Guide to Paediatric Haematology Morphology

Gillian Rozenberg, Consultant in blood film morphology, FAIMS (Life Member), FFSc (RCPA) is the Principal Medical Scientist working in the field of Diagnostic Haematology at the Prince of Wales Hospital, Sydney, Australia.

Acknowledgements

Introduction

Examination of the Blood Film. Preparation of the film. Examination of the film. Artefactual changes seen on the blood film. White cell artefact. Poor staining. Crush artefact. Platelet artefact. Red cell classification. Significance of the red cell distribution width (RDW).

Section 1: Red Cells

Erythrocytes in the neonate and childhood: Are they macrocytic, normocytic, or microcytic (why the change in size?). Foetomaternal haemorrhage. The art of blood film morphology. Red cell reference ranges. Reticulocyte reference ranges. Electron microscopic image of normal red cells. Cord blood. Anaemia in the neonate. ABO incompatibility. Rh haemolytic disease of the newborn. Twin to twin haemorrhage prior to birth. Erythroblastosis fetalis. Haemoglobin disorders. The a thalassaemias. Silent carrier a-thalassaemia trait. a- thalassaemia trait. Haemoglobin H disease. Haemoglobin H disease cresyl blue. Hydrops fetalis. Haemoglobin constant spring (HbCS). The β thalassaemias. Silent carrier β thalassaemia trait. β-thalassaemia trait. β-thalassaemia intermedia. β-thalassaemia major. Abnormal haemoglobins. Haemoglobin C. HBC trait. HBCC disease. In vitro test for detection of HBC. Haemoglobin E. HBE trait. HBEE disease. Hb E/thalassaemia. Hb E/β thalassaemia. Hb S/β thalassaemia. HB haemoglobin S. HBS trait. HBSS disease. In vitro sickling test for detection of HBS. Red cell membrane disorders. Herederitary spherocytosis. Hereditary elliptocytosis. South-east Asian ovalocytosis. Heredeitary stomatocytosis (Hydrocytosis). Hereditary xerocytosis. Heredeitary pyropoikilocytosis (HPP). Abetalipoproteinaemia. Vitamin E deficiency. Liver disease. Burns (third degree). Diamond blackfan anaemia (DBA). Haemolytic anaemias. Haemolytic anaemia dure to lead poisoning. Oxidant-drug-induced haemolytic anaemia. Pyruvate kinase (PK) deficiency. Autoimmune haemolytic anaemia (AIHA). Microangiopathic haemolytic anaemia. Valvular heart disease. Haemolytic uraemic syndrome (HUS). Thrombotic thrombocytopenic purpura (TTP). Marfan’s syndrome. Disseminated intravascular coagulation (DIC). Malignancy. HELLP syndrome. Paroxysmal cold haemoglobinuria (PCH). Congenital sideroblastic anaemia. Transient erythroblastopenia of childhood (TEC). Recovert from TEC. Miscellaneous red cell images. Splenectomy – Howell Jolly bodies. Splenectomy – Acanthocytes. Lipaemic plasma.

Section 2: White Cells

White cell reference ranges in infancy and childhood. Myeloid maturation. Myeloblast. Promyelocyte. Myelocyte. Metamyelocyte. Band form. Neutrophil. Eosinophil. Basophil. Abnormal Myeloid Cells. Pelger-Huët anomaly. Hypersegmented neutrophil. Hypergranulated neutrophils. Toxic vacuolation. Döhle bodies. Leukaemoid reaction. Kawasaki disease. Alder-Reilly anomaly. Mucopolysaccharidosis Type VI (MPS VI). Chédiak-Higashi anomaly. Basophilia/Mastocytosis. Cutaneous mastocytosis (CM). Mast cell leukaemia (MCL). Neonatal neutrophilia. Sepsis in the neonate. Bone marrow failure. Aplastic anaemia. Dyskeratosis congenita (DC). Pancytopenias. Fanconi anaemia (FA). Shwachman-Diamond syndrome (SDS). Neutropenia. Cyclic neutropenia. Kostmann syndrome. Eosinophilia. Eosinophilia in the neonate. Eosinophilia in early childhood. Leucoerythoblastosis. Osteopetrosis. Myeloproliferative neoplasms in the neonate and childhood. Transient abnormal myelopoiesis (TAM). Monocytes and macrophages. Monocytic maturation. Monoblast. Promonocyte. Monocyte. Gaucher disease. Niemann-Pick disease. Reactive haemophagocytic syndrome. Langerhans cell histiocytosis (LCH). Storage disorders in the neonate and childhood. a-Mannosidosis. Mucopolysaccharidoses. Hurler syndrome (Gasser lymphocytes). Cystinosis. Wolman disease. Monosomy 7 myeloproliferative disease (MPD). Cytogenetics. Juvenile myelomonocytic leukaemia (JMML). Cytogenetics. Myelodysplastic syndromes (MDS). Lymphocytes. Lymphocyte maturation. Lymphoblast. Prolymphocyte. Lymphocyte (small). Lymphocyte (large). Reactive lymphocytosis. Reactive lymphocytes (Infectious mononucleosis) (IM). Cytomegalovirus (CMV) infection. Varicella infection. Viral hepatitis. Bordetella pertussis. Acute infectious lymphocytosis. Sialic acid storage disease. Non-haemopoietic malignancies in the neonate and childhood. Neuroblastoma. Rhabdomyosarcoma. Ewing sarcoma.

Section 3: Platelets

Platelet reference ranges in infancy and childhood. Megakaryocytic maturation. Megakaryoblast. Promegakaryocytes. Megakaryocyte. Platelet abnormalities. Reactive thrombocytosis. Large and giant platelets. Platelet aggregates. Platelet satellitism. Thrombocytopenia. Thrombocytopenia due to increased destruction (ITP). Thrombocytopenia due to impaired or ineffective thrombopoiesis. Amegakaryocytic thrombocytopenia (AMEGA). Bernard-Soulier syndrome (BSS). Gray platelet syndrome (GPS). May-Hegglin anomaly (MHA). Thrombocytopenia with absent radii (TAR). Wiskott-Aldrich syndrome (WAS). Thrombocytosis. Lymphoproliferative neoplasms. B lymphoblastic leukaemia/lymphoma. T-lymphoblastic leukaemia. Immunophenotype. T lymphoblastic leukaemia/lymphoma. Immunophenotype.

Index.