Theme 21. Blood cell diseases.

Actuality. Diseases of blood cells include a great group of different disorders, many of which are
life-threatening. Understanding of their pathogenesis and morphologic signs is important for all
physicians.

Aim. To study the main theoretical statements, modern classifications and general characteristic
of each group of hematopoietic tissue disorders. To be able to explain pathogenesis, describe and
recognize in gross examination and slide the main morphologic features of anemias of blood loss,
megaloblastic anemias, thrombocytopenic purpura and hemolytic uremic syndrome, myelophtisic
anemia.

Integration with other disciplines. The study of diseases is based on the specific knowledge of
embryology, anatomy, histology and physiology of hematopoietic, lymphoid tissue and blood
cells. In order to understand adaptative reactions it is necessary to remind structural and
functional specifities of defensive mechanisms in this systems. Understanding of the course of the
disease is based on the knowledge of the sequence of typical pathologic processes (general
pathology).

Learning objectives:

• To understand the main steps of normal development of blood cells

• To give a definition of “anemia” and describe the typical morphologic features
• To list the main types of anemia and give examples of each group
• To differentiate morphologic changes seen in acute and chronic anemias of blood loss
• To understand the main mechanisms of intravascular and extravascular hemolysis and their
morphologic manifestations
• To give examples of the most common types of hemolytic anemias (explain the term
:microangiopatic anemia”)
• To understand mechanisms of anemias caused by deficiency of some vital substrates (iron,
vitamin B, folate) – megaloblastic anemias
• To describe morphologic changes seen in pernicious anemia
• To explain pathogenesis of aplastic anemias and give examples of the other forms of
marrow failure
• To explain the term “panmyelophtisis” and describe typical morphologic features
• To understand the mechanisms of bleeding disorders
• To give examples of the most common types of increased vascular fragility,
thrombocytopenia and defects in coagulation
• To compare pathogenesis and morphologic features of TTP and HUS
• To explain the term and give examples of polycytemia
• To understand the main causes and pathogenesis of the main forms of leukocytoses
(neutrophilic, eosinophilic, basophilic, monocytosis, lymphocytosis)
• To explain the term and give examples of typical “leukemoid reactions”
• To explain the term and give examples of “leucopenia”
• To describe pathogenesis and morphologic features of agranulocytosis
 • To describe morphologic features of lymph node hyperplasia

Be able to recognize in gross examination:

Pyoid bone marrow

Porphiral spleen
Splenomegaly
Hodgkin disease in intratoracal lymph nodes
Multiple myeloma of the skull
Leukemic infiltration of intestinal wall
Hepatomegaly in myeloid leukemia

Fill in the table with the signs of anemias of blood loss.

Acute Chronic
Common cause
Morphologic changes in the following organs:
Bone marrow
Skin, mucosa surfaces
Heart
Liver
Kidney

Fill in the table, comparing the following forms of hemolytic anemias

Pathogenesis Morphologic features

Intrinsic (intracorpuscular) abnormalities
Spherocytosis
Thalassemia syndromes
Sickle cell disease
Extrinsic(extracorpuscular) abnormalities
Transfusion reactions
Microangiopathic anemia
Malaria

34-years old man has chronic gastritis for 7 years. During last year disease was associated with
weakness, malaise and easy fatigability. Several weeks ago the patient developed signs of severe
paresthesia in the lower limbs. Fill in the table with the most important morphologic changes,
typical for anemia, described above. Name laboratory test, which is specific for disease

System/organ Mechanisms Morphologic changes

Bone marrow
Alimentary tract
Central nervous system
Fill in the table, comparing the following diseases
 Thrombotic thrombocytopenic purpura Hemolytic uremic syndrome
Etiology and pathogenesis
Clinical features:
Age/sex
Typical manifestations
Morphologic signs:
Spleen
Bone marrow

Fill in the table, comparing diseases, accompanied by panmyelophtysis:

Mechanisms Morphologic changes in the Other manifestations

bone marrow
Aplastic anemia
Metastasis
Myelofibrosis
Liver disease
Renal failure

Fill in the table, describing the following processes, which are the most common cause of lymph
node enlargement (lymphadenopathy)

Pathogenesis Morphologic signs Outcomes/Significance

Hyperplasia
nonspecific
specific
Lymphadenitis
Acute
Chronic
Lymphoma