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Hematopathology
LAB 2: Selected Hematologic Neoplasms

See Hematopathology Lab Introduction document for description of labs and expectations (on Website or available as PDF from download site).

Download the “Hematopathology Lab 1 2015 Neoplasms.ppt” and use as directed in Introduction. Remember to continue study of the “Hematology Atlas 2015.pptx” document from the first week.

If working from a computer outside the University network, the links to virtual slides embedded in the PowerPoint document may not work. This page provides access to the virtual slides.

The Case descriptions, Questions and links to virtual slides are reproduced below. All other required content (photomicrographs, graphics, factual content, answers to questions) are in the PowerPoint documents.

For comparison, please refer to the following NORMAL smears:

BLOOD SMEAR:  [WebScope] [ImageScope]

BONE MARROW SMEAR:  [WebScope] [ImageScope]


Case 1:  Peripheral blood stem cell disorder

Blood smear:  [WebScope] [ImageScope]

History:  55-year-old female presents with increasing fatigue, night sweats, weight loss, and abdominal "fullness." The patient has marked splenomegaly, 10 cm below the left costal margin, without lymphadenopathy. The CBC showed: WBC = 105,000 cells/mm3, Hb = 10.5 gm/dl, and platelets = 85,000/mm3.

Compare the blood smear in this patient to the normal blood and bone marrow smears and answer the following questions.

  1. What are the major abnormalities on the smear?

  2. What is the differential diagnosis based on the CBC and blood smear?

  3. Would flow cytometry help with the diagnosis?

  4. Would molecular or cytogenetic tests help with diagnosis?

Case 2:  Peripheral blood stem cell disorders

Blood smear #1:  [WebScope] [ImageScope]

Blood smear #2:  [WebScope] [ImageScope]

History #1:  58-year-old male with increasing weakness, fatigue, malaise, unexplained lower extremity bruises and weight loss over the previous six weeks. Petechiae on exam. WBC = 155,000 cells/mm3, Hb = 9.0 gm/dl, platelets = 11,000/mm3.

History #2: Four-year-old female with a febrile pharyngitis and otitis, unresponsive to antibiotics. Increasing fatigue, malaise, and nondescript bone and joint pains. Conjunctival pallor and petechiae on her lower extremities. WBC = 55,000 cells/mm3, Hb = 7.6 gm/dl, platelets = 5,000/mm3.

  1. What are the major abnormalities on the smear?

  2. Are these histories and smears from patients with acute leukemias, viral infections or sepsis?

  3. Look carefully at multiple abnormal cells.  Does their appearance provide any clues that help refine the diagnosis?

  4. Which are the most likely diagnoses based on smear findings?

  5. Is a bone marrow aspirate and biopsy necessary to establish the diagnosis?

  6. Can flow cytometry help with the diagnosis?

  7. What additional information is needed for precise classification, risk stratification and treatment decisions?


Case 3:  Peripheral blood lymphocytic disorder

Blood smear:  [WebScope] [ImageScope]

Additional Test Results:  Flow Cytometry

History:  The patient is a healthy 65-year-old male who was noted to have slightly enlarged axillary and cervical lymph nodes on an annual physical examination. The patient offered no complaints and was given a "clean bill of health" one year previously. No organomegaly was noted. The CBC showed: WBC = 45,000 cells/mm3, Hb = 13.5 gm/d., platelets = 185,000/mm3. Compare the blood smear in this patient to the normal and abnormal smears from other cases.

  1. What are the major abnormalities on the smear?

  2. What is the differential diagnosis based on the CBC and blood smear?

  3. How does the flow cytometry study help with the diagnosis?

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