Q1. Describe the normal morphology of the red blood cells (RBCs) Q2. Identify and describe the white blood cells (WBCs) in the smear Q3. Identify the platelets in the smear and describe their characteristics. How many do you see in the high power field?
Q4. Describe how a peripheral blood smear is made.
Case History A 22-year-old African-American man presents with severe pain in several joints and diffuse abdominal pain. He states he is active physically and participates in different sports several times a week. He has had no fevers or chills. Review of systems is negative for any symptoms of infection.
CASE 4 History A 60 year-old man presents with mild fatigue. Further questioning reveals a vague feeling of abdominal “fullness” and more bruising of his skin. Physical examination is remarkable for splenomegaly to the level of the umbilicus.
CBC findings: WBC 75.1x10 3 /uL Hemoglobin 8.5g/dL Hematocrit 25.5% Platelets 56,000/uL MCV 88.4 femtoliters (fL) RDW 16.1 The hematology analyzer has flagged the specimen for possible immature WBC forms
- WBCs are markedly increased in number, predominantly cells of the neutrophil series. -Many mature neutrophils are seen as well as earlier forms showing a)less nuclear segmentation (bands, myelocytes) and b) prominent primary granules without secondary fine pink granulation (promyelocytes). No blasts are seen. Peripheral Blood Smear Image A
Q1 Describe the findings on the peripheral smear. Do you agree that there is an increased number of immature WBC forms in the peripheral blood? Name the cells indicated by the arrows.
History A 35 year-old man presents for evaluation of an enlarged non-tender cervical lymph node. The node has shown progressive enlargement over the past 4 months. The patient denies other symptoms such as fevers, night sweats, weight loss or fatigue.
History A 51 year-old man presents with fatigue, malaise and occasional low grade fevers. Physical examination reveals bilateral non-tender cervical lymphadenopathy and an enlarged inguinal lymph node.
CBC WBC 6.2x10 3 /uL Hemoglobin 11.8g/dL Hematocrit 36.1% MCV 92.0 femtoliters (fL) RDW 16.1 Platelets 180,000/uL An excisional biopsy of a cervical lymph node was performed.
Describe the low and high power. Q1 Describe the low power histologic findings. Compare to the reactive lymph node Reactive
Q2 Describe the cells within the germinal centers. Compare to the reactive lymph node. Reactive node
Q3 What is your diagnosis? Q4 What specific genetic changes are seen in this type of lymphoma?
Q5 Summarize the morphologic features which distinguish this lymphoma from a reactive lymph node (reactive follicular hyperplasia). Q6 Describe the general course/prognosis of this lymphoma. Are all patients with this lymphoma treated?
History A 58 year-old man is seen by his primary care physician for a physical examination. Overall, he feels well. His wife is concerned about the “lumps” on his neck. Physical examination is remarkable for for non-tender cervical, axillary and inguinal lymphadenopathy. The spleen is not enlarged.
Q7. If this patient were to develop worsened anemia as well as jaundice, what would you include in your differential diagnosis? Q8. This patient is likely at increased risk for serious infections. Why?