https://haematologyetc.co.uk/index.php?title=Special:NewPages&feed=atom&hideredirs=1&limit=50&offset=&namespace=0&username=&tagfilter=haematologyetc.co.uk - New pages [en-gb]2024-03-28T14:28:52ZFrom haematologyetc.co.ukMediaWiki 1.39.0https://haematologyetc.co.uk/index.php?title=Schizont_DevelopmentSchizont Development2024-03-26T09:56:34Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:navy>'''How does schizont appearance change during their development?'''</span><br />
<br />
<br />
Schizonts formation involves successive cycles of asexual division that eventually result in the formation of multiple separate "merozoite" forms. Those merozoites are released as the red cell breaks down then go on to infect another red cell. Schizonts therefre look very different depending on which stage of development they represent. Below are images of schizonts at different developmental stages.<br />
<br />
<br />
----<br />
<br />
'''THE INITIAL ASEXUAL DIVISION'''<br />
<br />
<br />
The first recognisable stage occurs when the schizonts first divide their chromatin to form two distinct masses. This first stage is the least distinctive and can be difficult to distinguish from a late trophozoite or gametocyte with a double chromatin dot. But often the appearance is clear. <br />
<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:Schizontcartoon1.jpg|A|link={{filepath:Schizontcartoon1.jpg}}<br />
File:Schizontreal1.jpg|B|link={{filepath:Schizontreal1.jpg}}<br />
</gallery><br />
<br />
The cartoon image (A) shows the division of chromatin into two distinct purple chromatin masses within the blue parasite cytoplasm (at this point the cytoplams is not divided so indiviual merozoites are not really distinguishable). A clinical image of a parasite at this developmental stage (''P.ovale'' with well shown James'dots) is shown in panel (B).<br />
<br />
<br />
----<br />
<br />
'''IMMATURE SCHIZONT APPEARANCES'''<br />
<br />
<br />
As schizont development proceeds further cycles of division cause the appearance of mutiple separate areas chromatin that will eventually form the merozoies, although at this stage they still lie within a single cytoplasmic mass. The number of divisions varies between species, so in mature schizonts this can contribute to species identification (see schizont gallery). Note that as the parasites develop the haemoglobin is metabolised so the red cell becomes more pale, and the products of red cell breakdown (malaria pigment) become more prominent.<br />
<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:Schizontcartoon2.jpg|A|link={{filepath:Schizontcartoon2.jpg}}<br />
File:Schizontreal2.jpg|B|link={{filepath:Schizontreal2.jpg}}<br />
</gallery><br />
<br />
The cartoon image (A) shows the further division of chromatin (Chr) into many discrete massed within the blue parasite cytoplasm (Cy). Indiviual merozoites are still not distinguishable but the malaria pigment is obvious (Pi). A clinical image of a parasite at this developmental stage (again from ''P.ovale'' with well shown James'dots and malaria pigment) is shown in panel (B).<br />
<br />
<br />
----<br />
<br />
'''MATURE SCHIZONT APPEARANCES'''<br />
<br />
By this stage the individual merozoites can be distinguished, each with a chromatin dot and cytoplasm; they are now ready for release from the red cell. <br />
<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:Schizontcartoon3.jpg|A|link={{filepath:Schizontcartoon3.jpg}}<br />
File:Schizontreal3.jpg|B|link={{filepath:Schizontreal3.jpg}}<br />
</gallery><br />
<br />
<br />
The asexual division cycles are now complete cartoon image (A) shows the merozoites (M) as discrete chromatin with blue cytoplasm. Malaria pigment is present (P). The clinical image of a parasite at this developmental stage (again from ''P.ovale'' with well shown James'dots and malaria pigment) is shown in panel (B).<br />
<br />
<br />
----<br />
<br />
<br />
'''MEROZOITE RELEASE'''<br />
<br />
In the final stage the red cell membrane is broken down, swelling then separating to release the merozoites and any malaria pigment into the blood where each merozoite enters a red cell to form a new early trophozoite and increasing the infection load. <br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:Schizontcartoon4.jpg|A|link={{filepath:Schizontcartoon4.jpg}}<br />
File:Schizontreal4.jpg|B|link={{filepath:Schizontreal4.jpg}}<br />
</gallery><br />
<br />
<br />
Merozoites cause the red cell membrane to be expanded then to break down; the merozoites (M) are now clearly separate and move apart, the pigment (P) is also released during this process (A); this is shown in the clinical image (B) although this brief stage is rarely seen in practice (''P.malariae'').</div>Adminhttps://haematologyetc.co.uk/index.php?title=Red_cell_size_and_shapeRed cell size and shape2024-03-24T20:15:45Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:navy>'''How is red cell size and shape affected as malaria develops?'''</span><br />
<br />
<br />
During parasite develop,emt each species alters the red cell that they occupy. These changes differ between species causing characteristic changes to.red. cell size and red cell shape. These changes occur from a relatively early stage of parasite development although the very earliest trophozoites may yet show these features. These changes in size are retained at schizont and gametocyte stages, though shape may be different (see each species description).<br />
<br />
----<br />
<br />
'''SMALL ROUND RED CELLS'''<br />
<br />
''P.malariae''<br />
<br />
The red cells in this species remain round and are often small in size <br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:1SizePMET.jpg|A|link={{filepath:1SizePMET.jpg}}<br />
File:2SizePMLT.jpg|B|link={{filepath:2SizePMLT.jpg}}<br />
</gallery><br />
<br />
The early (A) and late trophozoites (B) shown in this image each lie within round erythrocytes with reduced size.<br />
<br />
<br />
----<br />
<br />
'''RED CELLS WITH UNCHANGED SIZE AND SHAPE'''<br />
<br />
''P.falciparum'' (and ''P.knowlesi'')<br />
<br />
Red cell size and shape is generally unchanged although they may become crenated <br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:3SizePMET.jpg|A|link={{filepath:|3SizePMET.jpg}}<br />
File:4SizePFLT.jpg|B|link={{filepath:4SizePFLT.jpg}}<br />
</gallery><br />
<br />
The early (A) trophozoites lie within red cells that do not change size or shape, at later development (B) they may remain unchanged or acquire subtle crenation. <br />
<br />
<br />
----<br />
<br />
'''ENLARGED AND DISTORTED RED CELLS'''<br />
<br />
For both ''P.ovale'' and ''P.vivax'' the red cells become progressively enlarged and distorted as the parasites develop. It may not be possible to distingish the species based on red cell appearances, but there are differences which should be looked for.<br />
<br />
<br />
''P.ovale''<br />
<br />
Expect increased red cell size but this may not be marked; the typical shape is an ovoid shape (hence the name) and there may be characteristic finbriation of cytoplams (that may be limited to one pole of the cell).<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:5SizePOET.jpg|A|link={{filepath:|5SizePOET.jpg}}<br />
File:6SizePOLT.jpg|B|link={{filepath:4SizePOLT.jpg}}<br />
</gallery><br />
<br />
Early (A) and late (B) trophozoites o ''P.ovale''. In each case there is a tendency for red cells to have an ovoid shape and there is distortion of the cytoplasm with sharp projectiosn (fimbriation). These orregular and spiky projections differ from the rounded crenation that may be seen in ''P.falciparum''.<br />
<br />
<br />
''P.vivax''<br />
<br />
This species tend to have the largest red cell size that becomes evident at quite and early stage; the typical shape is quite irregular fimbriation is not (generally) seen.<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:7SizePVET.jpg|A|link={{filepath:|7SizePVET.jpg}}<br />
File:8SizePVLT.jpg|B|link={{filepath:8SizePVLT.jpg}}<br />
</gallery><br />
<br />
Trophozoites of ''P.vivax'' cause increase in size and distortion of red cells as the parasites mature. Here, the the early trophozoite (A) is enlarged but still retains a relatively undistorted elongated shape (similar to ''P.ovale''); however the late form (B) is has a very irregular shape (note that unlike ''P.ovale'' the red cell is not fimbriated).</div>Adminhttps://haematologyetc.co.uk/index.php?title=Red_cell_sizeRed cell size2024-03-23T19:31:07Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:navy>'''How is red cell size and shape affected as malaria develops?'''</span><br />
<br />
<br />
During parasite develop,emt each species alters the red cell that they occupy. These changes differ between species causing characteristic changes to.red. cell size and red cell shape. These changes occur from a relatively early stage of parasite development although the very earliest trophozoites may yet show these features <br />
<br />
----<br />
<br />
'''SMALL ROUND RED CELLS'''<br />
<br />
''P.malariae''<br />
<br />
The red cells in this species remain round and are often small in size <br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:1SizePMET.jpg|A|link={{filepath:1SizePMET.jpg}}<br />
File:2SizePMLT.jpg|B|link={{filepath:2SizePMLT.jpg}}<br />
</gallery><br />
<br />
The early (A) and late trophozoites (B) shown in this image each lie within round erythrocytes with reduced size.<br />
<br />
<br />
----<br />
<br />
'''RED CELLS WITH UNCHANGED SIZE AND SHAPE'''<br />
<br />
''P.falciparum'' (and ''P.knowlesi'')<br />
<br />
Red cell size and shape is generally unchanged although they may become crenated <br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:3SizePMET.jpg|A|link={{filepath:|3SizePMET.jpg}}<br />
File:4SizePFLT.jpg|B|link={{filepath:4SizePFLT.jpg}}<br />
</gallery><br />
<br />
The early (A) trophozoites lie within red cells that do not change size or shape, at later development (B) they may remain unchanged or acquire subtle crenation. <br />
<br />
<br />
----<br />
<br />
'''ENLARGED AND DISTORTED RED CELLS'''<br />
<br />
For both ''P.ovale'' and ''P.vivax'' the red cells become progressively enlarged and distorted as the parasites develop. It may not be possible to distingish the species based on red cell appearances, but there are differences which should be looked for.<br />
<br />
<br />
''P.ovale''<br />
<br />
Expect increased red cell size but this may not be marked; the typical shape is an ovoid shape (hence the name) and there may be characteristic finbriation of cytoplams (that may be limited to one pole of the cell).<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:5SizePOET.jpg|A|link={{filepath:|5SizePOET.jpg}}<br />
File:6SizePOLT.jpg|B|link={{filepath:4SizePOLT.jpg}}<br />
</gallery><br />
<br />
Early (A) and late (B) trophozoites o ''P.ovale''. In each case there is a tendency for red cells to have an ovoid shape and there is distortion of the cytoplasm with sharp projectiosn (fimbriation). These orregular and spiky projections differ from the rounded crenation that may be seen in ''P.falciparum''.<br />
<br />
<br />
----<br />
''P.vivax''<br />
<br />
This species tend to have the largest red cell size that becomes evident at quite and early stage; the typical shape is quite irregular fimbriation is not (generally) seen.<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:7SizePVET.jpg|A|link={{filepath:|7SizePVET.jpg}}<br />
