Hematopathology

Duration: 1 Week

The purpose of this rotation is to give you an idea of how hematopathologists use clues from clinical history and physical exam, together with pathology findings to come up with a diagnosis/differential diagnosis for each patient, and to show you how ancillary tests such as cytogenetics can be very useful in making a diagnosis, determining therapy or prognosis and following the patient. During the rotation you shadow the hematopathology resident/fellow and review pathology cases with them. You will be assigned some cases, mainly abnormal peripheral blood cases, to review and figure out what is wrong. You will discuss cases with the hematopathology faculty, and pathology trainees in regularly scheduled sign out sessions. You also attend the pediatric and adult hematology clinical meetings held every week. Hematopathology is a fun and exciting specialty area, so have fun.

Objectives

Hematopathology general principals:

1. Have general understanding about how we use clinical history, blood and bone marrow findings to formulate differential diagnosis.
2. Have general understanding about how immunophenotyping, cytogenetics and molecular studies can be useful for making a diagnosis.
3. Have general understanding for molecular basis of hematologic diseases, in particular bcr-abl of CML, PML-RAR of acute promyelocytic leukemia.

Morphology general:

1. Recognize red cells, white cells, platelets in blood smears.
2. Use clues from the peripheral smear red cell morphology as well as lab and clinical data to work up cases of anemia.
3. Use morphology clues from the peripheral smear as well as lab and clinical data to work up cases of patients with high white cell counts.
4. Have basic understanding of hematopoiesis and recognize lineage of bone marrow cells.
5. Recognize normal bone marrow biopsy architecture, and identify cases where the bone marrow is abnormal.
6. Recognize normal morphology of lymph node.
7. Be able to identify lymph nodes where normal architecture is lost (effaced).

PERIPHERAL SMEAR/BONE MARROW DIAGNOSES

Red Cell Disorders:

1. Be able to classify anemia cases on the basis of bone marrow production (reticulocyte count) and MCV.
2. Recognize common types of anemia including:
   1. Iron deficiency
   2. Thalassemia + common hemoglobinopathies
   3. B12/folate deficiency
   4. Anemia of chronic disease
   5. Hemolytic anemia
   6. Aplastic anemia
3. Know basic structure of hemoglobin.

White Cell disorders:

1. Be able to recognize common reactive and neoplastic WBC disorders, and know clues to differentiate reactive from neoplastic disorders of white cells.
2. Reactive neutrophilia
3. Chronic myeloid leukemia.
4. Chronic lymphocytic leukemia
5. Reactive lymphocytosis
6. Acute leukemia; recognize Auer rods

LYMPH NODE/TISSUE DIAGNOSES

1. Be able to identify normal node architecture and effaced node architecture.
2. Lymphomas:
   1. CLL/SLL
   2. Follicular lymphoma
   3. Diffuse large B cell lymphoma
   4. Burkitt lymphoma
   5. Hodgkin lymphoma – recognize Reed-Sternberg cells