suppression test 11 Dermatitis 48
herpetiformis 48
Development of thrombi 111 Diffuse
chronic atrophic gastritis 12 large B cell lymphoma 81, 83 Dilute Russell’s viper venom test 115 Dimorphic
anemia 9
peripheral blood picture 42
Direct antiglobulin test 39, 40 Disorders of
primary hemostasis 99, 100 white cells 43
Disseminated intravascular coagulation 110, 110t, 111f
Distinct megaloblasts in bone marrow 8 Donath-Landsteiner antibodies 40 Down syndrome 54
Dry tap 75
Dwarf megakaryocytes 70 Dysmegakaryopoiesis 61 Dysplasia 60
E
Eczema 48
Ehlers-Danlos syndrome 100 Endemic Burkitt lymphoma 84 Endothelial injury 110
Enlarged cervical lymph nodes 124 Eosinophilia 47
Eosinophilic granuloma 48, 96 leukemia 48 Epstein-Barr virus 51 Erythrocytosis 63 Erythroleukemia 53 Erythromelalgia 66 Erythrophagocytosis 21 Erythropoiesis 18, 66, 77 Esophageal webs 7 Extramedullary
hematopoiesis 24, 65-67 hemopoiesis 24 infiltration 56, 58 myeloid tumors 47 Extravascular hemolysis 23
F
Fab classification of acute leukemias 53 Fetal hemoglobin 26, 27
Fever 51
Fibrinolysis abnormalities 112 Fibrotic stage 67
Filariasis 48
Fine needle aspiration cytology 93 Fluorescent in situ hybridization 70 Folate deficiency 48
Index 137
Folic acid 8
and iron deficiency 9 deficiency 8, 11, 15
Follicular lymphoma 81, 82, 82f Fragmentation syndrome 41 Functional disorders of platelet 104f Fungal infections 48
G
Gallstones 20 Gaucher-like cells 70 Giant
megakaryocytes 66 metamyelocytes 10 Glandular fever 51
Glanzmann thrombasthenia 100, 104 Glucose-6-phosphate dehydrogenase
deficiency 20 Gold standard test 7 Granulomatous
diseases 15 disorders 48 Gum bleeding 102
H
Haemophilus influenzae 33 Hairy cell 75
leukemia 49, 75, 81
Hand-Schüller-Christian disease 96 Hay fever 48
Heavy
chain disease 81 menstrual bleeding 120 Heinz bodies 21, 21f
Hematologic malignancies 49, 104 Hematopoietic stem cell 63 Hemoglobin 6, 9, 21, 25, 58
concentration 3
electrophoresis 26, 27, 34 Hemolytic anemia 4, 16, 23 Hemolytic
crisis 33
disease of newborn 36, 39 Hemophagocytic syndrome 15 Hemophilia 106 diathesis 99, 111 disorders 99
Henoch-Schönlein purpura 100
Hereditary
coagulation disorders 105, 106, 109t disorders 29
hemolytic anemia 23 spherocytosis 17, 122 High-performance liquid
Hookworm infestation 48 Humoral immune deficiency 80 Hydrops fetalis 38
Hypercoagulable state 113, 115 Hypereosinophilic syndrome 48 Hypersegmented neutrophil 9f Hypocellular bone marrow 13 Hypochromia 6
Hypofunction of spleen 33 Hypovolemic shock 33, 41
I
Immune
thrombocytopenia 115 thrombocytopenic purpura 102 Immunoglobulin deposition disease
76, 80
Immunohemolytic anemias 36 Impaired
absorption 5, 8 DNA synthesis 8 red cell production 4 Inactivates nitric oxide 31 Inactivation of nitric oxide 31 Incubation period 51
Indirect antiglobulin test 39, 40 Infectious
hepatitis 49
mononucleosis 45, 49 Inflammatory
bowel disease 49 diseases 49
Inherited hypercoagulable states 114 Intestinal metaplasia 12
Intravascular hemolysis 41 Iron
deficiency 104, 120
anemia 5, 6, 8, 27, 28t, 42, 120 deficient erythropoiesis 6 depletion 6
overload 24
Irreversibly sickled cells 31 Ischemic necrosis 111
J
Jaundice 20
K
Koilonychia 7 nails 120
Kostmann syndrome 48
L
Lacunar cell. 89 Langerhans cell 95
histiocytosis 95 LE cell test 40
Letterer-Siwe disease 96 Leukemia 15, 55 Leukemic meningitis 56 Leukemoid reaction 47 Leukocyte
alkaline phosphatase 47 common antigen 82 Leukocytosis 45, 66 Leukoerythroblastosis 67 Leukopenia 46
Life-threatening bleeding 106 Location of hemolysis 16, 17 Löeffler’s syndrome 48 Loss of
architecture 84