File:8SizePVLT.jpg|B|link={{filepath:8SizePVLT.jpg}}<br />
</gallery><br />
<br />
Early and trophozoites of ''P.vivax''. The increased size and red cell distortion increase as the parasites mature. In this case the early trophozoite (A) is enlarged but still retains a relatively undistorted elongated shape (similar to ''P.ovale''); however the late form (B) is has a very irregular shape (note there is no fimbriation).<br />
<br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Maurer%27s_dots_and_cleftsMaurer's dots and clefts2024-03-23T19:27:15Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:navy>'''What are Maurer's dots and clefts?'''</span><br />
<br />
These are blue-grey dots or linear structures seen at the late trophozoites of ''P.falciparum''. These structures lie within the erythrocyte cytoplasm and are the result of modification of the red cell by the parasite. The structures differ from the dots seen in ethrocytes infected by ''P.vivax'' or ''P.ovale'' since they are few in number (you could imagine being able to count them). They are not seen in early trophozoites so define the late trophozoite stage. <br />
<br />
<br />
<br />
<gallery mode="nolines" widths=250px heights=250px><br />
File:Maurer1.jpg|link={{filepath:Maurer1.jpg}}<br />
</gallery><br />
<span style="font-size:80%">The most frequent form - two early trophozoites of ''P.falciparum'' in a single erythrocyte</span><br />
<br clear=all><br />
<br />
----<br />
<br />
<span style="color:navy>'''Species significance'''</span> <br />
<br />
Maurer's dots and clefts are restricted to ''P.falciparum'' and can be distinguished from Schüffner's dots of ''P.vivax'' or the James' dots of ''P.ovale'' by their blue-grey colour, higher density and sometimes elongated (clefted) shape. <br />
----<br />
<br />
<span style="color:navy>'''Compare with:'''</span><br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:Maurer2.jpg|A. Maurer|link={{filepath:Maurer2.jpg}}<br />
File:Schuffner1.jpg|B. Schüffner|link={{filepath:Schuffner1.jpg}}<br />
File:James1.jpg|C. James|link={{filepath:James1.jpg}}<br />
</gallery><br />
<br />
<span style="font-size:80%">Maurer's dots and clefts in a late trophozoite of ''P.falciparum'' with two tropozoites and a mixture of dots and clefts (A). These are more dense and blue grey than the more numerous, softer, amd red/purple coloured Schüffner's dots seen in ''P.vivax'' (B) and James' dots in ''P.ovale'' (C)</span></div>Johnhttps://haematologyetc.co.uk/index.php?title=Stained_correctlyStained correctly2024-03-23T19:26:25Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:navy>'''Why is there an optimal pH for malaria evaluation?'''</span><br />
<br />
<br />
<gallery mode="nolines" widths="220px" heights="220px" ><br />
File:PHcorrect.jpg|A|link={{filepath:|PHcorrect.jpg}}<br />
File:PHincorrect.jpg|A|link={{filepath:|PHincorrect.jpg}}<br />
</gallery><br />
<br />
Trophozoites of ''P.vivax'' stained at pH7.4 (A) or pH6.9 (B). Note that staining at the more alkaline conditions (pH7.4) gives the red cell a pale blue colour when compared to the acidic conditions (pH6.9), with these conditions making both the trophozoite and the added cytoplasmic dots more visible, although the key features can be seen at either pH. <br />
<br />
----<br />
<br />
<span style="color:navy>'''Description'''</span><br />
<br />
<br />
The best detection and species identification in malaria is made when staining is performed at a slightly more alkaline pH - this makes parasites more visible compared with the grey of the surrounding red cells and makes some structures such as cytoplasmic dots more visible. These features are detectable at standard staining pH and both detection and species identification can be performed, it is just less easy.</div>Johnhttps://haematologyetc.co.uk/index.php?title=P.falciparum_gametocyte_galleryP.falciparum gametocyte gallery2024-03-20T22:37:45Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:black><br />
{| class="wikitable" style="border-style: solid; border-width: 0px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''''P.falciparum'' gallery of gametocytes'''''<br />
|}<br />
<br />
<br />
<span style="font-size:95%">'''Summary'''</span><br />
<span style="font-size:95%">Gametocytes in this species are highly distinctive. They develop within the red cell as long rods, however the red cell membrane continues to restrict them - the haemoglobin is fully metabolised so is not visible, but the residual membrane of the red cell "ghost" can usually be seen to the side of the red cell. The gametocytes differ with large (macrogametocyte) forms that become curved because of the red cell membrane restricting thir shape (banana form); the smaller (microgametocytes) retain the rod shape. In each case the gold/brown pigment overlies the chromatin area<br />
<br />
----<br />
<gallery mode="traditional" widths=240px heights=240px><br />
File:PFG2.jpg|<span style="font-size:80%">'''Macrogametocyte''' A long rod with empty red cell membrane to the right side. The form is not very curved but the disortion of the rod is clearly beginning</span>|link={{filepath:PFG2.jpg}}<br />
File:PFG3.jpg|<span style="font-size:80%">'''Microgametocyte''': the small rod does not fully fill the erythrocyte, the residual red cell membrane is lose to the side of the membrane</span>|link={{filepath:PFG3.jpg}}<br />
File:PFG4.jpg|<span style="font-size:80%">'''Macrogametocyte''' A nice typical "banana" form, the shape is very curved and pigment is seen scattered over he chromatin</span>|link={{filepath:PFG4.jpg}}<br />
</gallery>"</div>Adminhttps://haematologyetc.co.uk/index.php?title=P.falciparum_schizont_galleryP.falciparum schizont gallery2024-03-20T22:34:29Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:black><br />
{| class="wikitable" style="border-style: solid; border-width: 0px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''''P.falciparum'' gallery of late trophozoites'''''<br />
|}<br />
<br />
<br />
<span style="font-size:95%">'''Summary'''</span><br />
<span style="font-size:95%">The schizonts of ''P.falciparum'' sequester in the small vessels and rarely circulate in blood; when found they usually signify a very severe infection. If this is not the case then it is appropriate to ask if there is a different species causing the infection. Generally these are loosely formed with variable numbers of merozoites and a single clump of pigment, they are not "neat" like the parasites of ''P.malariae''.<br />
<br />
----<br />
<gallery mode="traditional" widths=240px heights=240px><br />
File:PFS1p.jpg|<span style="font-size:80%">'''Mature schizonts''' note the clumped brown pigment surrounded by loosely arranged merooites, some are early forms that are less well separated</span>|link={{filepath:PFS1p.jpg}}<br />
File:PFS2p.jpg|<span style="font-size:80%">'''A single merozoite''' the parasite is recognisable with just 4-5 merozoites and no pigment within a degenerate erythrocyte</span>|link={{filepath:PFS2p.jpg}}<br />
File:PFS3p.jpg|<span style="font-size:80%">'''Late schizonts''': 16-20 late merozoites prior to release are well formed and clearly separated with obvious pigment</span>|link={{filepath:PFS3p.jpg}}<br />
</gallery>"</div>Adminhttps://haematologyetc.co.uk/index.php?title=P.falciparum_late_trophozoites_galleryP.falciparum late trophozoites gallery2024-03-20T22:15:44Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:black><br />
{| class="wikitable" style="border-style: solid; border-width: 0px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''''P.falciparum'' gallery of late trophozoites'''''<br />
|}<br />
<br />
<br />
<span style="font-size:95%">'''Summary'''</span><br />
<span style="font-size:95%">At this stage we look for rings that are slightly thicker though still small with typical ring form, the red cells tend to become crenated and pale, losing central pallor as the parasites mature. Typical accolé forms, double chromatin dot forms, and multiple parasites within infected red cells are still present.<br />
<br />
----<br />
<gallery mode="traditional" widths=240px heights=240px><br />
File:PFLT1p.jpg|<span style="font-size:80%">'''Late rings''' Two cells both with typical dots: multiply infected and double dot forms</span>|link={{filepath:PFLT1p.jpg}}<br />
File:PFLT2p.jpg|<span style="font-size:80%">'''Double chromatin dot form''' also Maurers dost and clefts, slight crenation and lost pallor</span>|link={{filepath:PFLT2p.jpg}}<br />
File:PFLT3p.jpg|<span style="font-size:80%">'''Accolé form''': closely associated with the red cell membrane, scanty mauers dots</span>|link={{filepath:PFLT3p.jpg}}<br />
File:PFLT4p.jpg|<span style="font-size:80%">'''Accolé form''' A nice typical form with scanty well-formed Maurers dots</span>|link={{filepath:PFLT4p.jpg}}<br />
File:PFLT5p.jpg|<span style="font-size:80%">'''Small thick forms''' the red cell crenation is well demonstrated with scanty dots</span>|link={{filepath:PFLT5p.jpg}}<br />
</gallery>"</div>Adminhttps://haematologyetc.co.uk/index.php?title=Malaria_stage_recognitionMalaria stage recognition2024-03-19T14:23:02Z<p>Admin: Created page with "{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black" |colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''Geographical distribution''' |} ''P.falciparum'' infection occurs in tropical and subtropical areas of central and South America, Africa, and S.E.Asia; this resembles the distribution of ''P.malariae'' and overlaps but is distinct from the distribution of ''P.vivax'' and ''P.ovale''. Detailed..."</p>
<hr />
<div>{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''Geographical distribution'''<br />
|}<br />
<br />
<br />
''P.falciparum'' infection occurs in tropical and subtropical areas of central and South America, Africa, and S.E.Asia; this resembles the distribution of ''P.malariae'' and overlaps but is distinct from the distribution of ''P.vivax'' and ''P.ovale''.<br />
<br />
Detailed geographical information may be accessed here: [https://www.cdc.gov/malaria/travelers/country_table/a.html].<br />
<br />
<br />
----</div>Adminhttps://haematologyetc.co.uk/index.php?title=Species_identification:_summary_pageSpecies identification: summary page2024-03-17T18:38:24Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
<span style="font-size:80%">(click blue highlighted text to return to page)</span></br></br><br />
<span style="font-size:90%">[[Malaria Index|Malaria main index]]''</span></br><br />
<span style="font-size:90%">>This page: <u>Species Indentification: summary</u></span><br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: #afbddb |'''''Plasmodium falciparum'''''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=150px heights=150px><br />
File:PFETc.jpg|<span style="font-size:80%">''Early trophozoite''</span>|link={{filepath:PFETc.jpg}}<br />
File:PFLTc.jpg|<span style="font-size:80%">Late trophozoite</span>|link={{filepath:PFLTc.jpg}}<br />
File:PFSc2.jpg|<span style="font-size:80%">Schizont (rare)</span>|link={{filepath:PFSc2.jpg}}<br />
File:PFGc.jpg|<span style="font-size:80%">Gametocyte</span>|link={{filepath:PFGc.jpg}}<br />
</gallery><br />
<br />
<span style="font-size:95%">'''Summary'''</span><br />
*<span style="font-size:95%">Small and fine ring forms, look for typical forms accolé, multiple parasites per cell, double dot</span><br />
*<span style="font-size:95%">Characteristic Maurer's dots and clefts in late trophozoites</span><br />
