Physical exam and history : An exam of the body to check general signs of health,

including checking for signs of disease, such as lumps or anything else that seems unusual.
A history of the patients health habits and past illnesses and treatments will also be taken.

Complete blood count (CBC) with differential : A procedure in which a sample of

blood is drawn and checked for the following:
o

The number of red blood cells and platelets.

The number and type of white blood cells.

The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.

The portion of the blood sample made up of red blood cells.

ENLARGE

Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to
flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and
platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.

Peripheral blood smear : A procedure in which a sample of blood is checked for

changes in the number, type, shape, and size of blood cells and for too much iron in the
red blood cells.
Cytogenetic analysis : A test in which cells in a sample of blood or bone marrow are
viewed under a microscope to look for certain changes in the chromosomes.
Blood chemistry studies : A procedure in which a blood sample is checked to
measure the amounts of certain substances, such as vitamin B12 and folate, released into
the blood by organs and tissues in the body. An unusual (higher or lower than normal)
amount of a substance can be a sign of disease.
Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a
small piece of bone by inserting a hollow needle into the hipbone or breastbone.
Apathologist views the bone marrow, blood, and bone under a microscope to look
forabnormal cells. Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone
marrow needle is inserted into the patients hip bone. Samples of blood, bone, and bone marrow are
removed for examination under a microscope.

The following tests may be done on the sample of tissue that is removed:
o

Immunocytochemistry : A test that uses antibodies to check for

certain antigens in a sample of bone marrow. This type of test is used to tell the
difference between myelodysplastic syndromes, leukemia, and other conditions.
Immunophenotyping : A process used to identify cells, based on the types of
antigens or markers on the surface of the cell. This process is used to diagnose specific
types of leukemia and other blood disorders by comparing the cancer cells to normal
cells of the immune system.
Flow cytometry : A laboratory test that measures the number of cells in a
sample, the percentage of live cells in a sample, and certain characteristics of cells,
such as size, shape, and the presence of tumor markers on the cell surface. The cells
are stained with a light-sensitive dye, placed in a fluid, and passed in a stream before a
laser or other type of light. The measurements are based on how the light-sensitive dye
reacts to the light.
FISH (fluorescence in situ hybridization): A laboratory technique used to look
at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent
dye are made in the laboratory and added to cells or tissues on a glass slide. When

these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they
light up when viewed under a microscope with a special light.

erythrocyte series
(erythrocytic series) the succession of morphologically distinguishable cells that that are stages in erythrocyte
development: in order of maturity, the proerythroblast, basophilic erythroblast, polychromatophilic erythroblast,
orthochromatic erythroblast, reticulocyte, and erythrocyte.
granulocyte series
(granulocytic series) the succession of morphologically distinguishable cells that are stages in granulocyte
development: in order of maturity, the myeloblast, promyelocyte, myelocyte, metamyelocyte, the band or stab cell,
which is the least mature form normally found in the peripheral blood, and the mature segmented (polymorphonuclear)
granulocyte. Commitment to one of the granulocyte lines occurs in stem cells before the myeloblast stage is reached;
thus there are distinct neutrophil, eosinophil, and basophil series; however, the morphologic stages are the same.
lymphocyte series
(lymphocytic series) the succession of developing cells that ultimately culminates in mature lymphocytes. The
morphologically distinguishable forms are lymphoblast, prolymphocyte, and lymphocyte.
monocyte series
(monocytic series) the succession of developing cells that ultimately culminates in the monocyte. The morphologically
distinguishable forms are monoblast, promonoblast, and monocyte.
plasmacyte series
(plasmacytic series) a series of morphologically distinguishable cells that are stages in plasma cell development: in
order of maturity, the plasmablast (an activated B cell usually referred to as a large lymphocyte or lymphoblast),
proplasmacyte, and plasmacyte.
thrombocyte series
(thrombocytic series) the succession of developing cells that ultimately culminates in platelets (thrombocytes). The
morphologically distinct cell types are megakaryoblast, promegakaryocyte, and megakaryocyte, which fragments to
form platelets.

4-13. MEGAKARYOCYTIC SERIES

a. Megakaryoblast.
(1)Twenty to 50 microns in diameter.
(2) Nucleus. One to two large oval or kidney-shaped nuclei are present.
There is a fine chromatin pattern. Multiple nucleoli may be present which stain blue.
The nucleus cytoplasm ratio is approximately 10:1.
(3) Cytoplasm. The cytoplasm is blue, nongranular, and may have small,
blunt pseudopods. It is usually seen as a narrow band around the nucleus.
Figure 4-8a. Megakaryocytic series:
Megakaryoblast: Bone marrow.
b. Promegakaryocyte.

(1) Size. Twenty to 50 microns in diameter.

(2) Nucleus. One-to-two indented round or oval nuclei are present. They
may show slight lobulation. The nuclear chromatin is purple, coarse, and granular.
Multiple nuclei are present but may be indistinct.
c. Megakaryocyte.
(1) Size. Forty to 100 microns in diameter.
(2) Nucleus. Two-to-sixteen nuclei may be visible or the nucleus may show
multilobulation. No nucleoli are visible. The nuclear chromatin is purple, coarse, and granular.
(3) Cytoplasm. The cytoplasm is pinkish-blue in color and very granular.
Numerous blue-purple granules begin to aggregate into small bundles that bud of from
the cell to become platelets.