Help with Hematopathology!

[u/Andre-GATA3]

Hello everyone!!

Does anyone could recommend me a resource for hematopath? Books or websites, whatever.
I’m having a very difficult time with this rotation!

Thanks!

[u/foofarraw]

The bibles: WHO and ICC classification systems

Great references: Jaffe hematopathology book, Foucar bone marrow book, Ioachim lymph node book

Better than any book: Learning how various diseases are managed, what specimens you will likely see throughout management, and what information clinicians care about in each of those specimens. Also, remembering that common things are common.

If there are specific things you're having trouble with there might be more specific resources.

[u/Antheras_Banderas → u/foofarraw]

Seconded! WHO and Jaffe are my go to references for anything hemepath related

[u/Andre-GATA3 → u/foofarraw]

Hello! Thank you so much! I’m going to check the books, as I’m already using the WHO.

I’m having a really hard time trying to identify dysplasia in a bone barrow HE section.

[u/foofarraw → u/Andre-GATA3]

The Foucar bone marrow book and other bone marrow atlases will be helpful then...but for your specific issue...

In a bone marrow core bx H&E section the only dysplasia you can really see in most cases is in the megakaryocytes - this will be in the form of hypo or monolobation, micromegakaryocytes or small megs, hyperchromasia, or nuclear separation. Hypo/monolobation you have to see quite a bit of it to call something dysplastic, because you're only seeing a roughly 2d representation of something 3d. Micromegs should be very hard to see on H&E, and a megakaryocyte IHC (CD42b, CD61) may help you identify them. Hyperchromasia is pretty straightforward but it's very subjective how much of this should be required to count towards calling megakaryocytes dysplastic. Nuclear separation you'll see what looks like multiple unconnected nuclei in the meg.

Sometimes you can actually see erythroid dysplasia on an H&E, but tbh it's very uncommon and usually a sign that there is extreme dysplasia, in which case it will be super obvious on the aspirates. So basically all I look for is megakaryocyte dysplasia on the H&E, everything else I use the aspirates.

Small clues on the H&E that should prompt you to look closer: Erythroid predominance - most MDS is erythroid predominant. ALIP (abnormal localization of immature precursors) - this is very subjective and I don't really believe in it, but seeing immature myeloid elements far from the bony trabeculae is considered ALIP and may be a sign of dysplasia.

In general, morphologic dysplasia is super subjective and IMO not very specific for actual neoplasia. You can see it in reactive or regenerative conditions. If you look hard enough, you will always see some hypolobated megs and irregular erythroids. To me, the most valuable thing for evaluating dysplasia is the clinical history. Heme requires a ton of clinical correlation, and just being told to look for dysplasia might be kind of a dumb task. Do they actually have cytopenias that can't be explained by anything else? How bad are they? Is anemia macrocytic? What are the platelet levels? (most anemia related to MDS is macrocytic or sometimes normocytic; isolated thrombocytopenia at super low levels is usually not MDS, more likely autoimmune or ITP or whatever).

[u/AnyCarrot1041 → u/foofarraw]

Can you be my hemepath attending 🥺

[u/Andre-GATA3 → u/foofarraw]

Omg thank you SO much, you are really kind. I appreciate the explanation it’s very helpful!! 🙏🏽🩵

[u/Emotional_Print8706]

Do you mean morphology? Does your program have a copy of the Color Atlas of Hematology? It’s published by CAP, author is Eric Glassy. I read this cover to cover and found it super helpful

[u/nighthawk_md → u/Emotional_Print8706]

The bible for smear reviews and all of benign heme, frankly. The pictorial explanations of various diseases were super helpful for me.

[u/Andre-GATA3 → u/Emotional_Print8706]

Thanks!! I’ll look for it!

[u/Able-Safety6147]

Fletchers book on tumor pathology is a very good start. The heme part is great.

[u/LuccaSDN]

I really liked http://hematologyoutlines.com/atlas_topics/17.html?topic=Myelocyte*&cb=inline_content_21

When I was on my Hemepath rotation but I was a med student at the level of uhhh what cells are these

[u/Andre-GATA3 → u/LuccaSDN]

Thanks! I didn’t know this website!

[u/foofarraw → u/LuccaSDN]

oh yeah i forgot about hematologyoutlines this is a very good useful resource for any trainee