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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2768_Библиотеки_им_академика_М_И_Перельмана
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Chapter 20 Morphologic Changes After Myeloid Hematopoietic Growth Factors
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197
A
B
FIGURE 20.3 (A) Immature asynchronous granulo-
cyte. (B) Mature neutrophil with toxic granulation.
A
B
C
FIGURE 20.4 (A) Giant asynchronous immature gran-
ulocyte. (B) Hypogranular neutrophil with a Döhle
body. (C) Granulocyte with normal granulation.
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CHAPTER 21
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MICROORGANISMS
200
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SECTION 5 Miscellaneous
PLASMODIUM SPECIES
The following examples are representative of the developmental stages of malaria
that can be seen in the peripheral blood. Detailed criteria for identication of species
may be found in a parasitology text.
A
FIGURE 21.1A Plasmodium species. Rings (A) applique
form (B), and platelet on RBC (C) (PB ×1000). Platelets on
top of RBC often have a halo, or clear area surrounding
the platelet.
C
FIGURE 21.1C Plasmodium vivax schizont in a thin peripheral
blood lm. Note the number of merozoites and the
presence of brown hemozoin pigment.
(Courtesy Indiana Pathology Images.)
FIGURE 21.1B Plasmodium falciparum (arrow) crescent
(banana-shaped) gametocyte in thin peripheral blood
lm. (PB×1000).
(Courtesy Indiana Pathology Images.)
D
FIGURE 21.1D Two Plasmodium vivax trophozoites in
a thin peripheral blood lm. Note that the infected
red blood cells are enlarged and contain Schüffner
stippling, and the trophozoites are large and ameboid
in appearance, (PB ×1000).
(From Keohane E.A., Smith L., Walenga J. (Eds.)
(2016). Rodak’s hematology: clinical principles and
applications. (5th ed.). St. Louis: Saunders Elsevier.)
BABESIA SPECIES
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B
CHAPTER 21 Microorganisms
201
FIGURE 21.2A Babesia microti (PB ×1000).
FIGURE 21.2B Babesia microti (PB ×1000).
DESCRIPTION: Babesia species may be confused morphologically with Plasmodium falciparum, but lack of
pigment and absence of life cycle stages help differentiate Babesia spp. from P. falciparum. Extracellular
organisms (Figure 21.2, arrows) are more often seen in Babesia spp. Travel history is the best way to
differentiate between Babesia and Plasmodium
DESCRIPTION: Babesia species may be confused
morphologically with Plasmodium falciparum,
but absence of life stages as well as presence of
Maltese Cross helps to differentiate Babesia spp.
from P. falciparum. Extracellular organisms
(Figure 21.2A, arrows) are more often seen in
Babesia spp. Travel history is the best way to differentiate between Babesia and Plasmodium
C
FIGURE 21.2C Characteristic Maltese Cross of Babesia (arrow)
(PB×500).
(Courtesy George Girgis, CLS, IU Health.)
202
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SECTION 5 Miscellaneous
LOA LOA
FIGURE 21.3 Loa loa, a microlaria (PB, original magnication ×1000).
DESCRIPTION: Loa loa is a microlaria (Figure 21.3). Other microlariae may be seen in the peripheral blood.
Differentiation of microlariae may be challenging. Consult a parasitology/microbiology text, such as
Mahon and Lehman’s Textbook of Diagnostic Microbiology, 5th ed.
TRYPANOSOMES
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CHAPTER 21 Microorganisms
203
A
FIGURE 21.4A Trypanosoma brucei gambiense
(Giemsa stain, PB ×1000).
DESCRIPTION: Trypanosomes are examples of hemoagellates that may occasionally be encountered in the
peripheral blood (Figure 21.4A and B). Differentiating features may be found in a parasitology text.
B
FIGURE 21.4B Trypanosoma cruzi (Giemsa stain,
PB ×1000).
204
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SECTION 5 Miscellaneous
FUNGI
B
A
A
FIGURE 21.5A Histoplasma capsulatum (arrow) in neu-
trophil (PB ×1000).
B
FIGURE 21.5B Intracellular (A) and extracellular (B) yeast
in peripheral blood of an immunocompromised patient
(PB ×1000).
C
FIGURE 21.5C Cryptococcus neoformans (arrow)
(BM ×1000) (see also Figure 24.14).
BACTERIA
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CHAPTER 21 Microorganisms
205
A
FIGURE 21.6A Bacilli engulfed by a leukocyte. Note
vacuoles (PB×1000).
B
FIGURE 21.6B Extracellular bacteria from same spec-
imen as Figure 21.6A. Extracellular bacteria alone
may indicate contamination. Presence of intracellular bacteria may rule out contamination (PB ×1000).
C
FIGURE 21.6C Cocci engulfed by a monocyte
(PB ×1000).
D
FIGURE 21.6D Multiple organisms, including yeast and
cocci; most likely contamination from an intravenous
line (PB ×1000).
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SECTION 5 Miscellaneous
E
FIGURE 21.6E Anaplasma phagocytophilum (arrow) in
a neutrophil (PB ×1000).
F
FIGURE 21.6F Ehrlichia chaffeensis (arrow) in a mono-
cyte (PB ×1000).
(Courtesy J. Stephen Dumler, MD, Division of
Medical Microbiology, The Johns Hopkins Medical
Institutions, Baltimore, MD.)
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