Clinical Hematology Atlas, 5th Edition
Because the emphasis of an atlas is morphology, the Clinical Hematology Atlas is intended to be used with a textbook, such as Rodak’s Hematology, fifth edition, that addresses physiology and diagnosis along with morphology. This atlas is designed for a diverse audience that includes clinical laboratory science students, medical students, residents, and practitioners. It is also a valuable resource for clinical laboratory practitioners who are being retrained or cross-trained in hematology. It is not intended to be a detailed, comprehensive manual for diagnosis.
In this concise format, every photomicrograph and word has been evaluated for value to the microscopist. All superfluous information has been excluded in an attempt to maintain focus on significant microscopic findings while correlating this information with clinical diagnosis. What started as a primer for Clinical Laboratory Science students with no previous hematology education has evolved into an internationally recognized reference for multiple levels of expertise, from entry level to practicing professionals.
As is frequently expounded, morphology on a peripheral blood film is only as good as the quality of the smear and the stain. Chapter 1 reviews smear preparation, staining, and the appropriate area in which to evaluate cell distribution and morphology. A table that summarizes the morphology of leukocytes found in a normal differential, along with multiple examples of each cell type, facilitates early instruction in blood smear review.
Chapter 2 schematically presents hematopoietic features of cell maturation. General cell maturation, along with an electron micrograph with labeled organelles, will help readers correlate the substructures with the appearance of cells under light microscopy. Visualizing normal cellular maturation is essential to the understanding of disease processes. This correlation of schematic, electron micrograph, and Wright-stained morphology is carried throughout the maturation chapters. Figure 2-1 has been formatted to reflect recent hematopoietic theory. In addition, the chart aids readers in recognizing the anatomical sites at which each stage of maturation normally occurs.
Chapters 3 to 9 present the maturation of each cell line individually, repeating the respective segment of the overall hematopoietic scheme from Chapter 2, to assist the student in seeing the relationship of each cell line to the whole. In these chapters, each maturation stage is presented as a color print, a schematic, and an electron micrograph. A description of each cell, including overall size, nuclear-to-cytoplasmic ratio, morphologic features, and reference ranges in peripheral blood and bone marrow, serves as a convenient summary. The final figure in each of these chapters summarizes lineage maturation by repeating the hematopoietic segment with the corresponding photomicrographs. Multiple nomenclatures for erythrocyte maturation are used to accommodate use in multiple settings and demographic groups. Chapters 10 to 12 present discrete cellular abnormalities of erythrocytes, that is, variations in size, color, shape, and distribution, as well as inclusions found in erythrocytes. Each variation is presented along with a description of the abnormality, or composition of the inclusion, and associated disorders.
Because diseases are often combinations of the cellular alterations, Chapter 13 integrates morphologic findings into the diagnostic features of disorders primarily affecting erythrocytes.
In Chapter 14, nuclear and cytoplasmic changes in leukocytes are displayed and correlated with non-malignant leukocyte disorders.
Diseases of excessive or altered production of cells may be caused by maturation arrest, asynchronous development, or proliferation of one cell line, as presented in Chapters 15 to 19. Cytochemical stains are presented with disorders in which they are useful.
The therapeutic use of myeloid growth factors causes morphologic changes that mimic severe infections or malignancies. Chapter 20 presents examples of peripheral blood morphology following G-CSF or GM-CSF. It is the authors’ design that the cellular defects in leukocyte disorders be visually compared with the process of normal hematopoiesis for a more thorough comprehension of normal and altered development. Readers are encouraged to refer to the normal hematopoiesis illustration, Figure 2-1, for comparison of normal and abnormal cells and the progression of diseases.
Microorganisms, including parasites, may be seen on peripheral blood smears. A brief photographic overview is given in Chapter 21. Readers are encouraged to consult a microbiology reference, such as Mahon CM, Lehman DC, Manuselis G: Textbook of Diagnostic Microbiology, fifth edition, for a more detailed presentation.
Chapter 22 includes photomicrographs that are not categorized into any one particular area, such as fat cells, mitotic figures, metastatic tumor cells, and artifacts.
Chapter 23 describes findings expected in the peripheral blood of neonates, including anticipated variations in morphology and cellular distribution. Comparison of the hematogone, normal for newborns, with the blast cell of acute leukemia is included.
Chapter 24 is intended to be an overview of the most frequent microscopic findings in body fluids. It is not proposed as a comprehensive review of the cytology of human body fluids, but rather a quick reference for the beginning microscopist as well as the seasoned professional.
As with the third edition and fourth editions, the fifth edition features spiral binding, making the atlas more convenient when used at the microscope bench.
All of these chapters combine into what we believe is a comprehensive and valuable resource for any clinical laboratory. The quality of the schematic illustrations, electron micrographs, and color photographs stand for themselves. We hope that this atlas will enrich the learning process for the student and serve as an important reference tool for the practitioner.
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