*<span style="font-size:95%">The irregular and "tatty" schizonts very '''rarely seen''' in blood unless severe infection</span><br />
*<span style="font-size:95%">Characteristic elongated (often curved) 'banana' gametocytes</span><br />
</span><br />
<br />
<br />
<div style="width: 230px"><br />
{| class="wikitable" style="border-left:solid 4px gray;border-right:solid 4px gray;border-top:solid 4px gray;border-bottom:solid 4px gray; font-size:90%; color:navy; align:center"<br />
| colspan="1"''|[[Plasmodium falciparum: Morphology|'''CLICK''' for detailed description]]''<br />
|}<br />
</div><br />
<br />
<br />
<br />
----<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: #afbddb |'''''Plasmodium vivax'''''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=150px heights=150px><br />
File:PVETc.jpg|<span style="font-size:80%">''Early trophozoite''</span>|link={{filepath:PVETc.jpg}}<br />
File:PVLTc.jpg|<span style="font-size:80%">Late trophozoite</span>|link={{filepath:PVLTc.jpg}}<br />
File:PVSc.jpg|<span style="font-size:80%">Schizont (rare)</span>|link={{filepath:PVSc.jpg}}<br />
File:PVGc.jpg|<span style="font-size:80%">Gametocyte</span>|link={{filepath:PVGc.jpg}}<br />
</gallery><br />
<br />
'''Summary'''<br />
<br />
*Large and robust rings that become amoeboid during later development<br />
*Red cells become increasingly enlarged and distorted as parasites mature<br />
*Schüffner's dots are visible in appropriately stained thin blood films<br />
*All forms tend to circulate with large schizont and gametocyte forms present <br />
<br />
<br />
<div style="width: 230px"><br />
{| class="wikitable" style="border-left:solid 4px gray;border-right:solid 4px gray;border-top:solid 4px gray;border-bottom:solid 4px gray; font-size:90%; color:navy; align:center"<br />
| colspan="1"''|[[Plasmodium vivax: Morphology|'''CLICK''' for detailed description]]''<br />
|}<br />
</div><br />
<br />
<br />
----<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: #afbddb |'''''Plasmodium ovale'''''<br />
|}<br />
<br />
<br />
<br />
[[File:POETc.jpg|150px|link={{filepath:POETc.jpg}}]]<br />
[[File:POLTc.jpg|150px|link={{filepath:POLTc.jpg}}]]<br />
[[File:POSc.jpg|150px|link={{filepath:POSc.jpg}}]]<br />
[[File:POGc.gif|150px|link={{filepath:POGc.gif}}]]<br />
----<br />
<br />
<br />
'''Brief summary'''<br />
<br />
*rings are large and robust, with ring appearance often retained in late trophozoite stage<br />
*Red cells are enlarged often with oval shape and may have characteristic fimbriation <br />
*Schüffner's (James) dots seen in appropriately stained samples<br />
*All forms tend to circulate, parasites are large but tend to be smaller than for ''P.vivax'' <br />
<br />
<br />
''For more information''<br />
*[[''Plasmodium ovale'': Morphology|click for full description of ''P.ovale'' morphology]]<br />
*[[''Plasmodium ovale'': Gallery|click to visit the gallery of ''P.ovale'' forms]]<br />
----<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: #afbddb |'''''Plasmodium malariae'''''<br />
|}<br />
<br />
<br />
<br />
[[File:PMETc.jpg|150px|link={{filepath:PMETc.jpg}}]]<br />
[[File:PMLTc.jpg|150px|link={{filepath:PMLTc.jpg}}]]<br />
[[File:PMSc.jpg|150px|link={{filepath:PMSc.jpg}}]]<br />
[[File:PMGc.jpg|150px|link={{filepath:PMGc.jpg}}]]<br />
----<br />
<br />
<br />
'''Brief summary'''<br />
<br />
*Small rings (less delicate than ''P.falciparum'') and becoming elongated or solid as parasites mature<br />
*Red cells often small remaining a round shape and with no added dots unless heavily stained<br />
*All forms tend to circulate, characteristically look for "daisy" schizonts and small round gametocytes'' <br />
*Parasite number is often low<br />
<br />
<br />
''For more information''<br />
*[[''Plasmodium malariae'': Morphology|click for full description of ''P.malariae'' morphology]]<br />
*[[''Plasmodium malariae'': Gallery|click to visit the gallery of ''P.malariae'' forms]]<br />
<br />
<br />
----<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: #fff5ee |'''''Plasmodium knowlesi'''''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=150px heights=150px><br />
File:PKETc.jpg|<span style="font-size:80%">''Early trophozoite''</span>|link={{filepath:PKETc.jpg}}<br />
File:PKLTc.jpg|<span style="font-size:80%">Late trophozoite</span>|link={{filepath:PKLTc.jpg}}<br />
File:PKSc.jpg|<span style="font-size:80%">Schizont</span>|link={{filepath:PKSc.jpg}}<br />
File:PKGc.jpg|<span style="font-size:80%">Gametocyte</span>|link={{filepath:PKGc.jpg}}<br />
</gallery><br />
----<br />
<br />
<br />
'''Brief Summary''' <br />
<br />
*Very limited geographical distribution within S.E Asia<br />
*Small fine ring forms resemble those of ''P.falciparum'' and may have high parasite count<br />
*Later rings are more solid or elongated similar to ''P.malariae'', although faint dots may be present<br />
*Schizonts & gametocytes are often present and may resemble ''P.malariae'' but are less "neat"<br />
*Characteristically red cell size is unaffected, although distortion may be seen<br />
<br />
<br />
''For more information''<br />
*[[''Plasmodium knowlesi'': Morphology|click for full description of ''P.knowlesis'' morphology]]<br />
*[[''Plasmodium knowlesi'': Morfología|haga clic para obtener una descripción completa de la morfología de ''P.knowlesis'']]<br />
*[[''Plasmodium knowlesi'': Gallery|click to visit the gallery of ''P.knowlesi'' forms]]<br />
----</div>Adminhttps://haematologyetc.co.uk/index.php?title=Accol%C3%A9_formAccolé form2024-03-15T09:20:07Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: WhiteSmoke"|<span style="color:navy>'''What is a double dot form?'''</span><br />
<br />
Accolé forms may also be referred to as "edge" or “appliqué” form, and describes parasites in early or late trophozoites where the parasite appears closely opposed to the edge of the erythrocyte membrane - usually appearing to be flattened against the erythrocyte membrane.<br />
<br />
<br />
<gallery mode="nolines" widths=250px heights=250px><br />
File:MFaccole.jpg|link={{filepath:MFaccole.jpg}}<br />
</gallery><br />
<span style="font-size:80%">Note that the parasite is very closely in contact with the red cell membrane (''P.falciparum'' late trophozoite form with maurer's dots and clefts)</span><br />
<br clear=all><br />
<br />
----<br />
<br />
<span style="color:navy>'''Species significance'''</span> <br />
<br />
Most often considered to be a feature of p.falciparum infection and when frequent these appearances are helpful to indicate this species. However, the form is not fully specific and examples may occur in any species.<br />
<br />
----<br />
<br />
<span style="color:navy>'''Additional images'''</span><br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:MMaccole.jpg|A|link={{filepath:MMaccole.jpg}}<br />
File:MVaccole.jpg|B|link={{filepath:MVaccole.jpg}}<br />
File:MOaccole.jpg|C|link={{filepath:MOaccole.jpg}}<br />
</gallery><br />
<br />
<span style="font-size:80%">Malaria Accolé forms in: early trophozoite of ''P.malarae'' (A) early trophozoite of ''P.vivax'' (B) and ealy trophozoite of ''P.ovale'' (C). Note the differences in parasite and red cell size and shape and the presence or absence of additional dots<span></div>Johnhttps://haematologyetc.co.uk/index.php?title=Multiple_parasitesMultiple parasites2024-03-15T09:13:37Z<p>John: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:navy>'''What are double infected cells?'''</span><br />
<br />
In some cases more than one parasite (most often early or late trophozoites) can be seen within a single erythrocyte. This is surprisingly frequent suggesting some red cells are ore attractive to parasites, or that already infected cells are more susceptible.<br />
<br />
<br />
<br />
<gallery mode="nolines" widths=250px heights=250px><br />
File:11multiple1.jpg|link={{filepath:11multiple1.jpg}}<br />
</gallery><br />
<span style="font-size:80%">The most frequent form - two early trophozoites of ''P.falciparum'' in a single erythrocyte</span><br />
<br clear=all><br />
<br />
----<br />
<br />
<span style="color:navy>'''Species significance'''</span> <br />
<br />
Most often considered a feature indicating ''P.falciparum'' infection, and is certainly frequent in that species where it can be used to support the diagnosis. However, the form should not considered as specific, and may occur in any species (and is also a frequent finding for babesia parasites). <br />
<br />
----<br />
<br />
<span style="color:navy>'''Additional images'''</span><br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:11multiple2.jpg|A|link={{filepath:11multiple2.jpg}}<br />
File:11multiple3.jpg|B|link={{filepath:11multiple3.jpg}}<br />
File:11multiple4.jpg|C|link={{filepath:11multiple4.jpg}}<br />
</gallery><br />
<br />
<span style="font-size:80%">Double parasites in: late trophozoite of ''P.malaria'' (A) late trophozoite of ''P.vivax'' (B) and late trophozoite of P.ovale (C)</span></div>Johnhttps://haematologyetc.co.uk/index.php?title=Double_chromatin_dot_formsDouble chromatin dot forms2024-03-15T09:08:46Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: WhiteSmoke"|<span style="color:navy>'''What is a double dot form?'''</span><br />
<br />
Early or late trophozoites where the chromatin dot has two separate masses - a double dot that is sometimes said to resemble a signet ring, although this really only applies for typical ring forms where dots are relatively close together. <br />
<br />
<br />
<gallery mode="nolines" widths=250px heights=250px><br />
File:double1.jpg|link={{filepath:double1.jpg}}<br />
</gallery><br />
<span style="font-size:80%">Note how the chromatin dot of the ring form is divided into two purple masses</span><br />
<br clear=all><br />
<br />
----<br />
<br />
<span style="color:navy>'''Species significance'''</span> <br />
<br />
Most often this appearance seen in infection with ''P.falciparum'' and can be helpful to indicate this species; however the form is not fully specific and may occur in any species. <br />
<br />
----<br />
<br />
<span style="color:navy>'''Additional images'''</span><br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:double2.jpg|A|link={{filepath:double2.jpg}}<br />
File:double3.jpg|B|link={{filepath:double3.jpg}}<br />
File:double4.jpg|C|link={{filepath:double4.jpg}}<br />
</gallery><br />
<br />
<span style="font-size:80%">Malaria double chromatin dot forms in: late trophozoite of ''P.ovale'' (A) an early trophozoite of ''P.vivax'' (B) and ealy trophozoite of ''P.knowlesi'' (C)<span></div>Johnhttps://haematologyetc.co.uk/index.php?title=Plasmodium_falciparum:_MorphologyPlasmodium falciparum: Morphology2024-03-14T10:48:00Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
<span style="font-size:80%">(click blue highlighted text to return to page)</span></br></br><br />
<span style="font-size:90%">[[Malaria Index|Malaria main index]]</span></br><br />
<span style="font-size:90%">>[[Species identification: summary page]]</span></br><br />
<span style="font-size:90%">>>This page: <u>''P.falciparum'': morphology</u></span><br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''The early trophozoite'''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:PFETc.jpg|link={{filepath:PFETc.jpg}}<br />
File:PFET-main image.jpg|link={{filepath:PFET-main_image.jpg}}<br />
</gallery><br />
<br clear=all><br />
<br />
<br />
