Hematopathology
LAB 2: Selected Hematologic Neoplasms

See Lab 1 for introduction to new approach if necessary.

INSTRUCTIONS AND LINKS FOR LAB 2:

Download (save to desktop) the PowerPoint presentation entitled "Hematopathology Lab 2" from either Path Lab Resources or the adjacent hyperlink (CLICK HERE). Initiate the “Slideshow” mode using the “screen” icon or the appropriate dropdown menu. Resize the slideshow window for comfortable viewing and proceed.

The PPS uses simple space-bar/arrow/mouse-click triggered animations to present the case history, illustrative micrographs (from virtual slides), relevant questions and a uniform set of "answers". It also contains links to the M2 Hematopathology Website, the complete virtual slide for each case and the self-test tool for virtual slides. Your instructor will introduce each case then ask students to work through the questions, answers and virtual slides using the PPS on their laptops. He/she will answer individual questions as they arise and address areas of common difficulty.

Remember, there will be five questions based on virtual slides and the content in Lab 1 and 2 (the other five questions cover the material in the Atlas from week 1). Please make sure that you can identify the relevant findings on the virtual slides, not just the micrographs.

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:  The patient is a 55-year-old female who presented to her local physician with increasing fatigue, night sweats, weight loss, and abdominal "fullness." On physical examination, the patient was noted to have a firm, nontender spleen, 10 cm below the left costal margin. The liver was slightly enlarged to 2 cm below the right costal margin. No lymphadenopathy was identified. 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 molecular or cytogenetic tests help with the diagnosis?

4. What is the natural course of this disease? Are there changes in the blood or bone marrow smears that one can use to monitor progression?

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, and weight loss over the previous six weeks. He sought medical attention for several unexplained lower extremity bruises. Petechiae and bruises noted. WBC = 155,000 cells/mm3, Hb = 9.0 gm/dl, platelets = 11,000/mm3.

History #2:  Four-year-old female with a recent onset of pharyngitis and otitis, unresponsive to antibiotics. The patient was febrile to 101.3 degrees F with sudden onset of fatigue, malaise, and nondescript bone and joint pains. Physical exam revealed conjunctival pallor and petechiae on her lower extremities. WBC = 55,000 cells/mm3, Hb = 7.6 gm/dl, platelets = 5,000/mm3.

The questions below will lead you through a review of the approach to diagnosis and classifications of the acute leukemias. First, compare the blood smears in this case to the normal and abnormal smears from other cases.

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. Would flow cytometry help with the diagnosis?

5. Would molecular or cytogenetic tests help with the diagnosis?

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

7. What is/are the minimum criteria for diagnosis and what additional information is needed for precise classification?

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.

Compare the blood smear in this case 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?