Peripheral Smear and Hodgkin's Lymphoma Findings

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Questions and Answers

What age group exhibits a bimodal distribution for Hodgkin’s Lymphomas?

5-10 years and 20-30 years

15-20 years and elderly (correct)

0-5 years and 35-40 years

20-25 years and 60-70 years

Which of the following is the most common clinical feature of Hodgkin’s Lymphomas?

Cervical lymph node enlargement (correct)

Pulmonary fibrosis

Weight gain

Coughing

Which of the following symptoms are referred to as B symptoms in Hodgkin’s Lymphomas?

Joint pain and swelling

Fatigue and shortness of breath

Fever, night sweats, and weight loss (correct)

Nausea and vomiting

What characteristic is associated with the Reed-Sternberg cells in Hodgkin’s Lymphomas?

Large binucleate cells with prominent eosinophilic macronucleoli Signup and view all the answers

Which subtype of Hodgkin’s Lymphoma is most commonly associated with young individuals?

Nodular sclerosis HL Signup and view all the answers

What variant is identified in Non-Classical Hodgkin’s Lymphoma?

Nodular lymphocyte predominant HL Signup and view all the answers

What specific feature can be observed in Reed-Sternberg cells associated with CMV inclusions?

Owl’s eye appearance Signup and view all the answers

In which gender is Hodgkin’s Lymphoma more prevalent in non-classical types?

Male Signup and view all the answers

What type of Acute Lymphoblastic Leukemia (ALL) is usually seen in children?

B-ALL Signup and view all the answers

Which genetic mutation is associated with T-ALL?

NOTCH 1 Signup and view all the answers

Which marker is NOT typically associated with B-ALL?

CD 3 Signup and view all the answers

What is a common feature of hand mirror cells observed in ALL?

Cytoplasmic protrusions Signup and view all the answers

What does the presence of mediastinal involvement indicate in T-ALL compared to B-ALL?

Poor prognosis Signup and view all the answers

What peripheral smear finding is commonly associated with iron deficiency anemia?

Pencil cells Signup and view all the answers

Which type of anemia is characterized by macrocytic red blood cells?

Megaloblastic anemia Signup and view all the answers

Bite cells on a peripheral smear are often indicative of which condition?

G6PD deficiency Signup and view all the answers

Which condition is associated with spherocytes in a peripheral blood smear?

Hereditary spherocytosis Signup and view all the answers

What type of cell is indicated by blunted projections and is associated with chronic renal failure?

Burr cell Signup and view all the answers

Target cells on a peripheral smear can be indicative of which of the following conditions?

Iron deficiency anemia Signup and view all the answers

Which type of anemia is primarily caused by the lack of central pallor in red blood cells?

Spherocytosis Signup and view all the answers

Spurr cells are associated with which condition?

Abetalipoproteinemia Signup and view all the answers

What is the characteristic appearance of megaloblasts observed in bone marrow aspiration?

Sieve-like chromatin structure Signup and view all the answers

In the primary hemostasis process, what role does von Willebrand factor (vWF) play?

Mediates platelet adhesion to the vascular endothelium Signup and view all the answers

Which disease is associated with a deficiency of the GpIb-IX complex?

Bernard Soulier syndrome Signup and view all the answers

What is the first step in primary hemostasis?

Platelet adhesion to endothelium Signup and view all the answers

Which factor is referred to as the Christmas factor in the coagulation pathway?

Factor IX Signup and view all the answers

What type of factor is the Hageman factor (Factor XII)?

Serine protease Signup and view all the answers

Which condition is characterized by a defect in platelet aggregation due to a lack of GpIIb-IIIa?

Glanzmann thrombasthenia Signup and view all the answers

What denotes stable clot formation in the hemostasis process?

Fibrin and stable thrombus Signup and view all the answers

What is the shelf life of CPD-A anticoagulant?

35 days Signup and view all the answers

Which blood component is stored at a temperature of 2-6°C?

Whole blood Signup and view all the answers

What is the primary use of fresh frozen plasma (FFP)?

Hemophilia A Signup and view all the answers

Which component is most prone to bacterial contamination?

Platelets Signup and view all the answers

What changes occur in the life span of transfused red blood cells (RBCs)?

50-60 days Signup and view all the answers

How much does one unit of random donor platelets increase platelet count?

10,000/MM3 Signup and view all the answers

What is the storage temperature for cryoprecipitate?

-18 °C or lower Signup and view all the answers

Which infection is NOT screened for in blood products?

Tuberculosis Signup and view all the answers

Study Notes

Peripheral Smear Findings

Macrocytic RBCs: Can be seen in liver disease, hypothyroidism, megaloblastic anemia (B12/folate deficiency), or due to cytotoxic drugs. Macro ovalocytes can also be seen.
Pencil Cells: Associated with iron deficiency anemia.
Bite Cells: Indicator of G6PD deficiency.
Spherocytes: Absence of central pallor. Common in hereditary spherocytosis, autoimmune hemolytic anemia, blood transfusion reactions, and burns.
Burr Cell/Echinocyte: Blunt projections, present in chronic renal failure, uremia, and liver disease.
Spur Cell/Acanthocyte: Pointed spicules, seen in abetalipoproteinemia.
Sickle Cells: A characteristic feature of sickle cell anemia.
Target Cell/Codocyte: Seen in thalassemia, liver disease, and iron deficiency anemia.