<br />
The earliest growth stage, and may be the only form seen in this species:<br />
<br />
*[[Ring forms]] that are fine and delicate<br />
*Frequently the red cells contain [[multiple parasites]] <br />
*Parasites may have a distinctive [[Double chromatin dot forms|"double dot"]] or signet ring form<br />
*Parasites may appear on the [[Accolé form|accolé forms]] that appear flattened against the cell membrane<br />
*Affected red cells have normal size and haemoglobin content<br />
<br />
<br />
<div style="width: 350px"><br />
{| class="wikitable" style="border-left:solid 4px navy;border-right:solid 4px navy;border-top:solid 4px navy;border-bottom:solid 4px navy; font-size:90%; color:navy; align:center"<br />
| colspan="1"''|[[P.falciparum early trophozoites gallery|Click for ''P.falciparum'' early trophozoite gallery]]''<br />
|}<br />
</div><br />
<br />
<br />
----<br />
<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''The late trophozoite'''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:PFLTc.jpg|link={{filepath:PFLTc.jpg}}<br />
File:PFLT-main image.jpg|link={{filepath:PFLT-main_image.jpg}}<br />
</gallery><br />
<br clear=all><br />
<br />
<br />
<br />
The later growth stage:<br />
<br />
*Parasites resemble early ring forms, but are thicker and may be slightly larger<br />
*Additional blue/grey dots and clefts are seen in red cell cytoplasm when [[stained correctly]] <br />
*These dots have low number a characteristic "dot" or "line" form [[Maurer's dots and clefts]]<br />
*[[Red cell size and shape|Size and shape]] of infected red cells is usually unaffected, but may become crenated<br />
*The [[Double chromatin dot forms|double dot]], [[Accolé form| accolé]], and [[multiple parasites|multiple parasite]] forms remain present<br />
<br />
<br />
<div style="width: 350px"><br />
{| class="wikitable" style="border-left:solid 4px navy;border-right:solid 4px navy;border-top:solid 4px navy;border-bottom:solid 4px navy; font-size:90%; color:navy; align:center"<br />
| colspan="1"''|[[P.falciparum late trophozoites gallery|Click for ''P.falciparum'' late trophozoite gallery]]''<br />
|}<br />
</div><br />
<br />
<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''The schizont'''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:PFSc.jpg|link={{filepath:PFSc.jpg}}<br />
File:PFS-main image 2.jpg|link={{filepath:PFS-main_image 2.jpg}}<br />
</gallery><br />
<br clear=all><br />
<br />
The asexual form:<br />
<br />
*'''Do not generally circulate in this species unless overwhelming infection'''<br />
*The asexually formed developing "merozoites" cluster untidily <br />
*[[Schizont Development|Schizonts]] develop progressively to form 8-16 merozoites when mature<br />
*In this species the loose [[Malaria pigment|malaria pigment]] may be seen in clumps between the parasites<br />
*Red cell size is generally unaffected but [[Haemoglobin Metabolism|haemoglobin is lost]] (metabolised by the parasites)<br />
<br />
<br />
<div style="width: 350px"><br />
{| class="wikitable" style="border-left:solid 4px navy;border-right:solid 4px navy;border-top:solid 4px navy;border-bottom:solid 4px navy; font-size:90%; color:navy; align:center"<br />
| colspan="1"''|[[P.falciparum schizont gallery|Click for ''P.falciparum'' schizont gallery]]''<br />
|}<br />
</div><br />
<br />
<br />
----<br />
<br />
'''The gametocyte'''<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 5px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''The gametocyte'''<br />
|}<br />
<br />
<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:PFGc.jpg|link={{filepath:PFGc.jpg}}<br />
File:PFG-main image.jpg|link={{filepath:PFG-main_image.jpg}}<br />
</gallery><br />
<br clear=all><br />
<br />
<br />
<br />
The sexual replication form (very distinctive).<br />
<br />
*Gametocytes are elongated but are restricted into typical shape by the red cell membrane <br />
*They parasites are rod shaped but the membrane may cause them to curve into a “[[Banana gametocyte|"banana" form]]”<br />
*The residual membrane (empty of haemoglobin) is often seen as a "blister" to the side of the parasite<br />
*The single chromatin area is in the centre of the parasite, often has [[Malaria pigment|pigment]] overlying it<br />
*Gametocytes may not be be seen, or may be the only form present (particularly after treatment)<br />
<br />
<br />
<div style="width: 350px"><br />
{| class="wikitable" style="border-left:solid 4px navy;border-right:solid 4px navy;border-top:solid 4px navy;border-bottom:solid 4px navy; font-size:90%; color:navy; align:center"<br />
| colspan="1"''|[[P.falciparum gametocyte gallery|Click for ''P.falciparum'' gametocyte gallery]]''<br />
|}<br />
</div><br />
<br />
<br />
----</div>Adminhttps://haematologyetc.co.uk/index.php?title=P.falciparum_early_trophozoites_galleryP.falciparum early trophozoites gallery2024-03-14T10:45:30Z<p>Admin: </p>
<hr />
<div>----<br />
'''Navigation'''</br><br />
[[Plasmodium falciparum: Morphology|Go Back]]<br />
----<br />
<br />
{| class="wikitable" style="border-style: solid; border-width: 4px; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: FFFAFA"|<span style="color:black><br />
{| class="wikitable" style="border-style: solid; border-width: 0px; border-color: #023020; color:black"<br />
|colspan="1" style = "font-size:100%; color:black; background: CBD5CO |'''''P.falciparum'' gallery of early trophozoites'''''<br />
|}<br />
<br />
<br />
<span style="font-size:95%">'''Summary'''</span><br />
<span style="font-size:95%">At this stage we look for typical (and often frequent) delicate rings within red cells that have normal (or slightly crenated) appearance. Forms often seen in this species include accolé forms, double chromatin dot forms, and multiple parasites within infected red cells.<br />
<br />
----<br />
<gallery mode="traditional" widths=240px heights=240px><br />
File:PFET1p.jpg|<span style="font-size:80%">'''Fine ring form''' The small and delicate form of this species</span>|link={{filepath:PFET1p.jpg}}<br />
File:PFET2p.jpg|<span style="font-size:80%">'''Double chromatin dot form''' Two chromatin dots (sometimes known as "signet ring" form).</span>|link={{filepath:PFET2p.jpg}}<br />
File:PFET3p.jpg|<span style="font-size:80%">'''Accolé form''': The arrowed form is closely associated with the red cell membrane</span>|link={{filepath:PFET3p.jpg}}<br />
File:PFET4p.jpg|<span style="font-size:80%">'''Multiple parasites''' Two parasites within a single red cells (arrowed)</span>|link={{filepath:PFET4p.jpg}}<br />
File:PFET5p.jpg|<span style="font-size:80%">'''High parasitaemia''' Most of the typical early trophozoite ''P.falciparum'' forms are present</span>|link={{filepath:PFET5p.jpg}}<br />
</gallery>"</div>Adminhttps://haematologyetc.co.uk/index.php?title=Trophozoites:_diagnostic_guideTrophozoites: diagnostic guide2024-03-13T09:09:47Z<p>Admin: </p>
<hr />
<div>----<br />
<br />
''' ''P.falciparum'' '''<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:MFETr.jpg|link={{filepath:MFETr.jpg}}<br />
File:MFITr.jpg|link={{filepath:MFITr.jpg}}<br />
File:MFLTr.jpg|link={{filepath:MFLTr.jpg}}<br />
</gallery><br />
<br />
''Small and often delicate rings that thicken at later developmental stages although they remain relatively small with a "ring appearance". Note that the red cell size is unchaged and not distorted, also the appearance of characteristic Maurer's dots and clefts within the red cell cytoplasm as the parasites develop. Most frequently only the early developmental stage will be detected in blood''<br />
<br />
----<br />
''' ''P.vivax'' '''<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:MVETr.jpg|link={{filepath:|MVETr.jpg}}<br />
File:MVITr.jpg|link={{filepath:MVITr.jpg}}<br />
File:MVLTr.jpg|link={{filepath:MVLTr.jpg}}<br />
</gallery><br />
<br />
''The trophozoites are usually present at all developmental stages, during parasite development they become solid and irregular developing an increasingly amoeboid appearance. During this development the red cells become markedly enlarged and distorted, with characteristic Schüffner's dots.''<br />
<br />
----<br />
''' ''P.ovale'' '''<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:MOETr.jpg|link={{filepath:|MOETr.jpg}}<br />
File:MOITr.jpg|link={{filepath:MOITr.jpg}}<br />
File:MOLTr.jpg|link={{filepath:MOLTr.jpg}}<br />
</gallery><br />
<br />
''The rings are larger and more robust than in ''P.falciparun'', and they enlarge further during parasite development although in this species the characteristic ring appearance can often still be distinguished even late in development. Note that red cells become enlarged and distorted (typically elongation and fimbriation) with characteristic James' dots.''<br />
<br />
----<br />
''' ''P.malariae'' '''<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:MMETr.jpg|link={{filepath:|MMETr.jpg}}<br />
File:MMITr.jpg|link={{filepath:MMITr.jpg}}<br />
File:MMLTr.jpg|link={{filepath:MMLTr.jpg}}<br />
</gallery><br />
<br />
''The rings are small but generally appear more robust than ''P.falciparum'', the parasites become more solid often losing the central digestive vacuole and may become angular or extend as a band across the cells. Red cells are not enlarged or distorted and are often reduced in size as they mature in this species''<br />
----<br />
''' ''P.knowlesi'' '''<br />
<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:MKETr.jpg|link={{filepath:|MKETr.jpg}}<br />
File:MKITr.jpg|link={{filepath:MKITr.jpg}}<br />
File:MKLTr.jpg|link={{filepath:MKLTr.jpg}}<br />
</gallery><br />
<br />
The earliest forms of ''P.knowlesi'' may closely resemble ''P.falciparum'' with accole forms and multiple parasites in red cells common (often with high parasite number); as the forms mature they often extend and become solid or band-like resembling ''P.malariae''.<br />
----<br />
<br />
'''OTHER DISORDERS TO CONSIDER'''<br />
<br />
'''Babesia'''<br />
<br />
<gallery mode="nolines" widths="200px" heights="220px" ><br />
File:BabRing1.jpg|link={{filepath:|BabRing1.jpg}}<br />
File:BabRing2.jpg|link={{filepath:BabRing2.jpg}}<br />
File:BabRing3.jpg|link={{filepath:BabRing3.jpg}}<br />
</gallery><br />
<br />
The babesia parasite has a ring form that can resemble the rings of ''P.falciparum'' The major distinguishing features are free parasites (arrowed in image 2) that may occur in clumps, large numbers of parasites within cells, and complex forms where the division process leads to linked forms (classically the rarely found "Celtic Cross" appearance. <br />
----</div>Adminhttps://haematologyetc.co.uk/index.php?title=%27%27Plasmodium_falciparum%27%27:_Morphology''Plasmodium falciparum'': Morphology2024-02-26T11:54:37Z<p>Admin: </p>
<hr />
<div><br />
<br />
<br />
----<br />
<br />
'''Geographical distribution'''<br />
<br />
<br />
''P.falciparum'' infection occurs in tropical and subtropical areas of central and South America, Africa, and S.E.Asia; this resembles the distribution of ''P.malariae'' and overlaps but is distinct from the distribution of ''P.vivax'' and ''P.ovale''.<br />
<br />
Detailed geographical information may be accessed here: [https://malariaatlas.org/explorer/#/].<br />
<br />
<br />
----<br />
<br />
'''The early trophozoite'''<br />
<gallery mode="nolines" widths=200px heights=200px><br />
File:PFETc.jpg|link={{filepath:PFETc.jpg}}<br />
File:PFET-main image.jpg|link={{filepath:PFET-main_image.jpg}}<br />
