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31 Cards in this Set

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What is wrong with the neutrophils seen here?
Toxic granulations. The azurophilic granules are indicative of immaturity. Patient could have a massive infection or another reason to be putting out immature cells
What autosomal dominant congenital abnormality has basophilic inclusions that may resemble Dohle bodies? What other findings are characteristic on blood smear?
May-Hegglin anomaly, but also GIANT platelets. Usually benign, sometimes thrombocytopenia
What is a neutrophil anomaly associated with mucopolysaccharidoses, and what are the findings on blood smear?
Alder-Reilly anomaly. Blood smear will show many azurophilic granules in granulocytes, lymphocytes and monocytes.
What are the two possible causes of the pince-nez appearance of these polys?
Congenital (innocuous)
or acquired (pseudo Pelger-Huet - myelodysplasia)
If this cell was on a peripheral smear of a child with oculocutaneous albinism, what else would you expect on history?
Frequent infections from Chediak-Higashi syndrome, a defect in fusion/trafficking of vesicles (including melanosomes)
What type of anemia is seen here?
Iron deficiency anemia - hypochromatic with increased central pallor and pencil cells
What type of anemia is seen here?
Thallassemia - increased central pallor, target cells
What causes this type of anemia?
B12 deficiency - multilobulated PMN, irregular shapes
What can cause the appearance of these cells?
Thalassemia, Liver disease, severe Iron deficiency, Heme C disease, asplenia
What causes spherocytosis?
Hereditary spherocytosis caused by mutations in cytoskeleton proteins

Autoimmune hemolysis
What conditions can produce schistocytes?
Shearing stress caused by microangiopathies (DIC), aortic stenosis, or a mechanical heart valve
What disorder causes Rouleux, and what is the pathophysiology of it?
Multiple Myeloma produced paraprotein, which coats RBCs and carries a negative charge which causes them to stack
What infections, and which immunoglobulin is associated with this slide's appearance?
IgM, Mononucleosis, mycoplasm
What is seen here?
RBC infected with malaria
What type of lymphoma is seen here?
Burkitt's - note large vacuoles
What process is shown in this bone marrow biopsy?
Idiopathic myelofibrosis - collagen III fiber deposition
What type of ALL is seen here, and in what population is it most common
L1 - Small cell ALL, most common in pediatric cases. Note lymphocytes are similar in size to RBCs
What type of ALL is seen in this peripheral smear, and in what population is it most common?
Large cell ALL - most common in adults. Note size of lymphocytes compared to RBCs
What are the multinucleate RBCs here indicative of?
myelodysplasia
What are the ringed sideroblasts here indicative of?
myelodysplasia - iron not leaving with RBCs stuck in marrow
What feature of myelodysplastic syndrome is seen here?
Micromegakaryocyte, washed out appearance
What are these cells' appearance typical of?
Hairy cell leukemia - rare CLL, normal life expectancy
What is the appearance of these cells suggestive of in a patient with cervical adenopathy?
Lacunar cells, indicative of nodular sclerosis (here in lower power), most common type of HL
What are these popcorn appearing cells indicative of?
Lymphocyte-predominant (non-classic) HL. Very rare. CD 15/30 negative
If you didn't have a good heme pathologist, what might you mistake this biopsy from a retroperitoneal node for?
A sarcoma. It is lymphocyte depleted HL
How does this 2nd most common HL subtype differ from nodular sclerosis, the most common HL?
Mixed cellularity HL - has R-S cells (nod sclerosis does not) and lacks collagen bands.
What would these small, cleaved cells in a patient with diffuse rubbery adenopathy and CD19, 20 positive cell infiltrate suggest?
Follicular lymphoma (NHL)
How might a patient with this cell on peripheral smear present?
With raised cutaneous plaques of malignant T cells - Mycosis fungoides/Sezary syndrome
A patient presents with lymphocytosis, hypercalcemia, elevated LDH, and splenomegaly. You see this clover-leaf cell on peripheral smear. He is from Japan. What do you suspect, and what is prognosis?
Suspect Human T-cell leukemia/lymphoma, and prior infection by HTLV.

Poor prognosis: <1 year
What do these cells suggest in a child with a quickly growing sub-mandibular mass?
Burkitt's Lymphoma
A patient with M-protein in urine has this bone marrow appearance. What do you expect from their clinical presentation?
Multiple myeloma: CRAB:
HyperCalcemia
Renal impairment
Anemia
Bone lesions