intravascular volume 41 lymph node architecture 89
membrane fragments in circulation 17 Lupus anticoagulant antibody 114 Lymph nodes 74, 82, 86, 87 Lymphoblast 54
Lymphocyte
depleted classical Hodgkin lymphoma 81, 87, 91
predominant cells 92 rich classical Hodgkin
lymphoma 81, 87, 90 Lymphocytopenia 50
Lymphocytosis 49 Lymphoid neoplasms 81 Lymphoma 15, 55
Lymphoplasmacytic lymphoma 81
M
Macroangiopathic hemolytic anemia 41 Malignant
disease of bone marrow stem cell 52 lymphoid
cells 82f neoplasms 87
Mantle cell lymphoma 81 Marrow
aplasia 15 infiltration 4, 48 Massive splenomegaly 75 Mature
B cell neoplasms 81 T and NK cell neoplasms 81 T cell and NK cell neoplasms 85 Mean corpuscular
hemoglobin 5 concentration 5, 31 volume 4
Measles 49 Mediastinal
lymph nodes 88 thymic mass 56 Medium-sized cells 84 Megakaryocytic
hyperplasia 123 leukemia 53
Megakaryopoiesis 18, 66, 77 Megaloblastic
anemia 8, 9, 11, 13, 15, 46, 48, 121 precursors 11f
Menorrhagia 102 Metastatic tumors 48
Microangiopathic hemolytic anemia 41, 111
Microcytic hypochromic anemia 7, 25, 120 red blood cells 6f
Micronormoblastic maturation 7 Microscopically myeloblasts 59 Microvascular thrombi 111 Mild erythroid hyperplasia 27 Miliary tuberculosis 50 Missense point mutation 30 Mixed cellularity classical Hodgkin
lymphoma 81, 87, 90
uncertain significance 80 undetermined significance 76 spikes 78
Monocytic leukemia 53 Monocytosis 49
Monomorphic lymphoid cells 83
Mononuclear cells 51
Morphological classification of anemia 3t Morphology of
myeloblasts 58 neoplastic cells 88 Mucosal bleeding 102 Multiple
myeloma 49, 76, 78f, 125 tumor masses 76 Mumps 49
Mutated tyrosine kinase activation 58 Mycosis fungoides 81, 86
Myelodysplastic syndromes 15, 48, 54, 60, 104
Myelofibrosis 15, 64 Myeloid plasma cells 77
Myelomonocytic leukemia 53 Myelophthisic anemia 4 Myelopoiesis 18, 66, 77
Myeloproliferative neoplasms 62, 68, 104
N
Neoplastic cells 88 follicles 82 T cells 86
Nephrotic syndrome 79 Neutropenia 47 Neutrophilia 46 Nodular
lymphocyte predominant Hodgkin lymphoma 87, 92
sclerosis classical Hodgkin lymphoma 81, 87, 88
Non-Hodgkin lymphoma 48, 49, 94, 94t Non-neoplastic cells 87, 88
Non-steroidal anti-inflammatory drugs 104
Non-tender cervical lymphadenopathy 125
Nonthrombocytopenic purpura 99 Normochromic normocytic anemia 67 Normocytic normochromic anemia
38, 42, 70
Nucleated red cell precursors 25 Nucleus of macrophage 83 Numbness of both lower limbs 121 Nutritional deficiencies 15
O
Osmotic fragility test 19, 19f, 122 Osteosclerotic myeloma 76
P
Pancytopenia 13, 75 Pappenheimer bodies 42 Parietal cell antibody 12 Paroxysmal
cold hemoglobinuria 40
nocturnal hemoglobinuria 15, 41 Pathogenesis of
iron deficiency anemia 6 megaloblastic change 8
Rh hemolytic disease of newborn 37f sickle cell anemia 30f
thrombosis 111f Pathognomonic
Birbeck granules 95 of Hodgkin lymphoma 88 Pathophysiologic classification of
polycythemia 63t Patterson-Kelly syndrome 7 Paul Bunnell test 51 Pemphigus 48
Periodic acid Schiff stain 54f Peripheral
blood smear 6f, 9f, 56 lymph nodes 90 T cell lymphoma 81, 85 Pernicious anemia 11, 12 Persistent thrombocytopenia 71 Pharyngitis 51
Philadelphia chromosome 47, 68, 69f, 70 Pigment gallstones 122
Plasma cell 89
myeloma 76 neoplasm 76, 81 lactate dehydrogenase 11 Plasmacytoma 76, 80
Plasmodium falciparum gametocyte 132 Platelet
count 64, 107
function disorders 100 Plummer-Vinson syndrome 7 Poems syndrome 76
Polychromatophilia 21, 33 Polycythemia 48, 63
vera 62, 63, 64f, 65f, 104 Precursor lymphoid neoplasms 81
Index 139
Premature
destruction of spherocytes 17 RBC destruction 36