</gallery><br />
<br clear=all><br />
<br />
<br />
<br />
The earliest developing stage, and often the only form present in this species:<br />
<br />
*[[Ring forms]] that are fine and delicate<br />
*Frequently the red cells contain [[multiple parasites]] <br />
*Parasites may have a distinctive [[Double chromatin dot forms|double chromatin dot]] (signet ring form)<br />
*Parasites may appear on the [[Accolé form|edge of the red cell]] and have a flattened appearance (accolé forms)<br />
*Affected red cells have [[Size and shape of infected red cells|normal size]] and haemoglobin content<br />
<br />
<br />
[[P.falciparum early trophozoites gallery|Visit gallery of forms]]<br />
<br />
----<br />
<br />
'''The late trophozoite'''<br />
<br clear=all><br />
[[File:PFLT.jpg|rleft|220px|link={{filepath:PFLT.jpg}}]]<br />
<br clear=all><br />
<br />
<br />
<br />
The later developing stage:<br />
<br />
*Parasites resemble early ring forms, but thicker and slightly larger<br />
*Additional dots and clefts in cytoplasm when stained correctly (blue and relatively low in number). <br />
*These are [[Maurer's dots and clefts]]<br />
*[[Red cell size|Size and shape of infected red cells]] usually unaffected, but may become [[Red cell crenation|crenated]]<br />
*Look for [[Double chromatin dot forms|double chromatin dot]], [[Accolé form| Accolé forms]], [[multiple parasites|multiple parasites/cell]]<br />
<br />
<br />
<br />
<br />
----<br />
<br />
'''The schizont'''<br />
[[File:PFS.jpg|left|220px|link={{filepath:PFS.jpg}}]]<br />
<br clear=all><br />
<br />
<br />
<br />
The asexual replication stage:<br />
<br />
*'''Do not generally circulate in this species unless overwhelming infection'''<br />
*Contain multiple [[Schizonts|asexually formed]] developing parasites (most frequently 8-16) <br />
*[[Schizonts|Development is progressive]]: first there are multiple chromatin dots, later a distinct nucleus and cytoplasm appears<br />
*Loose [[Malaria pigment|pigment]] may be seen in clumps between the parasites<br />
*Red cell size is generally unaffected but haemoglobin will largely be absent (metabolised by the parasites)<br />
<br />
<br />
<br />
----<br />
<br />
'''The gametocyte'''<br />
<br />
[[File:PFG1.jpg|left|220px|link={{filepath:PFG1.jpg}}]]<br />
<br clear=all><br />
<br />
<br />
<br />
The sexual replication stage (very distinctive).<br />
<br />
*Gametocytes are elongated but are also restricted by the red cell membrane <br />
*They appear as [[Macrogametocytes & Microgametocytes|straight rods]] but frequently curve into a “[[Banana gametocyte|banana form]]”<br />
*The residual membrane (empty of haemoglobin) may appear as a "blister" to the side of the parasite<br />
*The single chromatin area is in the centre of the parasite, often [[Malaria pigment|pigment]] overlies or surrounds it<br />
*Gametocytes may not be seen in many cases.<br />
<br />
<br />
----<br />
<br />
'''Gallery'''<br />
<br />
[[PLASMODIUM FALCIPARUM Gallery|Click here to see gallery of ''Plasmodium falciparum'' forms]]<br />
<br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=%27%27P.falciparum%27%27_gallery''P.falciparum'' gallery2024-02-22T11:43:28Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 240px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[Species Main Menu|Return to Species Menu]]''<br />
|}<br />
</div><br />
<br />
----<br />
''' ''P.falciparum'' early trophozoites '''</br><br />
<span style="font-size:95%">'''Summary'''</span><br />
<span style="font-size:95%">At this stage we look for typical (and often frequent) delicate rings within red cells that have normal (or slightly crenated) appearance. Forms often seen in this species include accolé forms, double chromatin dot forms, and multiple parasites within infected red cells.<br />
<gallery mode="traditional" widths=240px heights=240px><br />
File:PFET1p.jpg|<span style="font-size:80%">'''Fine ring form''' The small and delicate form of this species</span>|link={{filepath:PFET1p.jpg}}<br />
File:PFET2p.jpg|<span style="font-size:80%">'''Double chromatin dot form''' Two chromatin dots (sometimes known as "signet ring" form).</span>|link={{filepath:PFET2p.jpg}}<br />
File:PFET3p.jpg|<span style="font-size:80%">'''Accolé form''': The arrowed form is closely associated with the red cell membrane</span>|link={{filepath:PFET3p.jpg}}<br />
File:PFET4p.jpg|<span style="font-size:80%">'''Multiple parasites''' Two parasites within a single red cells (arrowed)</span>|link={{filepath:PFET4p.jpg}}<br />
File:PFET5p.jpg|<span style="font-size:80%">'''High parasitaemia''' Most of the typical ''P.falciparum'' forms are present</span>|link={{filepath:PFET5p.jpg}}<br />
</gallery>"<br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Marker_patterns_erythroid_or_megakaryocyte_differentiationMarker patterns erythroid or megakaryocyte differentiation2024-01-31T10:51:17Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<span style="font-size:90%>'''Acute erythroid leukaemia (AEL)'''</br>This may be a difficult diagnosis since markers will often not allow cells to be distinguished from a reactive erythroid expansion, and the overlap with cases of myelodysplasia-related AML may have a marked erythroid expansion. In such cases the diagnosis of AEL requires careful exclusion of other disorders by correlation with morphology and other tests. <br />
<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
!colspan="2" <span style="font-size:90%; colour:white; text-align:left; border: 1px solid black; background:lightgrey">|'''Markers associated with erythroid differentiation in myeloid precursor neoplams'''</span><span style="font-size:90%; text-align:left; background:white"></span><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''General:''' General markers may vary, but typically patterns are given below:<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;" |There is very weak expression of [[CD45]] and [[HLA-DR]]. In contrast [[CD34]] and often [[CD117]] will be detected.<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Specific:''' Markers of erythroid differentiation are helpful, but require careful interpretation to discriminate from other causes (described below).<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD36]]'''<br />
|colspan="1" style = "font-size:84%;"|Expression is expected, but is not fully lineage specific as it may be seen in other AML forms including cases with monocytic or megakaryocytic differentiation.<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD71]]'''<br />
|colspan="1" style = "font-size:84%;"|A good marker of early erythroid differentiation that is expected to be expressed, although again not fully lineage specific and also found on reactive erythroid precursors.<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD235]]'''<br />
|colspan="1" style = "font-size:84%;"|A good marker of erythroid differentiation; however like CD72 does not distinguish neoplastic and reactive cells. It is acquired later in erythroid differentiation and therefore may not be expressed or be confined to a sub-population in AEL.<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Abberant phenotypic features:''' Some markers are frequently found:<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;" |Expression of [[CD13]], [[CD38]] or [[CD4]] may be encountered in some cases.<br />
</span><br />
|}<br />
</div><br />
<br />
-----<br />
<br />
<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
!colspan="2" <span style="font-size:100%; colour:white; text-align:left; border: 1px solid black; background:lightgrey">|'''Markers associated with megakaryocytic differentiation in AML'''</span><span style="font-size:90%; text-align:left; background:white"><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |This can be tricky initially since [[CD34]], [[CD45]] and [[HLA-DR]] are most often very weak or negative. [[CD13]] and [[CD33]] may be expressed but are not always present. Look for:<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD41]]'''<br />
|colspan="1" style = "font-size:84%;"|Platelet glycoprotein IIbIIIa<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD61]]'''<br />
|colspan="1" style = "font-size:84%;"|Platelet glycoprotein IIIa<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD36]]'''<br />
|colspan="1" style = "font-size:84%;"|Relatively non-specific (seen in erythroid and monocytic leukaemias) but often strongly expressed<br />
</span><br />
|}<br />
</div><br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
!colspan="2" <span style="font-size:100%; colour:white; text-align:left; border: 1px solid black; background:lightgrey">|'''Markers associated with basophilic differentiation in AML'''</span><span style="font-size:90%; text-align:left; background:white"><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |comment<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD22]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD123]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD203]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD11b]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
</span><br />
|}<br />
</div></div>Johnhttps://haematologyetc.co.uk/index.php?title=Marker_patterns_of_other_AML-related_differentiationMarker patterns of other AML-related differentiation2024-01-30T17:24:31Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<span style="font-size:90%>'''Acute erythroid leukaemia (AEL)'''</br>This may be a difficult diagnosis since markers will often not allow cells to be distinguished from a reactive erythroid expansion, and the overlap with cases of myelodysplasia-related AML may have a marked erythroid expansion. In such cases the diagnosis of AEL requires careful exclusion of other disorders by correlation with morphology and other tests. <br />
<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
!colspan="2" <span style="font-size:90%; colour:white; text-align:left; border: 1px solid black; background:lightgrey">|'''Markers associated with erythroid differentiation in AML'''</span><span style="font-size:90%; text-align:left; background:white"></span><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''General:''' In AEL cases may vary but may have very weak expression of [[CD45]] and [[HLA-DR}}. In contrast [[CD34]] and often [[CD117]] will be detected.<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;" |'''Specific:''' Markers of erythroid differentiation are helpful, but require careful interpretation to discriminate from other causes (described below).<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD36]]'''<br />
|colspan="1" style = "font-size:84%;"|Expression is expected, but is not fully lineage specific as it may be seen in other AML forms including cases with monocytic or megakaryocytic differentiation.<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD71]]'''<br />
|colspan="1" style = "font-size:84%;"|A good marker of early erythroid differentiation that is expected to be expressed, although again not fully lineage specific and also found on reactive erythroid precursors.<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD235]]'''<br />
|colspan="1" style = "font-size:84%;"|A good marker of erythroid differentiation; however like CD72 does not distinguish neoplastic and reactive cells. It is acquired later in erythroid differentiation and therefore may not be expressed or be confined to a sub-population in AEL.<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;" |'''Abberant phenotype:''' Expression of CD13, CD38 or CD4 may be encountered in some cases.<br />
