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Tochi Ajiwe

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Pathology and Laboratory Medicine Mini-Rotation:
Blood Morphology
Inspired by: Dr. Elena Nedelcu

Presented and created by: Tochi Ajiwe
Microbiology
Hematopathology
Transfusion Medicine
MY JOURNEY
MOCK BOARD EXAM!!!
Expectations
and
Objectives
1. Further understanding of Clinical Pathology
2. Ask as many questions as possible
3. Develop the "mind of a pathologist" by increasing my understanding of the job and it's specifics
4. Learn cell morphology and diagnose basic blood diseases
I
M
PRESS EVE
R
YO
N
E!!!!
Erythrocytes (RBCs)
Leukocytes
(WBCs)
Thrombocytes
BLOOD
aka platelets
Erythrocytes
Structurally the simplest cell in the body
Basic function is the creation and maintenance of an environment salutary to the function of hemoglobin
"Bags of Hemoglobin"
Erythrocyte Indices
Mean Corpuscular Volume (MCV)
Mean volume of all RBCs counted in a sample. Expressed in femtoliters
When MCV is low....
Microcytic
When MCV is normal....
Normocytic
When MCV is high....
Macrocytic
A variation of cell sizes is termed
Anisocytosis
<76 fL
76 - 100 fL
100< fL
Mean Corpuscular
Hemoglobin (MCH)
Represents mean mass of hemoglobin in the RBC.
Expressed in picograms.
Tends to track along with MCV
Mean Corpuscular Hemoglobin Concentration
Mean concentration of hemoglobin in the red cell
When MCHC is low.....
Hypochromic
When MCHC is normal....
Normochromic
When MCHC is high....
Hyperchromic
ANEMIA
Defined as any condition resulting from a significant decrease in the total body erythrocyte mass
Classification
Cytometric
Erythrokinetic
Biochemical
Parameters are more easily and less expensively measured
First parameter used to place a patient during work up
MCHC and MCV are used.
Second parameter used when classifying a case based on rate of RBC turnover
If high, NORMOREGENERATIVE anemia exists. If low, HYPOREGENERATIVE anemia exists
Ex. Hemorrhage, hemolysis, aplastic anemia
More serious type cases receive biochemical tests
Identifying a depleted cofactor for hematopoesis
abnormally functioning enzyme
abnormal function of the immune system
Ex. Sickle cell
Erythrocyte Case #1
An 18-year olf female reported to a physician complaining of general weakness, lethargy, and inability to do walk to her classes and do her daily routines. Further questioning revealed that she was having excessive bleeding during menstruation from the previous 6 months. She had experienced periods of light headedness, cramping in her legs, and a desire to crunch on ice. Her appetite had also reportedly decreased.
Hb................... 7 mg.dL (12-16)

MCV............... 65fL (76-100)

MCHC............. 25mg/dL (32-36)

Platelet ct......350 (133 - 333)

Iron-Deficiency Anemia
Menstrual blood loss in women plays a major role in iron metabolism
The average monthly menstrual blood loss is approx 50mL
Women with heavy flows must absorb 3-4 mg of iron from the diet each day
Symptoms of pica can result which explains the chewing of ice
Defined as a decreased total iron body content
Diagnosis?
Leukocytes
Granulocytes
Polymorphonuclear leukocytes
leukocytes characterized by the presence of differently staining granules in their cytoplasm
membrane bound enzymes

Basophils
The least numerous leukocyte
Characterized by their large blue granules
Release histamine

Eosinophils
Seen at the site of parasitic invasions and allergic reactions
Very distinct
Neutrophils
Most populous and short lived
Lifespan: 4-5 days
Usually the first responders to microbial infection
Agranulocytes
Mononuclear leukocytes
Lack of granules
Macrophage
Basically monocytes in the tissues

SHOULD NEVER BE SEEN IN THE BLOOD
Monocytes
More closely related to neutrophils than all the granulocytes
Produced by marrow, circulate for awhile then enter the tissues and mysteriously transformed intp histiocytes
Unlike neutrophils, they can survive the phagocytosis of microbes
Lymphocyte
Brains of the Immune System
can move back and forth between blood vessels and tissue
during infection, become activated and large. Can easily be mistaken for a monocyte
Leukocyte Case #1
A 10-year-old Kurdish boy was presented with generalized bone pain and fever of 1 month’s duration which was associated with sweating, fatigue, nose bleeding, breathlessness and severe weight loss. The patient's mother had been worried that the Strep infection from a previous check up had not cleared up as the child was still complaining of a sore throat and had been very lethargic.

Upon further workup, the physician found signs of hepatosplenomegaly and enlarged lymph nodes

A CBC, bone marrow aspirate, and throat culture were ordered.
Preliminary Throat Culture Report
3+ endogenous flora
This report shows that the patient has bacteria normally found in the respiratory tract. No abnormal bacteria such as "Strep" were noted.
CBC
WBC............................75.6x10³ (3.9 - 10.0x10³)/mm³

RBC.............................2.41 (4.4 - 6)

Hb...............................7 gm/dl (14 - 18)

Hct..............................21% (40-52%)

MCV............................65 (80 - 100)

MCHC........................24 (30 - 36)

Platelets....................29 (150 -300)
WBC Differential Count
Band................................................0%

Neutrophil.....................................3%

Lymphocyte...................................0%

Monocyte.......................................0%

Eosinophil.....................................0%

Basophil........................................0%

Blasts.............................................97%
very fine nuclear chromatin, nucleoli, and the high nuclear to cytoplasmic ratio is characteristic of this diagnosis.
ACUTE LYMPHOBLASTIC LEUKEMIA
Most common cancer in children under fifteen in US
Fatigue resulted from anemia
Most favorable outcome is for patients with early precursor B cell Very high cure rate in children but cure rate in adults is low
Chemotherapy and Radiation treatment
Thrombocytes
Cell fragments derived from megakaryocytes
Major role in hemostasis
If the number of platelets is too low (thrombocytopenia), excessive bleeding can occur.
If the number of platelets is too high (thrombocytosis), blood clots can form (thrombosis)
5. Solidify my passion for medicine
Effects of the Internship
Introduced me to the daily responsibilities of the teaching physician
Confirmed that, in the future, I want to become a teaching physician at a hospital
Forced me to be punctual (I'm usually I'm late for everything)
Gained insight from several residents on my future
Learned a ton of information about Bangladesh
WHERE DID THE MAGIC HAPPEN??
University of Texas Medical School at Houston Department of Pathology and Laboratory Medicine and Memorial Hermann Hospital
Supervisor: Elena Nedelcu M.D
Attendings: Amer Wahed M.D, Andy Nguyen M.D, and Audrey Wanger Ph. D
Average Day at Memorial Hermann
8:00 am: CP Review
9:00 am: Report to assigned rotation with attending
9 - 12:00 pm: Work at assigned rotation
12 - 1:00 pm: Lunch
1 - 5 or 6pm: Continue working
Project: BLOOD MORPHOLGY
Given to Department as an interactive introduction to morphology for First Year residents and Medical Students
Characterized by either a failure of Iron reutilization or low amount of iron for RBC formation
Most common form of anemia in patients
Full transcript