Hodgkin’s Lymphomas (HL)

Bimodal Distribution: Most common between ages 15-20 years and in elderly individuals.
Common Feature: Cervical lymph node enlargement is the most common finding.
B Symptoms: Fever (Pel Ebstein: waxing and waning fever), night sweats, and weight loss.
Mediastinal Involvement: Common in nodular sclerosing HL, can also be seen in T-ALL.
Reed-Sternberg (RS) Cells: Characterized by large binucleate cells with prominent eosinophilic macronucleoli.
- Lacunar RS Cell: Large empty spaces seen in the cytoplasm.
- Popcorn/LH RS Cell: Lymphohistiocytic variant with nucleoli appearing like "popcorn”
Owl's Eye Appearance: Large binucleate cells with prominent eosinophilic macronucleoli. Note: Also seen in CMV inclusions.
Types of HL: - Classical HL: - Nodular Sclerosis (M/C): Most common globally. - Mixed Cellularity (M/C in India): - Lymphocyte Rich (Mostly HIV associated): - ** Lymphocyte Depleted:** - Non-Classical HL: - Nodular Lymphocyte Predominant HL (NLPHL): M:F = >F, more common in younger patients, Lacunar RS cell variants

Acute Lymphoblastic Leukemia (ALL)

FAB Classification: Based on morphology (L1, L2, L3). Difficult to differentiate ALL-L2 from AML.
WHO Classification:
- B-ALL: More common, better prognosis, commonly seen in children.
- T-ALL: Less common, poorer prognosis, more common in adults, mediastinal involvement present.
  - Loss of Function Mutations (B-ALL):
    - PAX5.
    - NOTCH 1 gene.
    - E2A.
    - RUN X1.
    - EBF gene.
    - t(12;21)
  - Gain of Function Mutations (T-ALL):
    - E2A.
    - RUN X1.
    - EBF gene.
Peripheral Smear: >20% lymphoblasts present
Hand Mirror Cells: Cytoplasmic protrusion seen in ALL.
Investigations:
- Special Stain: PAS +ve (Dot and block)
- Markers:
  - B-ALL: CD 19, CD 20, CD 22, PAX 5, TdT
  - T-ALL: CD 1, CD 2, CD 3, CD 5, CD 7
IOC: Flow Cytometry
Note: AML-M6 is also PAS positive but shows diffuse positivity, while ALL shows block/dot positivity.

Bone Marrow Aspiration Findings

Megaloblast: Erythroid precursors with sieve-like chromatin.
Note: Folic acid deficiency anemia is similar to B12 deficiency anemia but without neurological complications.

Hemostasis

Interplay of 3 Components:
- Platelets: Normal count 1.5 - 4 lakhs/mL
- Vascular Endothelium
- Coagulation Cascade
Primary Hemostasis
- Step 1: Platelet adhesion to endothelium. vWF (present on endothelium) binds to GpIb-IX (present on platelets).
- Step 2: Platelets aggregate to each other through factor GpIIb-IIIa on their surface, forming an unstable clot.
- Blood Clot: Aggregation of platelets, fibrin, and an unstable clot/thrombus.
Stable clot/thrombus: A stable clot
Platelet Aggregation Disorders:
- Deficiency of Factor:
  - GpIb-IX: Bernard Soulier syndrome
  - GpIIb-IIIa: Glanzmann thrombasthenia
  - von Willebrand Factor: von Willebrand disease

Secondary Hemostasis

Coagulation Pathway:
- XII: Hageman factor, a serine protease. (Intrinsic pathway)
- XI: Plasma thromboplastin, an antecedent serine protease. (Intrinsic pathway)
- IX: Christmas factor, a serine protease. (Intrinsic pathway)
- VII: Stable factor, a serine protease. (Extrinsic pathway)
- XIII: Fibrin stabilizing factor, a transglutaminase. (Both pathways)
- PL: Platelet membrane phospholipid. (Both pathways)

Blood Banking

Anticoagulants Used:
- CPD (Citrate PO43- dextrose): 21 days shelf life
- CPD-A (Citrate PO43 dextrose adenine): 35 days shelf life
- SAG-M (Sodium adenine glucose mannitol): 42 days shelf life
Blood Components and Storage:
- Whole Blood:
  - Volume: 350 mL or 200 mL.
  - Shelf Life: 2-6 °C (based on anticoagulant).
  - Use: Acute blood loss, fresh frozen plasma used for multiple coagulation factor deficiency.
- Fresh Frozen Plasma (FFP):
  - Volume: ≤ -18°C.
  - Shelf Life: 1 year.
  - Use: Hemophilia A (rich in factor VIII), von Willebrand disease, factor XIII deficiency, hypofibrinogenemia.
- Cryoprecipitate:
  - Volume: 10-20 mL.
  - Shelf Life: 1 year.
  - Use: Hemophilia A, von Willebrand disease, factor XIII deficiency, hypofibrinogenemia.
- Random Donor Platelets:
  - Volume: 50-70 mL.
  - Storage Temperature: 20-24 °C with agitation.
  - Shelf Life: 5 days.
  - Use: Thrombocytopenia
- Single Donor Platelets:
  - Volume: 200-300 mL.
  - Storage Temperature: 20-24 °C with agitation.
  - Shelf Life: 5 Days.
  - Use: Thrombocytopenia
Notes:
- 1 unit of blood increases Hb by 1 g% (in blood).
- 1 unit of random donor platelets increases platelets by 10,000/μL.
- 1 unit of single donor platelets increases platelets by 30,000/μL.
- Blood is screened for: HIV, Hepatitis B/C, malaria, and syphilis.
- Malaria can be transmitted by all blood products.
- Platelets are the component most prone to bacterial contamination.
- The lifespan of transfused RBCs is 50-60 days.

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Description

This quiz covers key peripheral smear findings associated with various blood disorders, including macrocytic anemia and spherocytosis. Additionally, it explores Hodgkin's Lymphomas, focusing on their epidemiology and clinical features. Test your knowledge on these important topics in hematology.