</span><br />
|}<br />
</div><br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
!colspan="2" <span style="font-size:100%; colour:white; text-align:left; border: 1px solid black; background:lightgrey">|'''Markers associated with megakaryocytic differentiation in AML'''</span><span style="font-size:90%; text-align:left; background:white"><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |Most often [[CD34]], [[CD45]] and [[HLA-DR]] are weak or negative, although [[CD13]] and [[CD33]] may be expressed<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD41]]'''<br />
|colspan="1" style = "font-size:84%;"|Platelet glycoprotein IIbIIIa<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD61]]'''<br />
|colspan="1" style = "font-size:84%;"|Platelet glycoprotein IIIa<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD36]]'''<br />
|colspan="1" style = "font-size:84%;"|Relatively non-specific (seen in erythroid and monocytic leukaemias) but often strongly expressed<br />
</span><br />
|}<br />
</div><br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
!colspan="2" <span style="font-size:100%; colour:white; text-align:left; border: 1px solid black; background:lightgrey">|'''Markers associated with basophilic differentiation in AML'''</span><span style="font-size:90%; text-align:left; background:white"><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |comment<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD22]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD123]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD203]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''[[CD11b]]'''<br />
|colspan="1" style = "font-size:84%;"|<br />
</span><br />
|}<br />
</div></div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_cytometry:_Myeloid-defining_markersFlow cytometry: Myeloid-defining markers2024-01-13T17:53:06Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<span style="font-size:90%;>To assign myeloid lineage in MPAL, only lineage-defining charateristics should be considered.</span><br />
<br />
<div style="width: 100%; border: 1px solid black; font-size:100%"><br />
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="0"<br />
!colspan="2" <span style="font-size:90%; font-color:navy; style="text-align: left; border: 1px solid black; background:pale gray">|'''Requirements to assign myeloid lineage'''</br></span><br />
<div class="mw-collapsible mw-collapsed" data-expandtext="Click for explanation" data-collapsetext="Hide explanation"><br />
<div class="mw-collapsible-content"><br />
<span style="font-size:80%; text-align:left;"></br>The assignment of myeloid lineage recognises MPO expression to be a defining marker of myeloid lineage. However MPO is expressed only by around 80% of AML cases. The assignment of myeloid lineage can therefore also be made if monocytic lineage can be established, requiring at least 2 of 5 possible lineage markers to be detected (although only 3 of these can be established by flow cytometry).</br><br />
</span><br />
</div></div></div><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 1'''<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''Demonstrate expression of Myeloperoxidase (MPO)'''<br />
|colspan="1" style = "font-size:90%;"|[[MPO|Myeloperoxidase]] expression alone may be sufficient to establish myeloid lineage, but be aware of the limitations: '''(1)''' intensity should be at least half of that of mature neutrophils in at least of proportion of cells measured by the same method; '''(2)''' there are circumstances where judgement is required (see notes).<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 2'''<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''Demonstrate clear evidence of monocytic lineage'''<br />
|colspan="1" style = "font-size:90%;|If MPO is not demonstrated then myeloid lineage may still be assigned through demonstration of monocytic features. This can be assigned by the detection of '''at least two''' of the following features: By flow cytometry: [[CD11c]], [[CD14]], [[CD64]]; by other approaches: '''lysozyme''' or '''non-specific esterase''' in malignant cells (enzyme cytochemistry)<br />
|-<br />
|}<br />
</div><br />
<br />
<span style="font-size:85%;>'''Notes on interpretation of MPO positivity'''</br><br />
The WHO classification advises that MPO expression is assessed by its intensity of expression and includes some flexibility in interpretation. The is based on several considerations:</br><br />
(1) The techniques used to detect MPO do not have the same sensitivity: immunohistochemistry > flow cytometry > enzyme-cytochemistry. This means diagnosis of MPAL may be method dependent – expressing MPO as intensity allows expression to be compared with that of normal cells detected using the same method. For flow cytometry an expression level that is at least half as intense as normal neutrophils provides greater diagnostic confidence.</br> <br />
(2) MPO is not fully specific for myeloid lineage in all cases: this is particularly the case when expression is uniform and dim, so an element of subjectivity is present when interpreting (particularly when detected by more sensitive techniques such as immunocytochemistry).</br><br />
(3) Context of MPO may be important: Applying a threshold of >10% cells being positive for MPO may improve specificity. Detecting variability of expression level of MPO by blast cells may suggest partial maturation and support myeloid lineage origin (often together with variable light scatter). The presence of other myeloid markers may provide greater confidence that MPO is lineage specific. Similarly, be aware of common patterns of aberrancy that are associated with specific alternative diagnoses: Dim (weak) expression of MPO may be a feature of otherwise typical B-LL/LBL; Burkitt-like entities may have strong MPO staining however other investigations will confirm their nature and other myeloid markers will be absent.</span><br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_cytometry:_Myeoid-defining_markersFlow cytometry: Myeoid-defining markers2024-01-13T17:50:56Z<p>John: Blanked the page</p>
<hr />
<div></div>Johnhttps://haematologyetc.co.uk/index.php?title=Table_of_frequent_aberrant_markers_in_AMLTable of frequent aberrant markers in AML2024-01-12T12:11:41Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<div style="width: 100%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background: #bcd4e6"|'''What s the importance of abberent marker expression?'''<br />
|}<br />
</div><br />
The key point is that AML will frequently express immunological markers not typically associated with myeloid lineage. This is aknowledged in diagnostic criteria and providing diagnostic criteria are applied they do not require a change in diagnosis.</br>The most frequent "abberencies" observed in AML are</br><br />
</br>(1) The expression of CD7 by nearly half of cases</br>(2) The expression of CD19 (often associated with particular AML subtypes)<br />
<br />
-----<br />
<div style="width: 100%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background: #bcd4e6"|'''Do abberent markers have patterns?'''<br />
|}<br />
</div><br />
Markers associated with lymphoid maturation that may also be expressed by the lineage maturation, particularly monocytic lineage<br />
CD2 CD4, 36 38 MONOCYTIC 5%<br />
<br />
Frequent abberant markers in AML that are often associated with genetic/cytogenetic subtype: <br />
CD19 30% CBF RUNX1, BCRABL <br />
CD56 CBF RUNX1<br />
NPM1 OFTEN LACK CD34<br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Recognition_of_APL_differentiationRecognition of APL differentiation2024-01-11T22:13:53Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[Atypical patterns of primitive marker expression in acute myeloid leukaemia|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<br />
<span style="font-size:90%">'''Recognition of acute promyelocytic leukaemia'''</span><br />
<br />
[[Image:AML M1.png|130px]] <br />
<br />
<span style="font-size:90%">Typical APL has cells that are hypergranular (A) or may be the microgranular variant (B) generally the cells will have a range of granulation or nuclear appearance. While CD45 expression tends to be weak, in almost all cases the variable morphological features cause a wide range of side-scatter with the abnormal cells often forming a "cloud" extending toward the neutrophil area. This can make the cells (particular hypergranular forms) difficult to distinguish from reactive myeloid populations (or occasionally from MDS). Absent HLA-DR on APL cells can help distinguish from reactive cells (expressing HLA-DR), but correlation with morphology and clinical features and other confirmatory tests are essential to the recognition of APL.''</span><br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Recognition_of_blast_cells_with_monocytic_differentiationRecognition of blast cells with monocytic differentiation2024-01-11T22:10:29Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[Atypical patterns of primitive marker expression in acute myeloid leukaemia|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<br />
<div id="AML_MonoPic"><span style="font-size:90%;">'''Recognition of blast cells with monocytic differentiation'''</span></div><br />
<br />
[[Image:AMLM5A.jpg|130px|caption]]<span style="font-size:90%;"> '''A''' monoblastic AML</span><br />
[[Image:AMLM5B.jpg|130px|caption]]<span style="font-size:90%;"> '''B''' monocytic AML</span><br />
<br />
<span style="font-size:90%">'''Panel A''': Where cells have a monoblastic differentiation (generally large blast cells with primitive chromatin and nucleoli that lack ''monocytic shape'' often with basophilic cytoplasm) the monoblasts tend to express markers of primitive phenotype, while typical antigens of monocytic differentiation may be variable or weakly expressed.'''Panel B''': Where cells undergo more appreciable monocytic differentiation (note the more condensed chromatin, lack of nucleolus, and ''monocytic shape'' of there nucleus) these cells tend to have stronger CD45 expression and often express typical monocyte antigens, primitive markers may be variably expressed or absent.</br></br>*Mixed patterns of monoblastic monocytic and myeloid differentiation within the same case are also frequently found. </br>''Correlation of immunophenotype with morphology and clinical features may be necessary to accurately identify such cells as blasts.''<br />
</span><br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_Cytometry:T-Lymphoid_lineage_assignment_in_MPALFlow Cytometry:T-Lymphoid lineage assignment in MPAL2024-01-09T13:28:03Z<p>John: Created page with "---- <div style="width: 200px"> {| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy" | colspan="1"''|Return to previous page'' |} </div> ---- <div style="width: 95%"> {| class="wikitable" style="border-style: solid; border-width: 5px; color:black" |colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed Pheno..."</p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[Flow cytometry:MPAL|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed Phenotype Acute Leukaemia (MPAL): basics'''<br />
|}<br />
</div><br />
