kashdoc21
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Q .bone marrow aspirate … how to tell? Characteristics ..
In what condition do u find large immature cells with large nuclei n scanty basophilic cytoplasm ?
Q. how to determine Left shift in a blood smear ?
kindly give a few tips to decipher these on the slides ... i m having difficulty und these concepts
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| ManuNastai
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to th first I have no idea; it must be an acute leukemia 'cause there mainly young cells and... it's myeloblastic? lymphocytes shouldn't get coloured... it's kind of a guess
second.. you don't have to descipher the formula. it is given to you. if it's left shifted, you have mainly unsegmented neutrophils which are found in acute inflamation. if it's right shifted you have segmented which correspond to older inflamation. if i remember right it is left shifted when there are more than 30% unsegmented. not sure about this last thing
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| kashdoc21
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thank you dr manu
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| vallia
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In the bone marrow aspirate practically you can find all imature cells from all the cell lines. that means you can see myeloblasts, promyielocytes, myelocytes, metamyelocites-which matures in that order. also you can see lymphoblasts, monoblasts, meakarioblasts, proerytroblasts. all of them are cells derived from pluripotent hematopoetic cell and mature in bone marrow. Now to differentiate between them i think you have to be very experienced, all have large nucleus, more basophile cytoplasm than blood cells, and granulations (red for the cell that will transform to eosinophils, blue for the cells that will transform in basophils, azurophile granule for the cell that will transform in neutrophils). the megakarioblasts are big.
In blood smear normally you can see only mature cells, these are granulocytes (neutrophils, basophils, eosinophils), Lymphocytes, monocytes, erytrocytes and platelets. These cells have very specific appearance. If you see immature cells like metamyelocytes, myelocytes you can suspect leukemia (in this case chronic myeloid), if you see even more young cells like blasts you suspect acute leukemia. it is difficult to differentiate in a blood smear the myeloblasts (granulocyte precursor from lymphoblasts-lymphocytes precursor), so the exactly cell line of blasts will be discover after bone marrow aspirate. Now , left shift in a blood smear means appearance of young cells in blood. the younger the more left deviated.(considering for example myeloblast---promyelocyte---myelocyte---metamyelocyte----stab cell----neutrophils, left deviance means appearance in blood of cells younger than neutrophils).
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| vallia
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normal bone marrow
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normal marrow.jpg (70 KB, 19 downloads)
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| vallia
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normal blood smear
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normal cells.jpg (49 KB, 17 downloads)
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| vallia
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myeloblasts in acute myeloid leukemia
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myeloblasts, AUER rods.jpg (81 KB, 24 downloads)
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| vallia
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observe large immature cells in blood smear, chronic myeloid leukemia here.
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CML, bands, metamyelocytes, myelocytes.jpg (88 KB, 17 downloads)
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| vallia
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here cells from lymphocyte line, this is CLL
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CLL , mature lymphocytes.jpg (86 KB, 12 downloads)
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| vallia
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si lymphoblasts in acute lymphocyte leukemia
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ALL lymphoblasts.jpg (81 KB, 11 downloads)
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| ManuNastai
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marvelous pictures vallia! ok, I took the book and read:
left shift is when there is more than 10% band neutrophils of the total neutrophil number or presence of any neutrophil less mature than a band.
I'd like to dicuss with those of you who understand very good and can recognize all these periferal blood smear pictures.
I don't get why in the pictures with AML and CML you can't see the center of those erytrocytes... is it because another one is overlaping the center? why are those RBCs so clumped together?
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| vallia
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hi manu, it's not uncommon to see different grades of hypocromia or poikilocytosis in blood smears with leukemia because the patient are ussualy under heavy treatment affecting the bone marrow. and erytrocytes , having a biconcave form, appear on smear with a central palor (not to much though).
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| ManuNastai
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yes, but the ones in your slides don't have it and I was questioning why?
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| vallia
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i think it's important to recognise on blood smear characteristic appearance of cells, the approach of a blood smear will be, first aspect of erytocytes, it is hypocromia,(Iron deficiency) hyperchromia, spherocytes (spherocytosis), microcitosis(Fe deficiency), macrocytosis (Folate, Vit B12 deficiency), , sicKle cells?, Howell Jolly bodies (in splenectomy, megaloblastic anemia), target cells in thalassemia, then leucocytes, see number of total leucocytes and differentiate number for every type of granulocyte and also monocytes and lymphocytes. these cells increase number in specific diseases., important is also to see if there are abnormal immature cells on blood smear (here diagnose the type of leukemia, myeloid or lymphoid, acute or chronic). If it's acute you see blasts, if it's chronic you see more mature cells.
Now some characteristics, for Chronic myeloid leukemia- total leucocytes 50.000-400.000/mm3, predominat granulocytes, metamyelocites, myelocytes, basophiles characteristically increased in number, myeloblasts relatively low 10%. For Acute Myeloid leukemia , Auer rods and blasts 30%. For Chronic lymphocytic leukemia , increased number of small mature lymphocytes , to 300.000, distroyed lymphocytes on prepairing the smear because ofcells fragility,
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