HEMATOPATHOLOGY

IDENTIFY: Normal Bone Marrow

Why normal? Due to the ratio of the fat cells to the cellular
elements. There is no hypercellularity.
Fat cells (red arrow): round spaces
Cell elements (yellow arrow): dark structures
Pink areas (black arrow): bony spicules

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At higher magnification
Identify the pointed structure: Megakaryocytes
They produce your platelets
Elements in the bone marrow: lymphocytes/WBC, myelogenous
elements, erythroid lineage

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2

How to differentiate bet erythroid and myelogenous series

Myelogenous: cells/nuclei are larger & paler than erythroid, some
have abundant & granular cytoplasm like promyelocytes (yellow arrow)
Stages: blast cells (most immature) (lymphoblast or
myelogenous series) -> promyelocyte -> myelocyte ->
bands -> mature
Some have eosinophilic cytoplasm: future eosinophils
Erythroid: round, densely chromatic/hyperchromatic nuclei, no
granules in cytoplasm (black arrow)

REVIEW! (Sorry malabo. Zinoom ko lang kase yung camera ko :)))

IDENTIFY:
1.
2.

Myelogenous series band stage (usually seen as horseshoe shaped)

Erythroid series

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Higher magnification: You can now see clearly the fat cells (arrow)

IDENTIFY: Bone Marrow

Difference between this and the 1st picture is
that all you see here are bony spicules and
fat cells; very little cellular elements

IDENTIFY: normal or abnormal? ABNORMAL

Why? Abundant cellular elements (ratio between cellular
elements and fat cells is large)
Important to first know the age of the patient:
If it says, this is a bone marrow of a 3 y/o M this is
NORMAL. Because at this age, the amount of cellular
elements is really greater than the fat cells. As one
grows older, (ex. senior citizens), there will be an
increase in the percentage of fat cells
This slide could be normal or abnormal depending on
the age. Hypercellularity is evident in this area (circle)

IDENTIFY: Aplastic Anemia (typical picture on the leftmost part) [one

point na daw to sa exam :D]
In a peripheral blood smear:
Pancytopenia (all elements are decreased RBC, WBC,
platelets)
You can see in this picture that all you have are fat cells; no
cellular elements, no megakaryocytes

What are these cells predominantly made of?

ERYTHROID (example is shown by the red arrow)
Why?
Most of the cells present have round nuclei, densely
chromatic, no abundant/granular cytoplams
There are also MYELOID cells (black arrow)
Larger and paler, granular cytoplasm
In this slide, immature cells are rarely seen. An example of a cell in the
band stage (myeloid series) is encircled. It can easily be identified by its
horse-shoe shape.
IDENTIFY: Erythroid Hyperplasia
CBC:
Hgb & Hematocrit: high
WBC count: normal or decreased (depending on amount of
hyperplasia)
Platelet: normal or decreased (depending on proliferation of
erythroid series because their proliferation can compress/
limit the proliferation of other cells)

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1
REVIEW!
Identify:
1. Erythroid cell
2. Myeloid cell (horse shoe shaped)
3. Platelet (rarely seen in cases of erythroid hyperplasia)

IDENTIFY: normal/abnormal? ABNORMAL

Why?
Ratio of cellular elements and fat cells are increased; very
few fat cells
Possibile diseases(at this magnification)
Leukemia
Polycythemia vera

At this magnification, you can only say that there is

increased cellularity/hypercellularity. You cannot identify
what lineage yet. Therefore you cannot diagnose yet.
You cannot see megakaryocytes
At this magnification, the cells seem similar

At this magnification, you should be able to diagnose.

Cells are pale = proliferation of MYELOID cells
Diagnosis: Acute Leukemia (there is proliferation of blast cell/immature
cells in the bone marrow, limiting/compressing other elements like
megakaryocytes)
CBC:
-

RBC: decreased
Platelets: decreased
WBC: increased
Abundance of blast/immature cells

In Chronic Leukemia, there is also increased cellularity but mature cells

are present

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IDENTIFY: LYMPH NODE

Normal or abnormal? ABNORMAL
Why?
Increase in cellularity (but hard to identify at this
magnification)
More importantly, you CANNOT see the germinal centers of
the follicles. Supposedly at the cortical area of the lymph
node, there should be follicles

IDENTIFY: LYMPH NODE (abnormal)

With follicle formation
What is the abnormality/adaptive change? [ tatanong daw sa exam :D]
Hyperplasia of the LN
Prominent features pointing to hyperplasia:
o
Increase in cellularity
o
In the LN, prominent cells are B lymphocytes(seen
in germinal centers) and T lymphocytes (seen in
parafollicular area)
o
In a normal follicle, you can see the germinal
centers but they are not very prominent. In this
slide, you can see prominent germinal centers
(arrow). Enlarged germinal center indicates that
there is probably an infection that caused the LN to
enlarge.
Diagnosis: Follicular Hyperplasia or Reactive Hyperplasia of the
Lymph Node

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IDENTIFY predominant cell: PLASMA CELLS (yellow arrow)

Round, densely staining nuclei
Cytoplasm is eosinophilic (pink) in relation to the nucleus
Nuclei is eccentrically located (nuclei is not at the center; it is
pushed to the side)
Diagnosis: Plasma cell Cytoma or Multiple Myeloma
(lalabas daw to sa exam as: identify what disease process :D)

IDENTIFY: LYMPH NODE (abnormal)

At this magnification, all the cells appear the same.
-

May have been taken from the lungs due to presence of

anthracotic pigments (arrow)

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Normal architecture of lymphocytes: hyperchromatic, round nuclei and

scanty cytoplasm
In this slide: nuclei are angulated and not round in appearance,
chromatin pattern is granular
IDENTIFY: Immature/abnormal lymphocytes
At lower magnification, all the cells are similar (monotonous
proliferation of lymphocytes all are pale cells)
Diagnosis: Lymphoma of LN/ Non-Hodgkins Lymphoma/ Diffuse B
cell lymphoma

IDENTIFY pointed structure:

Pale area surrounding the cell: lacunar cells
Cells inside: Reed- Sternberg cells (binucleated, large cell
with prominent nucleoli) black arrow
Diagnosis: Hodgkins Lymphoma (nodular sclerosis)
Why ND? Because you have fibrosis and sclerosis.
Other types: lymphocyte rich, mixed cellularity, lymphocyte depleted,
nodular lymphocyte predominant (tatanong daw to sa exam kase di
naten nasagot nung demo :D)

Type of Hodgkin Lymphoma

1. Nodular sclerosis most common type
2. Mixed cellularity - commonly seen in HIV patients
3. Lymphocyte rich affects M > F; site is in the lymph node >
mediastinum
4. Lymphocyte depleted sites: abdominal organs,
retroperitoneal lymph nodes; (+) B symptoms
5. Nodular lymphocyte predominant HL M > F
Sites: LN (cervical, axillary, inguinal), mediastinum,
spleen
Frequent relapse but responsive

Sorry for the not so clear pics. Cinapture ko lang kase yung picture from the video I took :D Hope
this helps
Lalala-lala