<span style="font-size:90%;">MPAL requires a diagnosis of acute leukaemia (>20% blast cells) but in which differentiation does not occur along a single lineage. This diagnosis is uncommon (2-3% of acute leukaemia).</span><br />
<br />
<span style="font-size:90%;">Flow cytometry provides initial evidence of MPAL. However conclusions may subsequently be modified (e.g. by results of immunohistochemistry, cytogenetics, or genetics). It is important that the provisional nature of flow cytometry assignment of MPAL is acknowledged.</br></br></span><br />
<br />
<span style="font-size:90%;">'''Types and frequency of MPAL types'''</span></br><br />
<span style="font-size:90%;">(1) MPAL with features of Myeloid and B-lineage (MPAL M/B) (>50% cases)</br></span><br />
<span style="font-size:90%;">(2) MPAL with features of Myeloid and T-lineage (MPAL M/T) (>33% cases)</br></span><br />
<span style="font-size:90%;">(3) MPAL with combinations: MPAL B/T (rare) or B/T/M (very rare)</br></span></br><br />
<span style="font-size:90%;">Following further analysis cases may be assigned additionally as:</span></br><br />
:<span style="font-size:90%;">MPAL with t(9;22) (q34.1;q11.2); BCR-ABL1;</span></br><br />
:<span style="font-size:90%;">MPAL with t(v;11q23.3); with KMT2A re-arrangement</span></br><br />
<br />
----<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed phenotype: biphenotypic pattern, bilineal pattern and blast cell number'''<br />
|}'<br />
<br />
</div><br />
<br />
<span style="font-size:90%;">The blast population may express markers of the two separate lineages both on the same cell (bi-phenotypic pattern) in which case blast number must exceed 20%, alternatively the blast cells may have two lineages that co-exist (bi-lineal pattern) in which case the combined blast cell number must exceed 20%.</span><br />
<br />
----<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background:#bcd4e6"|'''Mixed phenotype: diagnosis'''<br />
|}'<br />
</div><br />
<br />
<span style="font-size:90%>To diagnose MPAL, the leukaemia should meet '''at least two of the three criteria''' below:<br />
<span id="anchor_0"></span>.<br />
<div style="width: 90%; border: 1px solid black; font-size:100%"><br />
{| class="wikitable" style="color:black; background-color:white;" cellpadding="0"<br />
!colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Criteria to assign myeloid lineage'''<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;"|The case has '''lineage-defining features''' of myeloid maturation. This allows myeloid lineage to be defined in MPAL</br>[[Flow Cytometry:Myeloid lineage assignment in MPAL|Click here to review criteria for myeloid lineage assignment based on lineage-defining features]]</br></br>'''Note:''' myeloid-associated lineage markers cannot be contribute to myeloid lineage assignment in MPAL.<br />
|-<br />
!colspan="2" style = "font-size:90%; color:black; background:#ddeee1"|'''Criteria to assign B-lymphoid lineage'''<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;"|The case has '''lineage-defining features''' of B-lymphoid maturation. This allows B-lymphoid lineage to be defined in MPAL</br>[[Flow Cytometry:B-lymphoid lineage assignment in MPAL|Click here to review criteria for B-lymphoid lineage assignment]]</br></br>'''Note''' Where T-lineage is also considered the diagnostic value of CD79A is reduced so should not be considered in the lineage assignment.<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |Criteria to assign T-lymphoid lineage<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;"|[[Flow Cytometry:T-Lymphoid lineage assignment|Click here to review criteria for T-lymphoid lineage assignment]]<br />
|}<br />
</div><br />
<br />
----<br />
Consider also:<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_Cytometry:B-lymphoid_lineage_assignment_in_MPALFlow Cytometry:B-lymphoid lineage assignment in MPAL2024-01-09T10:47:00Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[Flow cytometry:MPAL|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<br />
<div style="width: 95%; border: 1px solid black; font-size:100%"><br />
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="0"<br />
!colspan="2" <span style="font-size:90%; font-color:navy; style="text-align: left; border: 1px solid black; background:pale gray">|'''Requirements to assign B-lymphoid lineage'''</br></span><br />
<div class="mw-collapsible mw-collapsed" data-expandtext="Click for explanation" data-collapsetext="Hide explanation"><br />
<div class="mw-collapsible-content"><br />
<span style="font-size:80%; text-align:left;"></br>For B-lymphoid lineage assignment the key lineage-marker is CD19. However, this marker has recognised expression in many cases of otherwise typical AML cases so additional criteria of expression intensity it is required that other markers must be expressed in addition to allow B-lineage assignment. Rarely CD19 is absent in which case a laregr number o other B-cell markers is required.</br><br />
</span><br />
</div></div></div><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 1'''<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;"|'''Required''' [[CD19|Strong expression of CD19]]</br>'''Required also''' ONE of either: [[CD10]], [[CD22]], or [[CD79a]] (surface or cytoplasmic)<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 2'''<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;"|'''Required''' [[CD19|Weak expression of CD19]]</br>'''Required also''' TWO of either: [[CD10]], [[CD22]], or [[CD79a]] (surface or cytoplasmic)<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 3'''<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black;"|[[CD19|CD19 is not expressed]]</br>'''In this rare occurrence then requires''' THREE of either: [[CD10]], [[CD22]], or [[CD79a]] (surface or cytoplasmic)<br />
|-<br />
|}<br />
</div><br />
----<br />
<span style="font-size:85%;>'''Notes on interpretation of B-lineage'''</br><br />
CD19 is considered by WHO to have high but not complete specificity for B-lineage. Its’ use requires the intensity of expression to be considered: “strong” CD19 expression should exceed 50% of the level seen on normal B progenitors in at least some of the leukaemic cells, while weaker CD19 expression has lower specificity and requires stronger additional evidence of B-lineage commitment (see Table above). Note also: (1) CD79a has frequent expression in T-LL/LBL, so should not be used to suggest B-lineage if that disorder is considered. (2) PAX5 identified by immunohistochemistry has a low evidence base in MPAL diagnosis so should be interpreted with caustion. (3) In the absence of CD19 expression, B-lineage may still be assigned if three other B antigens are expressed.</br><br />
</span><br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_Cytometry:Myeloid_lineage_assignment_in_MPALFlow Cytometry:Myeloid lineage assignment in MPAL2024-01-09T10:42:00Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[Flow cytometry:MPAL|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<span style="font-size:90%;>To assign myeloid lineage in MPAL, only lineage-defining charateristics should be considered.</span><br />
<br />
<div style="width: 100%; border: 1px solid black; font-size:100%"><br />
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="0"<br />
!colspan="2" <span style="font-size:90%; font-color:navy; style="text-align: left; border: 1px solid black; background:pale gray">|'''Requirements to assign myeloid lineage'''</br></span><br />
<div class="mw-collapsible mw-collapsed" data-expandtext="Click for explanation" data-collapsetext="Hide explanation"><br />
<div class="mw-collapsible-content"><br />
<span style="font-size:80%; text-align:left;"></br>The assignment of myeloid lineage recognises MPO expression to be a defining marker of myeloid lineage. However MPO is expressed only by around 80% of AML cases. The assignment of myeloid lineage can therefore also be made if monocytic lineage can be established, requiring at least 2 of 5 possible lineage markers to be detected (although only 3 of these can be established by flow cytometry).</br><br />
</span><br />
</div></div></div><br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 1'''<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''Demonstrate expression of Myeloperoxidase (MPO)'''<br />
|colspan="1" style = "font-size:90%;"|[[MPO|Myeloperoxidase]] expression alone may be sufficient to establish myeloid lineage, but be aware of the limitations: '''(1)''' intensity should be at least half of that of mature neutrophils in at least of proportion of cells measured by the same method; '''(2)''' there are circumstances where judgement is required (see notes).<br />
|-<br />
|colspan="2" style = "font-size:90%; color:black; background:#ddeee1" |'''Marker option 2'''<br />
|-<br />
|colspan="1" style = "font-size:90%; color:black;" |'''Demonstrate clear evidence of monocytic lineage'''<br />
|colspan="1" style = "font-size:90%;|If MPO is not demonstrated then myeloid lineage may still be assigned through demonstration of monocytic features. This can be assigned by the detection of '''at least two''' of the following features: By flow cytometry: [[CD11c]], [[CD14]], [[CD64]]; by other approaches: '''lysozyme''' or '''non-specific esterase''' in malignant cells (enzyme cytochemistry)<br />
|-<br />
|}<br />
</div><br />
<br />
<span style="font-size:85%;>'''Notes on interpretation of MPO positivity'''</br><br />
The WHO classification advises that MPO expression is assessed by its intensity of expression and includes some flexibility in interpretation. The is based on several considerations:</br><br />
(1) The techniques used to detect MPO do not have the same sensitivity: immunohistochemistry > flow cytometry > enzyme-cytochemistry. This means diagnosis of MPAL may be method dependent – expressing MPO as intensity allows expression to be compared with that of normal cells detected using the same method. For flow cytometry an expression level that is at least half as intense as normal neutrophils provides greater diagnostic confidence.</br> <br />
(2) MPO is not fully specific for myeloid lineage in all cases: this is particularly the case when expression is uniform and dim, so an element of subjectivity is present when interpreting (particularly when detected by more sensitive techniques such as immunocytochemistry).</br><br />
(3) Context of MPO may be important: Applying a threshold of >10% cells being positive for MPO may improve specificity. Detecting variability of expression level of MPO by blast cells may suggest partial maturation and support myeloid lineage origin (often together with variable light scatter). The presence of other myeloid markers may provide greater confidence that MPO is lineage specific. Similarly, be aware of common patterns of aberrancy that are associated with specific alternative diagnoses: Dim (weak) expression of MPO may be a feature of otherwise typical B-LL/LBL; Burkitt-like entities may have strong MPO staining however other investigations will confirm their nature and other myeloid markers will be absent.</span><br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Tables_of_diagnostic_patterns_associated_with_aberrancy_or_alternative_diagnosis_in_AMLTables of diagnostic patterns associated with aberrancy or alternative diagnosis in AML2024-01-05T11:20:13Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
--------<br />
<br />
[[Flow cytometry:MPAL|Click here for detailed description of MPAL diagnosis]]</br><br />
<br />
