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Welcome to the Hematopathology Case-Based Atlas. The Atlas is a collection of classic hematology cases, representing both adult and pediatric conditions. Each case in the Atlas consists of a concise patient history, corresponding CBC findings and other pertinent laboratory data, as well as digitized slide(s) of peripheral blood smears, bone marrow aspirates/biopsies, lymph node biopsies, and/or other relevant histological tissues. The slides are annotated to highlight important diagnostic features, although we encourage you to review the slides with the annotation turned off (which is our default setting) just as if you were reviewing these slides in the clinical laboratory. The slides are best viewed with Aperios ImageScope software, which is available as a free download from www.aperio.com. The annotations work best when the slides are viewed with ImageScope. The slides can be viewed using the web-based Spectrum viewer instead, but some of the annotations may not display correctly. For each case, please first review the case history and CBC findings, and then click on the link to open the web-based slide viewer. To then view the slide in ImageScope, please click on View in ImageScope. This link is found on the top right corner of the web-based viewer. A morphological diagnosis and a brief description of the hematological disorder are available for each case, for you to review after you have made your own morphological diagnosis. The majority of the cases are from the teaching files of the BC Childrens Hospital Division of Hematopathology. We would like to thank our patients and our colleagues for making these cases available to us. In particular, we would like to extend our sincere gratitude to Dr. Bonnie Massing, an expert hematopathologist and a great teacher. If you have any questions or comments about this Atlas, please let us know at jford@cw.bc.ca Jason Ford Sophia Wong Summer 2009
Table of Contents
Hemepath Case 1 Hemepath Case 2 Hemepath Case 3 Hemepath Case 4 Hemepath Case 5 Hemepath Case 6 Hemepath Case 7 Hemepath Case 8 Hemepath Case 9 Hemepath Case 10 Hemepath Case 11 Hemepath Case 12 Hemepath Case 13 Hemepath Case 14 Hemepath Case 15 Hemepath Case 16 Hemepath Case 17 Hemepath Case 18 Hemepath Case 19 Hemepath Case 20 Hemepath Case 21 Hemepath Case 22 Hemepath Case 23 Hemepath Case 24 Hemepath Case 25 Hemepath Case 26 Hemepath Case 27 Hemepath Case 28 Hemepath Case 29 5-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 11-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 67-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 15-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 7-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 3-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 4-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2-Month-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 5-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Newborn Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4-Month-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 7-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 22-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 7-Month-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 5-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 13-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 63-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 3-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 9-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 52-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 33-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 60-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 3-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 55-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Newborn Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 13-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Hemepath Case 30 Hemepath Case 31 Hemepath Case 32 Hemepath Case 33 Hemepath Case 34 Hemepath Case 35 Hemepath Case 36 Hemepath Case 37 Hemepath Case 38 Hemepath Case 39 Hemepath Case 40 Hemepath Case 41 Hemepath Case 42 Hemepath Case 43 Hemepath Case 44 Hemepath Case 45 Hemepath Case 46 Hemepath Case 47 Hemepath Case 48 Hemepath Case 49 Hemepath Case 50 Hemepath Case 51 Hemepath Case 52 Hemepath Case 53
23-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 19-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 17-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 65-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 21-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 38-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 25-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 70-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 2-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 62-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 11-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 33-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 13-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 25-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 17-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 26-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 21-Year-Old Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Newborn Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Newborn Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 9-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 22-Year-Old Woman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 3-Year-Old Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 38-Year-Old Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4-Year-Old Girl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
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OTHER LABORATORY FINDINGS Urine dipstick for blood LDH Direct Coombs Test Biphasic Donath-Landsteiner Test (+) High (+) complement only (+)
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OTHER LABORATORY FINDINGS Osmotic Fragility Test Flow for Eosin-5-maleimide Increased fragility Reduced fluorescence
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OTHER LABORATORY FINDINGS Serum Fe Serum Ferritin Serum Bilirubin Hams Test Sucrose Lysis Test High High Mild increase (+) (-)
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OTHER LABORATORY FINDINGS BUN Serum Creatinine Urinalysis High High Cellular casts with dysmorphic RBCs
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