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Zorluk: OrtaHematology and Oncology

Match each patient's clinical presentation with the most likely predominant finding on their peripheral blood smear.

  • A 68-year-old man with massive splenomegaly, early satiety, and a 'dry tap' on bone marrow aspiration.Teardrop cells (dacrocytes) and nucleated red blood cells
  • A 24-year-old woman with intermittent jaundice, splenomegaly, and a family history of gallstones at a young age.Small, densely staining red blood cells lacking central pallor
  • A 35-year-old woman with severe epistaxis, widespread ecchymoses, and laboratory evidence of disseminated intravascular coagulation.Large immature myeloid cells containing numerous needle-like inclusions (Auer rods)
  • A 65-year-old man with generalized, painless cervical lymphadenopathy and an absolute lymphocyte count of 45,000/µL.Mechanically disrupted, fragile lymphocytes (smudge cells)

Cevap

Primary myelofibrosis correlates with teardrop cells; hereditary spherocytosis correlates with spherocytes lacking central pallor; acute promyelocytic leukemia correlates with Auer rods; and chronic lymphocytic leukemia correlates with smudge cells.
Each clinical presentation contains classic pathognomonic features that align with a specific peripheral blood smear finding. Understanding the underlying pathophysiology (e.g., marrow fibrosis, membrane defects, granule release, or cell fragility) allows for accurate pairing of the disease state to its microscopic appearance.

Adım Adım Çözüm

1
Evaluate the first vignette describing an older adult with massive splenomegaly and a dry bone marrow tap.
Identify the diagnosis as primary myelofibrosis.
Marrow fibrosis leads to a leukoerythroblastic smear with teardrop cells due to the mechanical stress on red blood cells exiting the marrow.
2
Evaluate the second vignette describing a young adult with hemolytic anemia symptoms and early gallstones.
Identify the diagnosis as hereditary spherocytosis.
Cytoskeletal membrane defects lead to the formation of spherocytes, which are prematurely destroyed in the spleen.
3
Evaluate the third vignette describing a patient with sudden onset of bleeding and DIC.
Identify the diagnosis as acute promyelocytic leukemia (APL).
The release of procoagulants from the primary granules (Auer rods) inside the neoplastic promyelocytes triggers DIC.
4
Evaluate the fourth vignette describing an older adult with prominent lymphocytosis and lymphadenopathy.
Identify the diagnosis as chronic lymphocytic leukemia (CLL).
The malignant lymphocytes in CLL are physically delicate, leading to the artifactual appearance of smudge cells on the peripheral smear.

Anahtar Kavram

Recognizing specific morphological abnormalities on a peripheral blood smear is essential for diagnosing various hematologic malignancies and intrinsic red blood cell disorders.
Tahmini Süre:1m 30s
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Hematology and Oncology

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