Primary
amyloidosis 80
antiphospholipid syndrome 115 hemostatic plug 99
myelofibrosis 62, 66 Produces hemolytic anemia 30 Progressive cytopenias 60
Proliferating hematopoietic stem cells 68 Promyelocytic leukemia 53
Protein C and S deficiency 114 Prothrombin time 107 Pseudo Gaucher cells 70 Pulmonary eosinophilia 48
Q
Qualitative
disorders of leukocytes 50 platelet disorders 101, 104 Quantitative
and qualitative disorders of leukocytes 45 deficiency of vWF 109 disorders of leukocytes 45 platelet disorders 101
R
Raspberry-red tongue 121 RBC enzyme analysis 21 Reactive marrow fibrosis 66 Recurrent splenic infarction 32 Red cell
count 64
distribution width 5 indices 43, 6, 9, 18, 25 protoporphyrin 7 size 3
Reed-Sternberg cells 87, 88, 89f, 90, 91 Refractory
anemia with excess blasts 61 ring sideroblasts 61 cytopenia 61
with multilineage dysplasia 61 Renal
disease 80 failure 79, 104 function tests 78
Repeated spontaneous abortions 115 Respiratory distress syndrome 110
Reticulocyte
count 6, 25, 15, 18, 21, 33, 38 hemoglobin 7
Rh
hemolytic disease of newborn 37 incompatibility 37
Rheumatoid arthritis 49 Ring sideroblasts 42 Rouleaux formation 131 Roundworm infestation 48 Russell’s viper venom 115
S
Salmonella typhimurium 33 Sarcoidosis 15, 49
Scabies 48 Schilling test 11, 12 Secondary
antiphospholipid syndrome 115 hemostatic plug 99
Sequestration crisis 33 Serum
albumin 78 bilirubin 11, 34 ferritin 7, 26 folic acid levels 11 haptoglobin 26, 34 homocysteine 11 iron 7, 26
and ferritin 11 status 26
hemolytic anemia 23, 38 infections 48
Severity of bleeding 101
Sex-linked recessive disorders 106 Sézary
cells 86
syndrome 81, 86 Sickle Sickled red cells 35f
Sickling crisis 32 test 34, 35, 35f
Sideroblastic anemia 8, 42 Skin
bleeding 102 diseases 48 Small
lymphocytic lymphoma 73, 81 T lymphocytes 89
Sore throat 51
Spherocytes and raised osmotic fragility test 122 Splenic B cell marginal zone
lymphoma 81 Spoon shaped nails 120 Stages of
erythropoiesis 128 Hodgkin lymphomas 94t megakaryopoiesis 129 myelopoiesis 132 Starry sky appearance 84f Striking basophilia 71
Structure of red cell membrane 17f Subacute combined demyelination 13 Subleukemic leukemia 52
Substitution of glutamic acid 30 Sudden trapping of blood 33 Suppression of stem cells 48 Synthesis of fetal hemoglobin 23 Syphilis 49
Systemic lupus erythematosus 49
T
T cell
large granular lymphocytic leukemia 81
prolymphocytic leukemia 81
T lymphoblastic leukemia/lymphoma 81 Target cells 122
Thalassemia syndrome 22 Thrombocytopenia 100, 101 Thrombocytosis 101, 104
Thrombotic disorders 99, 100, 113 Total
iron binding capacity 26 leukocyte count 46, 47, 51, 70 plasma iron-binding capacity 7 WBC count 58
Tourniquet test 103 Toxoplasmosis 49
Traditional classification of leukemia 53t
Tropical eosinophilia 48 Tuberculosis 15, 49 Tumors 15 Types of
antiglobulin test 39 immune thrombocytopenic purpura 102
Langerhans cell histiocytosis 96t white blood cell 45
U
Ulcerative colitis 49 Unconjugated bilirubin 38 Urine urobilinogen 26, 34 Urticaria 48
Uses of
direct antiglobulin test 39 indirect antiglobulin test 40
V
Vascular disorders 110 purpura 99
Vessel wall abnormalities 99 Viral
hepatitis 108 infections 45, 48, 49 Vitamin
B12 8, 15, 48 absorption 12 deficiency 8, 11 K deficiency 105
von Willebrand disease 105, 108
W
White cell count 64
WHO classification of acute
leukemia 53
lymphoblastic and myeloid leukemia 53t
Hodgkin lymphoma 87t lymphoid neoplasms 81t MPN 62
myelodysplastic syndromes 61t myeloproliferative neoplasm 62t Widespread exfoliative erythroderma 86 Wiskott-Aldrich syndrome 100