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
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