Apus darah tepi

Pembuatan apus darah tepi

Apus darah tepi : CITO

• Lekemi akut

• Lekemi kronik

• Anemi aplastik

• ITP

• Anemi hemolitik

Diagnosis klinis

Gejala dan tanda Anemi

Organomegali (+) Organomegali (-)

Anemi hemolitik

Anemi Fe defisiensi

Diagnosis klinis

Anemi + manifestasi perdarahan

Organomegali (+) Organomegali (-)

Lekemi akut

MDS

Sindroma Evans

Anemi aplastik

Diagnosis klinis

Manifestasi perdarahan kulit, mukosa

ITP

Apus darah tepi

Diagnosis

Tindakan

Transfusi

PRC WRC Trombosit

Steroid

ADT : lokasi eritrosit

Kepala

Badan

Ekor

ADT : lokasi lekosit

12 3

4

4

4

1 : kepala

2 : ekor3 : Limfosit

4 : granulosit, monosit

ADT : pembesaran 10x

• Perkiraan jumlah lekosit

Normal : 25-40 lekosit / lapang pandang

• Dugaan lekemi : monoton

ADT (10X)

Normal

ADT (10X)

Lekopeni

ADT (10X)

Lekositosis

ADT (10X)

Lekositosis, monoton : lekemi

ADT (40X)

• Perkiraan jumlah lekosit : hitung 10 lapang pandang = N

N x 2000

10Jumlah lekosit =

ADT (100x)

• Morfologi eritrosit, lekosit, trombosit

• Jumlah trombosit

ADT (100X)

Hemolitik (+) Hemolitik (-)

Eritrosit

ADT (100x) : eritrosit

Polikromasi, normoblast Anemi hemolitik

ADT (100x) : eritrosit

Polikromasi Anemi hemolitik

ADT (100x) : eritrosit

Anemi hemolitikPolikromasi, normoblast

ADT (100x) : eritrosit

Anemi hemolitikPolikromasi, normoblast

ADT (100x) : eritrosit

Normokrom normositer

ADT (100x) : eritrosit

Hipokrom mikrositer Fe defisiensi

Hipokrom mikrositer : fe defisiensi

ADT (100x) : eritrosit

Hipokrom mikrositer, normoblast, target cell

Talasemia

ADT (100x) : eritrosit

Roulleoux, sel plasma Mieloma multipel

ADT (100x)

sel plasma Mieloma multipel

ADT (100x)

sel plasma Mieloma multipel

Sel plasma (flame cell) : bone marrow

Sel plasma (flame cell) : bone marrow

Bone marrow

ADT (100x) : eritrosit

Tear drops Mielofibrosis

ADT (100x) : eritrosit

Burr cell MAHA

ADT (100x) : eritrosit

schistocyte MAHA

ADT (100x) : eritrosit

Burr cell, schistocyte MAHA

ADT (100X) :lekosit

Lekemi (+)Lekemi (-)

Akut Kronis

ALL AML CLL CML

Lekemi : klinis

Akut Kronis

Keluhan utama

Trombosit

Perdarahan

Trombositopeni

Organomegali

Anemi

Normal

Trombositosis

Trombositopeni

Lekemi akut : klinis

ALL AML

Umur

Organomegali

Hipertrofi gusi

Muda

+++

-

Tua

+/-

+

Lekemi kronik : klinis

CML CLL

Umur

Organomegali

30-50

Lien +++

50-60

Limfadenopati

Lien +

ADT (100x) : lekosit

Blast , anak inti 1-2, monoton, sitoplasma sedikit, smudge cell

ALL

ADT (100x) : lekosit

Blast , anak inti 1-2, monoton, sitoplasma sedikit, smudge cell

ALL

ADT (100x) : lekosit

Blast , anak inti 2-5, variasi, sitoplasma banyak

AML

AML

AML

ADT (100x) : lekosit

Blast , anak inti 2-5, variasi, sitoplasma banyak

AML

ADT (100x) : lekosit

AML

ADT (100x) : lekosit

AML

ADT (100x) : lekosit

AMLALL

Promielosit (faggot cell) : AML M3

ADT (100x) : lekosit

Monoton, limfosit matur, smudge cell

CLL

ADT (100x) : lekosit

Monoton, limfosit matur, smudge cell CLL

ADT (100x) : lekosit

Pasar malam CML

CML

Basofil

ADT (10 dan 100x) : lekosit

Lekositosis , dominan batang dan segmen

Reaksi lekemoid : infeksi, paraneoplasma

ADT (100x) : lekosit

Reaksi lekemoid CML

ADT (100x) : lekosit

Limfosit atipik / limfosit plasma biru DHF

Dengue : limfosit atipik

ADT (100x) : lekosit

Pelger Huet anomaly MDS

Granula toksik

Granula toksik

Monosit

ADT (100x) : lekosit

EosinofiliaITP, penyakit mieloproliferatif , infeksi cacing, asma

ADT (100x) : trombosit

• Hitung trombosit 10 lapang pandang = n

Jumlah trombosit = n x 20.000

10

Atau

n x 2000

ADT (100x) : trombosit

• Trombosit cukup :

minimal pada 5 lapang pandang ditemukan 8-20 trombosit

bila ADT tidak homogen, dilihat pada 10 lapang pandang

Stevens ML. Fundamental of Clinical Hematology 1997; p 265

ADT (100x) : trombosit

Trombosit normal (cukup)

ADT (100x) : trombosit

Trombositopeni, giant trombositITP, DHF, Aplastik, Lekemi

Dengue :: giant thrombocyte

ADT (100x) : trombosit

Trombositosis Trombositosis sekunder : infeksi, inflamasi, perdarahan

ADT (100x) : trombosit

Trombositosis, giant trombosit Trombositosis primer

ADT (100x) : trombosit

Trombositosis primer

ADT (100x) : trombosit

Trombositosis primer

ADT (100x) : LEB (lekoeritoblastik)

LEB

• Anemi hemolitik

• Mielofibrosis

• Metastase keganasan ke sumsum tulang

BM : eritropoiesis

Apus sumsum tulang

Normoblast bridging : MDS( internuclear chromatine bridge)

Apus sumsum tulang

Normoblast bridging : MDS( internuclear chromatine bridge)

Apus sumsum tulang

Normoblast bridging : MDS( internuclear chromatine bridge)

Lekosit dengan vacuole ec chloramphenicol