[[Flow cytometry:ALAL-NOS|Click here for detailed description of ALAL-NOS use]]</br><br />
<br />
[[Flow cytometry:AUL|Click here for detailed description of AUL diagnosis]]</br><br />
<br />
[[Flow cytometry:ETP-ALL|Click here for detailed description of ETP-ALL]]</br><br />
<br />
[[Flow cytometry:BPDCN|Click here for detailed description of BPDCN diagnosis]]</br></div>Johnhttps://haematologyetc.co.uk/index.php?title=Tables_of_diagnostic_markers_supporting_assignment_of_primitive_phenotype_in_AMLTables of diagnostic markers supporting assignment of primitive phenotype in AML2024-01-05T11:13:42Z<p>John: </p>
<hr />
<div>----<br />
<gallery mode="nolines" widths="120px" heights="200px" border="1px" ><br />
file:ManWithAbs.jpg<br />
</gallery><br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
--------<br />
<br />
[[Markers used to demonstrate primitive nature in AML]]<br />
<br />
[[Atypical patterns of primitive marker expression in acute myeloid leukaemia]]</div>Johnhttps://haematologyetc.co.uk/index.php?title=Tables_of_diagnostic_markers_supporting_lineage_assignment_in_AMLTables of diagnostic markers supporting lineage assignment in AML2024-01-05T10:50:55Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 4px green;border-right:solid 4px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
--------<br />
<br />
'''Markers used to assign myeloid lineage in acute leukaemia'''<br />
<br />
[[Myeloid lineage-defining markers|Table of markers used to assign myeloid lineage in acute leukaemia]] (lineage-defining set)<br />
<br />
[[Myeloid lineage-associated markers|Table of markers used to assign myeloid lineage in acute leukaemia]] (lineage-associated set)<br />
<br />
----<br />
<br />
'''Markers used to refine classification or contribute to diagnosis in difficult cases of in acute leukaemia'''<br />
<br />
[[Additional immunophenotypic markers useful in lineage assignment or subtyping of AML|Additional markers used to classify acute myeloid leukaemia types]] (difficult cases)<br />
----<br />
<br />
'''Markers used to assign B-lymphoid lineage in acute leukaemia'''<br />
<br />
[[Flow Cytometry:B-lymphoid lineage assignment]]<br />
<br />
----<br />
<br />
'''Markers used to assign T-lymphoid lineage in acute leukaemia'''<br />
<br />
[[Flow Cytometry:T-Lymphoid lineage assignment]]<br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_cytometry:ETP-ALLFlow cytometry:ETP-ALL2024-01-04T11:23:24Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
--------<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background:#ddeee1"|'''Early T precursor acute lympholastic leukaemia (ETP-ALL)'''<br />
|}<br />
<br />
<span style="font-size:90%;">The immunophenotype of ETP-ALL requires careful consideration – this reflects that the condition was identified using gene expression profiling rather than by immunophenotype. Using immunophenotype to establish the diagnosis is therefore challenging and may underestimate the number of true cases.* and may not be easily separated from ALAL T/my or T-ALL</br></br>To diagnose ETP-ALL the cells need to meet specific criteria. These are given in the table below:</br></span><br />
<br />
<br />
<div style="width: 95%"; ><br />
{| class="wikitable" <br />
!colspan="2" style = "background:palegrey;border:solid"|'''<span style="font-size:90%;">Requirement 1: Expressed antigens'''</span></br><br />
|-<br />
!colspan="2" style = "background:white;border:solid; font-size:90%;"|1. T-lineage should be demonstrated by [[CD3|cCD3]] expression: (may be heterogenous but should be expressed by ≥25% of blasts) [[Flow Cytometry:T-Lymphoid lineage assignment|See assignment of T-Lymphoid lineage in ETP-ALL]]</span></br><br />
<span style="font-size:90%;">2. One or more myeloid antigen ([[CD11b]], [[CD13]], [[CD33]], [[CD65]], [[CD117]]) and/or stem cell antigens ([[CD34]], [[HLA-DR]]) should be present</span></br></br><br />
<span style="font-size:90%;">Note CD7 is consistently positive in ETP-ALL and does not count as a stem cell antigen in this context</span><br />
|-<br />
!colspan="2" style = "background:palegrey;border:solid; font-size:90%"|'''Requirement 2: Non-expressed antigens'''<br />
|-<br />
!colspan="2" style = "background:white;border:solid; font-size:90%;"|<br />
<span style="font-size:90%;">1. It is required that the following are absent surface-CD3, CD1a and CD8 (<5% of blasts)</br><br />
2. CD5 expression should be absent or dim CD5 expression (<75% positive blasts)</span></br><br />
<br />
<span style="font-size:90%;">CD4 may have the same pattern as CD5 but is not formally included in the definition</span><br />
|-<br />
|}<br />
<br />
----<br />
<br />
<br />
<span style="font-size:90%;">'''NOTES'''</br></span><br />
<span style="font-size:90%;">1.The ETP-ALL immunophenotype may also be established by immunohistochemistry.</br>2. Distinction from mixed-phenotype acute leukaemia (MPAL) requires that MPO is not expressed - in this context of ETP-ALL the WHO advocate a threshold of <3% to define negative myeloperoxidase expression (by cytochemistry or flow cytometry). This threshold is different from that of T/myeloid MPAL so may not be optimal but is retained at present.<br />
</br>3. T-ALL cases that have an immunophenotype similar to ETP-ALL but where CD5 is expressed (≥75% of blasts) may be designated as “near-ETP-ALL”, but the clinical implications of such a designation remain unclear.</span><br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=ETP-ALLETP-ALL2024-01-04T10:59:52Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
ETPs are recent immigrants from the bone marrow (BM) to the thymus, derived from hematopoietic stem cells, which retain a certain level of multilineage pluripotency.7,8 By gene expression profiling, ETP cells share similarities with hematopoietic stem cells and myeloid progenitor cells.5 The definition of ETP-ALL/LBL is based on the immunophenotype of the leukemic cells, which are typically CD1a−, CD8−, CD5− (dim), and positive for 1 or more stem cell or myeloid antigens.5 In the World Health Organization (WHO) classification, ETP-ALL/LBL falls within the early T-ALL/LBL category. ETP ALL has been reported in 11% to 12% of childhood T-ALL/LBL5,9 and in 7.4% of adult T-ALL/LBL.9 ETP-ALL/LBL is also characterized by a distinct molecular profile with a lower incidence of NOTCH1 mutations and frequent presence of FLT3 and DNMT3A mutations.6,10-12<br />
<br />
ETP-ALL had a characteristic immunophenotype: CD1a and CD8-negative, CD5-negative, or dim (<75% of blasts positive) with one or more stem cell/myeloid markers positive (≥25% of blasts positive) (6). This served as the rationale for defining ETP-ALL under the latest WHO 2017 classification: positive intracytoplasmic CD3 expression and CD7 expression, CD1a-negative, CD8-negative, negative or dim expression of CD5 (<75% positive), and positive (≥25% of blasts population) for at least one stem cell or myeloid antigen, including CD34, HLA-DR, CD13, CD33, CD117, CD11b, and CD65 (4, 7). CD2 and CD4 may also be positive in ETP-ALL under the latest WHO 2017 classification (4).</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_cytometry:BPDCNFlow cytometry:BPDCN2024-01-02T12:02:50Z<p>John: </p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
<div style="width: 95%"><br />
{| class="wikitable" style="border-style: solid; border-width: 5px; color:black"<br />
|colspan="1" style = "font-size:90%; color:black; background:#ddeee1"|'''Blastic plasmacytoid dendritic cell neoplasm (BPDCN)'''<br />
|}<br />
<br />
<br />
This is a rare diagnosis but one that presents some practical diagnostic difficulties since BPDCN is derived from myeloid cells and therefore may have morphological and immunophenotypic characteristics which overlap with typical AML or acute undifferentiated leukaemia. Morphologically the primitive cells may resemble AML or have lymphoid morphology, and a skin rash is present in most cases. In view of the diagnostic overlap, correlation with morphology, histopathology and clinical information is important when making this diagnosis.</br></br><br />
<br />
Using standard diagnostic panels, cases of BPDCN generally have the following features: <br />
*BPCDN typically have features of primitive phenotype: the cells typically lie in the "blast area" - with dim to moderate CD45 expression with low side scatter. CD7, TdT, CD38 and HLA-DR are frequently expressed. '''CD34 is characteristically absent''' <br />
*'''Lineage-defining markers of myeloid, T or B cell are not expressed''': i.e. there is no expression of MPO, CD14 or lysozyme; cCD3 is not expressed, and CD19 is not expressed (as well as CD20, cCD22, CD79a) <br />
*'''One or more myeloid lineage-associated features may be detected''': expression of CD33 is relatively common (>50%), CD117 may also be expressed (<20%), CD13 may be found although is infrequent (<5%). Therefore cases may fit the criteria to assign myeloid lineage (two myeloid-associated markers).<br />
</br>Diagnosis is then based on specific criteria:<br />
<br />
<div style="width: 95%"; ><br />
{| class="wikitable" <br />
!colspan="2" style = "background:palegrey;border:solid"|For cases meeting the criteria above, then the following are required:</br><br />
|-<br />
!colspan="2" style = "background:white; font-size:90%; border:solid; "|Cells of BPDCN will express: '''bright [[CD56]] and/or [[CD4]]'''<br />
|-<br />
!colspan="2" style = "background:palegrey;border:solid"|Then will also meet either Criteria set 1 '''OR''' Criteria set 2</br><br />
|-<br />
!colspan="1" style = "background:white;border:solid; font-size:90%;"|Criteria for BPCN (set 1)<br />
!colspan="1" style = "background:white;border:solid; font-size:90%;"|'''[[CD123]] expressed''' together with one of: CD303, CD304, TCF4, TCL1<br />
|-<br />
!colspan="1" style = "background:white;border:solid; font-size:90%;"|Criteria for BPCN (set 2)<br />
!colspan="1" style = "background:white;border:solid; font-size:90%;"|'''[[CD123]] not expressed''' but at least three of CD303, CD304, TCF4, TCL1 are expressed<br />
|}<br />
<br />
----</div>Johnhttps://haematologyetc.co.uk/index.php?title=Flow_cytometry:ALAL-NOSFlow cytometry:ALAL-NOS2023-12-31T13:11:18Z<p>John: Created page with "---- <div style="width: 200px"> {| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy" | colspan="1"''|Return to previous page'' |} </div> ---- Reserved for cases where a primitive haematopoietic malignancy is established but where confident assignment to any specific category is not possible. This diagnosis is rar..."</p>
<hr />
<div>----<br />
<div style="width: 200px"><br />
{| class="wikitable" style="border-left:solid 5px green;border-right:solid 5px green;border-top:solid 5px black;border-bottom:solid 5px black; font-size:90%; color:navy"<br />
| colspan="1"''|[[The flow cytometric diagnosis of AML|Return to previous page]]''<br />
|}<br />
</div><br />
<br />
----<br />
<br />
Reserved for cases where a primitive haematopoietic malignancy is established but where confident assignment to any specific category is not possible.<br />
<br />
This diagnosis is rarely indcated as a final classification since almost all cases can be ascribed to an existing group.<br />
However, as a provisional diagnosis the term can have some value in cases where additional immunohistochemistry or molecular test results are awaited that might provide further diagnostic certainty.<br />
<br />
----</div>John