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• 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 patient’s health habits and past illnesses and treatments will also be taken.

• Complete blood count (CBC) with diferential : A procedure in which a sample ofblood is drawn and checked for the following:

o  The number of red blood cells and platelets.

o  The number and type of white blood cells.

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

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

ENLARE

omplete blood count (!). !lood is collected by inserting a needle into a "ein and allowing the blood to

#ow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and

platelets are counted. The ! is used to test for, diagnose, and monitor many di$erent conditions.

•

Peripheral blood smear : A procedure in which a sample of blood is checked forchanges in the number, type, shape, and si%e of blood cells and for too much iron in thered blood cells.

• Cyto!enetic analysis : A test in which cells in a sample of blood or bone marrow are"iewed under a microscope to look for certain changes in the chromosomes.

• Blood chemistry studies : A procedure in which a blood sample is checked tomeasure the amounts of certain substances, such as "itamin !&' and folate, released intothe 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 remo"al of bone marrow, blood, and asmall piece of bone by inserting a hollow needle into the hipbone or breastbone.Apathologist "iews the bone marrow, blood, and bone under a microscope to look

forabnormal cells. !one marrow aspiration and biopsy. After a small area of skin is numbed, a bonemarrow needle is inserted into the patient’s hip bone. amples of blood, bone, and bone marrow areremo"ed for examination under a microscope.

 The following tests may be done on the sample of tissue that is remo"ed:

o "mmunocytochemistry : A test that uses antibodies to check forcertain antigens in a sample of bone marrow. This type of test is used to tell thedi$erence between myelodysplastic syndromes, leukemia, and other conditions.

o "mmunophenotypin! : 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 specictypes of leukemia and other blood disorders by comparing the cancer cells to normalcells of the immune system.

o #low cytometry : A laboratory test that measures the number of cells in asample, the percentage of li"e cells in a sample, and certain characteristics of cells,such as si%e, shape, and the presence of tumor markers on the cell surface. The cellsare stained with a light*sensiti"e dye, placed in a #uid, and passed in a stream before alaser or other type of light. The measurements are based on how the light*sensiti"e dyereacts to the light.

o #"$% (&uorescence in situ hybridi'ation): A laboratory techni+ue used to lookat genes or chromosomes in cells and tissues. ieces of -A that contain a #uorescentdye are made in the laboratory and added to cells or tissues on a glass slide. /hen

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these pieces of -A bind to specic genes or areas of chromosomes on the slide, theylight up when "iewed 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 megaaryoblast, promegaaryocyte, and megaaryocyte, which fragments to

form platelets.

4-13. MEGAKARYOCYTIC SERIESa.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.

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(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 off from

the cell to become platelets.