TABLE 10-1 normochromic: normal color (i.e. normal Hb content); normocytic: normal size and shape of RBC; hemolytic: red cell lysis TABLE 10-2 REACTIVE HEMATOPOIETIC HYPERPLASIA (NONLYMPHATIC) SCF indicates colony stimulating factor; IL, interleukin. TABLE 10-3 CLASSIFICATION IN SUBTYPES OF ACUTE MYELOPROLIFERATIVE DISEASES* FAB indicates French-American-British classification. *Acute myeloproliferative diseases are clonal neoplastic disorders of hematopoietic stem cells, the classification of which is determined by their preferential cytologic differentiation. Adapted from Hoffman R et al. Hematology. Philadelphia: Churchill-Livingstone; 2000. TABLE 10-4 CLASSIFICATION OF LYMPHOMA (NHL) ENTITIES
Hematopoietic and Lymphatic Tissues
Neoplastic Lymphatic Disorders
Category
RBCs
Characteristics
Blood loss, acute
Initially: normochromic, normocytic
Later: hypochromic reticulocytosis
Acute volume depletion
RBC reduction secondary to fluid influx
Rapid RBC regeneration
Blood loss, chronic
Hypochromic
Reduced iron stores
Increased Destruction of Erythrocytes
Hemolytic anemias
Features of hemolysis and tissue siderosis
Bone marrow: significant erythropoietic hyperplasia
Splenomegaly
Immunologic
Reticulocytosis
Autoantibodies against RBC (infection or drug induced)
Isohemagglutinins (transfusion induced, erythroblastosis fetalis)
Mechanical
Schistocytes
Microangiopathic:
Hemolytic uremic syndrome
Thrombotic thrombocytopenic purpura
Trauma by intracardiac artificial devices
Multiple hemangiomas (e.g., hepatic)
Hereditary
Spherocytosis
Elliptocytosis
Sickle cells
Hypochromic, microcytic
Heinz bodies
RBC membrane and cytoskeleton deficiencies
Hemoglobinopathies: sickle cell anemia, thalassemia
Enzyme deficiencies (e.g., of hexose monophosphate shunt)
Deficient Erythropoiesis
“Stem cell” defect
Normochromic,
Normocytic to mildly macrocytic
Aplastic anemia (with pancytopenia), pure red cell aplasia secondary to myelofibrosis (with thrombocytopenia, splenomegaly)
Maturation defect
Megaloblastic
Anisocytic
Hypochromic
Poikilocytic
Pernicious anemia (vitamin B12 deficiency), folate deficiency, anemia, iron deficiency (infection, tumor, chronic blood loss)
Hb synthesis defect
Sideroblasts
Sideroblastic anemia
Involved Cell Compartment
Cause
Erythrophilic, neutrophilic, and megakaryopoiesis
Blood loss or transient myelotoxic agents
Preferentially neutrophilic
Pyogenic bacterial infections, extensive tissue necroses
Less extensive: drugs such as SCF, steroids
Neutrophilic and histiocytic (frequently with lymphocytes and eventual granuloma formation)
Chronic infections such as by intracellular organisms (e.g., Rickettsia, Yersinia, Salmonella, mycobacteria), mycoses, collagen-vascular diseases (e.g., lupus erythematosus)
Preferentially histiocytic
Protozoal infection (e.g., malaria)
Suggestive viral infection (hemophagocytic syndrome)
Phagocytosis defects (infantile septic granulomatosis, Chediak-Higashi syndrome, and others)
Metabolic (various storage diseases: morbus Gaucher, morbus Niemann-Pick, and others)
Eosinophilic
Allergic diseases
Parasitic infestations
Viral infections with immune complex reaction (e.g., Hodgkin disease)
Treatment with IL-2
Basophilic
Certain allergic diseases (e.g., food allergies)
Certain endocrine disorders (e.g., myxedema)
Estrogen treatment
FAB Class
Subtype Name
Abbreviation
Proportion of Acute Myeloproliferative Diseases (%)
M0
Acute myeloblastic leukemia, stem cell (i.e., minimal differentiation)
AML
3-5
M1
Acute myeloblastic leukemia without maturation
AML
15-20
M2
Acute myeloblastic leukemia with maturation
AML
25-30
M3
Acute promyelocytic leukemia
APL
5-20
M4
Acute myelomonocytic leukemia
AMML
20-30
M5
Acute monoblastic leukemia
AMOL
2-9
M6
Acute erythroleukemia
AEL
3-5
M7
Acute megakaryoblastic leukemia
3-12
Revised European American Lymphoma (REAL) Classification
Classification of anemias by immediate cause is shown in Table 10-1. Acute blood loss initially causes blood volume depletion; normochromic anemia becomes overt 24 to 48 hours later, after some volume is replaced. Chronic blood loss (e.g., in intestinal ulcers, polyposis, hypermenorrhea) with depletion of the body’s iron stores causes hypochromic anemia. Erythrocyte destruction causes several anemias. Immunohemolytic anemia arises spontaneously after infection or drug treatment or in erythroblastosis fetalis, the incompatibility of erythrocyte antigens between an Rh-negative mother and her Rh-positive fetus. Microangiopathic hemolytic anemia (MAHA) is caused by mechanical shear forces from fibrin strands in small vessels (hemolytic uremic syndrome, disseminated intravascular coagulation, or multiple hemangiomas) or from artificial devices in the bloodstream (e.g., cardiac valvular prostheses). Peripheral blood smears show fragmented erythrocytes (schistocytes, fragmentocytes).You may also need
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