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  1. 1. Anemias Physical and cytological aspects
  2. 2. Anemias – physical aspects <ul><li>Pallor: </li></ul><ul><ul><li>Facial pallor may not always be a sign of anemia as the vascularization of the facial skin depends on many factors. </li></ul></ul><ul><ul><li>Palm pallor is a better clinical indicator of anemia. </li></ul></ul>
  3. 3. Anemias – physical aspects <ul><li>The typical “mongoloid” aspect of a patient with beta-thalassemia major, due to hypertrophy of hematopoietic marrow containing facial bones. </li></ul><ul><li>The hyperpigmented skin, sign of iron overload (hemochromatosis) caused by continuous hemolysis and frequent red cell transfusions is also evident. </li></ul>
  4. 4. Anemias – physical aspects <ul><li>Pallor and scleral jaundice in a patient with mild hemolysis (upper image). </li></ul><ul><li>Pallor, marked cutaneous and scleral jaundice in a patient with massive hemolysis (lower image). </li></ul>
  5. 5. Anemias – physical aspects <ul><li>Depapilated tongue (Hunter’s glossitis) in a case of megaloblastic anemia. </li></ul>
  6. 6. Anemias – cytological aspects <ul><li>Normal red cells (upper image). Notice the “doughnout-like” shape of the erythrocytes, with the thickness of the coloured peripheral area being approximately equal to that of the discoloured central area. </li></ul><ul><li>Hypochromic red cells (lower image). Notice the thin, ring-like coloured area of the severly hypochromic erythrocytes (anulocytes). This aspect is typical for iron deficiency anemia (IDA). </li></ul>
  7. 7. Anemias – cytological aspects <ul><li>Iron deficiency anemia. Perls stain: the typical aspect is the absence of siderotic granules in erythroblasts. </li></ul>
  8. 8. Anemias – cytological aspects <ul><li>Large, oval shaped red cells (macroovalocytes), hypersegmented neutrophil (left) and Cabot’s ring (lower right) in a case of megaloblastic anemia. </li></ul>
  9. 9. Anemias – cytological aspects <ul><li>Megaloblastic anemia: bone marrow. </li></ul><ul><ul><li>Megaloblastic oxyphil erythroblast (upper image). </li></ul></ul><ul><ul><li>The typical “blue marrow” aspect of the megaloblastic anemia marrow cytology picture (lower image). </li></ul></ul>
  10. 10. Anemias – cytological aspects <ul><li>Increased number of reticulocytes (reticulocytosis): </li></ul><ul><ul><li>Reticulocytosis is typical for hyper-regenerative anemias: </li></ul></ul><ul><ul><ul><li>After severe acute hemorrhage </li></ul></ul></ul><ul><ul><ul><li>In hemolytic anemias. </li></ul></ul></ul><ul><ul><ul><li>After B12/folic acid treatment of megaloblastic anemias. </li></ul></ul></ul>
  11. 11. Anemias – cytological aspects <ul><li>Hereditary microspherocytosis: </li></ul><ul><ul><li>The typical small, fully coloured (no central discoloured area) spherical red cells (blue arrows) on the peripheral smear (upper image). </li></ul></ul><ul><ul><li>Persistence of some microspherocytes and the presence of Howell-Jolly bodies (small, round, purple inclusions in erythrocyte cytoplasm) in a patient with hereditary microspherocytosis after splenectomy (lower image). </li></ul></ul><ul><ul><li>Howell-Jolly bodies (red arrow) are small remnant DNA inclusions in erythrocyte cytoplasm. These inclusions are normally pitted out by the spleen during erythrocyte circulation, but will persist in individuals with functional or anatomic asplenia. </li></ul></ul>
  12. 12. Anemias – cytological aspects <ul><li>Beta thalassemia, peripheral blood: </li></ul><ul><ul><li>“ Target” cells (red arrow) and basophilic stippling (small, multiple purple iclusions in erythrocyte cytoplasm, green arrow) with mild microcytosis and hypochromia in a case of minor beta-thalassemia (upper slide). </li></ul></ul><ul><ul><li>Microcytosis, hypochromia, target cells, erythroblastosis and Howell-Jolly bodies in a case of splenectomized beta thalassemia major (lower slide). </li></ul></ul>
  13. 13. Anemias – cytological aspects <ul><li>Schizocytes (fragmented red cells) are typical of mechanical destruction of red cells – mechanic hemolytic anemias. Conditions associated with schizocytes are: </li></ul><ul><ul><li>Mechanic heart prosthetic valves </li></ul></ul><ul><ul><li>Disseminated intravascular coagulation </li></ul></ul><ul><ul><li>Thrombotic thrombocytopenic purpura </li></ul></ul>
  14. 14. Anemias – cytological aspects <ul><li>Dacryocytes (teardrop cells). Frequent dacryocytes on the peripheral smear are typical for idiopathic myelofibrosis . </li></ul>