Technical difficulties

I apologize...but right now I can't post new information due to the fact that the computer that I used to download pictures is down. Sorry for the incovenience.
Regards,
Luis

Christmas

Christmas is getting there and I received yesterday the gifts from my family....each one of them sent me a gift....but I guess from all the gifts that I received ..the one that I really like it was all the love on the postcards...I received a postcard in Spanglish(half spanish and half english)...and was hilarious....I missed so much my family, friends and specially my daughter. I asked Santa if he can bring me for christmas some company....but just a good one.....hope he bring me what I asked for christmas....

Some pictures to share

Smudge Cell in a Patient with Chronic Lymphocytic Leukemia Immersion Oil 100x
Gram positive cocci in chains in positive blood culture Streptococcus pneumoniae Immersion oil 100x
Prolymphocyte in peripheral blood smear Immersion Oil 100x
Trichomonas vaginalis in a Wet mount Immersion Oil 100x
Blast Cell in Peripheral Blood Smear Immersion Oil 100x
Blast Cell and Stomatocyte in Peripheral Blood Smear Immersion Oil 100x


All this pictures have been taken at the Foote Hospital in Jackson,MI
Some coworkers have collaborated by let me know when there is something interesting to take pictures of....They are great people....All this pictures and related diseases will be discussed in details later....I just want to share this pictures with my colleague technologist.

Sideroblastic Anemia

Sideroblastic Anemia is anemia associated with mithochondrial iron loading in erythroid precursors in the bone marrow and also associated with defective production of red blood cells. Causes of this type of anemia include:
a. Congenital defect (Hereditary Sex linked, autosomal in males)
b. Adquired defect
c. Association with malignant disordes like Acute Myelogenous Leukemia, Polycythemia vera, Myeloma or Myelodysplastic disorders.
d. Secondary to drugs like chloramphenicol,after chemotherapy,toxins like alcohol and chronic lead poisoning.
For the diagnosis of this type of anemia we based the variable red cell indices, microcytic hypochromic, increased serum iron, increased serum ferritin and ringed sideroblast in a bone marrow aspirate. The body have adequate iron but is unable to incorporate it into the hemoglobin synthesis. At least 10% of people with this disorder will develop Acute Leukemia (discussed further).

Ringed Sideroblast = Iron granules accumulates in the nucleus of the metarubricytes(Normoblast) forming this type of cells. Metarubricyte is one of the stage of the red blood cell development.

Iron Deficiency Anemia

Even with efforts by the US Goverment to combat this very common anemia still its prevalence. More common in women and childs than men. Iron deficiency anemia can occur from the following conditions; Nutritional deficiency, incomplete iron absorption, increase demand of iron or excessive loss of iron. Nutritional deficiency can occur if not enough iron is taken by dietary or from an imbalanced vegetarian diet. Incomplete iron absorbtion can occur in diseases like celiac disease, sprue, resection of the small vowel or absence of factors for the iron intake. Increase demand ocuur in childhood, pregnancy or increase period of blood regenaration. Excessive loss of iron can occur from chronic blood loss, heavy menstruation or abnormalities on the gastrointestinal tract. Laboratory findings in this type of anemia include hypochromic and microcytic anemia, Hemoglobin and hematocrit decreased, decreased MCV,MCH and MCHC, increase serum iron, increase tottal iron binding capacity, increase percentage of saturation and decreased ferritin ( iron storage). In this picture you can see a lymphocyte which is our reference about size. Usually the red cells are almost the same size of the nucleus of the lymphocyte.Also can be notice a bigger central pallor ( hypochromia).
Iron Deficiency Anemia
( Microcytic Hypochromic) 100 x Immersion oil

Chronic Blood Loss Anemia

Chronic blood loss anemia can be related with heavy menstruation in women,urinary tract abnormalities and very often with disorders in the gastrointestinal tract. The blood loss is usually in small amounts for extended period of time. This blood loss does not disrupt the blood volume. At the beggining the anemia seen can be normochromic and normocytic until the iron storage is depleted. Once the iron storage is depleted can be seen hypochromic and microcytic anemia. White blood cell count is normal and platelets can be increased. A person with gastrointestinal bleeding can present a positive fecal blood test (occult blood in feces).

Acute Blood Loss Anemia

Acute blood loss anemias are related with severe injury, accidents or surgery.
Acute blood loss does not produce immediate anemia but the body will adjust to the situation by increasing the volume using the fluid from the extravascular spaces having a diluting efect on the remaining cells which eventually produce the anemia.
The following results can be seen in a patient with acute blood loss:
Increase white blood cells and platelets. Volume disruption with no iron deficiency.
Hematocrit and reticulocyte ( immature red blood cells) usually normal.
After the hemorrhage takes about 48 t0 72 hours for hemoglobin and hematocrit falls and the anemia becomes apparent. When reticulocytes increased in the circulation a transient macrocytosis develops ( around 3 to 5 days after the blood loss). Everything would go back to normal after the replacement of the blood loss by transfussion if neccesary. Perhaps some of the red cell values will take longer to get back to normal.

Abnormal RBC"s

Poikilocitosis.
100x Immerssion oil
Anisocytosis. 100x Immersion oil.
Hypochromia. 100x Immersion Oil

I willl post more pictures as soon as I receive it at the hospital.

Anemias

Anemia is something very common and is defined as the hemoglobin and or hematocrit below the lower limit within the 95% reference interval for age,sex and geographic location. From that at least 2.5% of individuals are classified as anemic. Anemias can be absolute or relative. Absolute refers to a decreased red cell mass and relative as a higher plasma volume. Absolute anemia fall into two major pathophysiologic categories: impaired cell production and increased cell destruction and loss in excess in which the bone marrow can't replace these loses. The presence of anemia maybe a bad sign of an underlying condition in which such identification is important to correct it. Relative anemia in which the plasma volume increasse can occur in pregnancy, macroglobulinemia and splenomegaly.
I will defined these terms later. Anemias can be classified by pathophysiology or red cell morphology. When is classified by red cell morphology we have three major categories....Normocytic,Microcytic or Macrocytic. Signs of anemia can be; easy fatigability, dyspnea or difficult to breath, faintness, vertigo, palpitation and headache. Physical findings include; pallor, a rapid bounding pulse, low pressure, fever, edema and systolic murmurs. Also there is a classification of anemias associate with the pathophysiology(reason):
Categories of Anemias by Pathophysiology:
A. Blood Loss
1. Chronic
2. Acute
B. Hemolytic
1. Acquired disorders
2. Inherited defects
C. Impaired Production
1. Iron deficiency
2. Chronic Disease
3. Megaloblastic
4. Sideroblastic
5. Aplastic
D. Hemolytic hemoglobin disorders (Hemoglobinopathies)
We will discussed each one in details, laboratory findings and treatment if neccesary.