Diphyllobothrium latum Sushi

itadakimasu!

TAPE WORMS: Diphyllobothrium latum. Ugh. I always found it kind of gross that these tape worm segments (proglottids) break off into your stools, releasing all those little eggs. We were told by our hematopathologist professor that you can get this tapeworm from eating raw fish. Because I really like sushi, this kind of disturbs me. It doesn't stop me from eating sushi though, just like how all the coronary artery disease lectures haven't stopped me from eating fried chicken and pizza.

The relevance behind Diphyllobothrium is its relationship to vitamin B12 deficiency (vitamin B12 is also known as cobalamin). This tape worm will end up absorbing all the body's B12, which will eventually lead to a vitamin B12 deficiency induced macrocytic anemia characterized by the presence of megaloblasts and hypersegmented neutrophils. Remember, B12 is an important for DNA synthesis and is needed in the enzymes L-methylmalonyl-CoA mutase and methionine synthase. You will see elevated levels of both L-methylmalonyl-CoA and homocysteine in a vitamin B12 deficient patient. 

Hemophilia

Poisoned, shot four times, beaten, and drowned.

Rasputin: what a legend. The fact (rumor?) that it took poison, multiple gunshots, and finally a little bit of drowning to successfully murder him makes him seem almost supernatural. (Hey, remember that animated Anastasia movie?)

But on a more relevant note, Rasputin was also known for his role as the "healer" of Alexei Nikolaevich, Tsarevich of Russia. Alexei suffered from hemophilia, which is a bleeding disorder. In fact, a couple of royal descendants of Queen Victoria were hemophiliacs (oh those silly inbreeders, not that I'm judging). There are a variety of hemophilia disorders, but the two types of most significance are hemophilias A and B. 

Hemophilia A (the most common hemophilia) is an X-linked recessive disorder resulting in a deficiency of Factor VIII in the coagulation cascade. 

Hemophilia B is an X-linked recessive disorder resulting in a deficiency of Factor IX in the coagulation cascade. The deficiencies in factors VIII and IX will contribute to ineffective formation of fibrin (= ineffective clotting). 

Note that a common complication of hemophilia is hemophilic arthropathy, where there is bleeding in the joints that may result in joint deformities if left untreated. 

Granulocyte Development: Band Forms

Who remembers Planter's Cheez Balls?

Band forms: these are the cells that are one step away from differentiating into neutrophils. Compared to neutrophils (which typically have a multi-lobed nucleus), band forms have a nucleus that is more horse-shoe shaped. (I think they look more cashew/peanut shaped though, hence the Planter's peanuts nucleus). Band forms may increase in the presence of an infection. 

The development of granulocytes (note that they all contain granules!) follows this order:

Myeloblasts
Promyelocytes
Myelocytes
Metamyelocyte
Band form
Neutrophil

A mnemonic for granulocyte development: Mother, Please Make My Bed.

Hemolytic Uremic Syndrome (HUS)

HAMBOIGER

This was supposed to be a play on Pizza Hut --> Burger Hut --> Burger HUS? The attempt to be somewhat clever falls flat. 

ANYWAY: Hemolytic Uremic Syndome (HUS) presents as a triad of symptoms including hemolytic anemia, renal failure, and thrombocytopenia. Childhood-type HUS is associated with Escherichia coli O157:H7 (a gram negative rod that that expresses a Shiga-like toxin). Try not to eat undercooked hamburgers if you can!

FYI: HUS is classified as a thrombotic microangiopathy. Also, I'm probably wrong about E. coli being flagellated.

     

Auer Rods - Acute Myelogenous Leukemia - Part 2

Tick tock

More AML fun facts!

Cytogenetic abnormalities in AML may include t(8;21), inv(16), t(15;17), and monosomies/deletions in chromosomes 5 and 7. 

t(15;17) is associated with PML (acute promyelocytic leukemia) where there is a fusion of the PML protein with retinoic acid receptor-α (RARα). Remember to treat with ATRA. 

AML can also develop secondarily after treatment with topisomerase II inhibitors. This can result in MLL gene rearrangements on chromosome 11q23.

Auer Rods - Acute Myelogenous Leukemia - Part 1

LOL ROFLMAO BBQ WTF?

Auer rods: azurophilic needles/rods in myeloblasts. Seen in Acute Myelogenous Leukemia (AML).

AML is diagnosed when there are >20% blasts in the bone marrow.

Click here for a little more information on FML.

Reed Sternberg Cell - Hodgkin's Lymphoma

Hoot Hoot!

Reed Sternberg cell: giant B-lymphocyte-derived cells that have an owl's eye appearance. Found in Hodgkin's Lymphoma. 

Remember: they're CD15 and CD30 positive