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MOEFOLOGI DARAH MOEFOLOGI DARAH TEPITEPI
NINING SRI WURYANINGSIHNINING SRI WURYANINGSIH
FK UKDWFK UKDW
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MORFOLOGI DARAH TEPIMORFOLOGI DARAH TEPI
• Tujuan melihat morfologi sel2 darah tepi , baik eritrosit, lekosit maupun thrombosit
• Untuk diagnose anemia /causatif, keganasan hematologi
• Untuk evaluasi theraphi
• Syarat: dicantumkan klinis dan hasil hematologi rutin
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Pem. Morfologi EritrositPem. Morfologi Eritrosit
• Identifikasi sel darah secara umum
• Melihat macam kelainan morfologi
• Cara melaporkan (manual):– Daerah baca ; zona IV atau V– Mikroskopis : obyektif 10 X selayang
pandang, obyektif 40x bersamaanhitung jenis lekosit
– Eritrosit berinti (+) berapa sel per 100 lekosit
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Pro Eritroblast Polikromatopilik Eritrosit Basopilik Orthopilik
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Macam kelainan MorfologiMacam kelainan Morfologi
• 3 hal; Ukuran, bentuk, kelainan warna ( 3S )
• Ukuran; mikrosit; makrosit (anisositosis)
• Bentuk; Ovalosit, Eliptosist.Buur sel, Tear drop ( Poikilositosis )
• Warna; hipokrom, hiperkrom , polikromasi
• Gabungan kelainan ukuran dan bentuk
• Benda2 inklusi
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Acanthosit Abeta Lipoproteinemia – Severe Liver disease
Schistosit DIC – Trombositopeni Purpura
Burr Sel Uremia - CRF
Sickle sel Sickle sel anemia
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Stomatosit Liver disease - Alkoholisme
Sperosit Hereditair – Anemia hemolitik
Tear drop Fibrosis - Malignancy
Elliptosit Heriditair anemia
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Stomatosit Liver disease - Alkoholisme
Sperosit Hereditair – Anemia hemolitik
Tear drop Fibrosis - Malignancy
Elliptosit Heriditair anemia
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Makrosit ditemukan pada :
• Defisiensi asam folat dan vitamin B12
• Penyakit hati yang berat• Alkoholisme
• Hipotiroidisme• Post splenektomi• Kontrasepsi oral
• Pansitopenia• Bayi baru lahir 2-3 bulan kehidupan ( Faali )
• Anemia hemolitik• Keracunan obat ( anti metabolit, anti konvulsan )
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Mikrosit ditemukan pada :Anemia defisiensi besiAnemia penyakit kronisThallasemiaAnemia karena bahan toksik
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Hipokrom ditemukan pada :Anemia defisiensi besiThallasemiaKeracunan timah hitam
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Polikromasi ditemukan pada :Perdarahan akut dan kronisHemolisis Pengobatan dengan zat besi, asam folat, vitamin B12
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Sel target ditemukan pada :Penyakit hatiThallasemiaHemoglobinopati ( penyakit, Hb-C, sel sikel )Post splenektomi
Sferosit ditemukan pada :Sferosit herediterAnemia hemolitik didapat ( AIHA, luka bakar )ThallasemiaABO-HDNPenghancuran cepat di RESKelainan hatiReaksi transfusiD I C
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Eliptosit / ovalosit ditemukan pada :Eliptositosis herediterAnemia defisiensi besiThallasemiaAnemia megaloblastikKadang pada anemia hemolitik
Stomatosit ditemukan pada :Sferositosis herediterStomatosit herediterKelainan hatiAlkoholismeKadang pada hemolisis
Sel cerutu / Pensil/ cigar cell-. Anemia defisiensi Fe
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Sel burr ditemukan pada :Penderita uremiaPenyakit hatiKanker lambungPerdarahan ulkus peptikumPengobatan dengan heparinHipotiroidism
Akantosit ditemukan pada :Penyakit hatiKeracunan alkoholA beta lipoproteinDefisiensi vitamin EDefisiensi piruvat kinaseDefisiensi lecitin-kholesterol acyl transferasePost splenektomi
Sel Krenasi :Mengkerut ok cairan hipertonis
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Sel sikel ditemukan pada :Sickle cell disorders / Anemia
Skistosit ditemukan pada :Anemia hemolitik mikroangiopatiD I COperasi katub jantungSindrom uremik hemolitikTrombotik trombositopeni purpuraLuka bakar luas
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MORFOLOGI LEKOSIT
Granulosit(Tdp granula dlm sitoplasma)
Non Granulosit(Tdk tdp granula dlm sitoplasma)
• Netrofil• Eosinofil• Basofil
• Monosit• Limfosit
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MIELOID LIMFOID
HEMATOPOESIS
Sumber: Diggs et al (1985), The Morphology of Human Blood Cells, Abbot
Pluripotential stem cell
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Tanda2 keganasan umum yang Tanda2 keganasan umum yang harus diwaspadaiharus diwaspadai
• Sel : ukuran abnormal, cenderung berkelompok/ bergerombol,monoton
• Sitoplasma : mudah rusak/ pecah, hipogranulasi. Inklusi yang tdk lazim (Auer , supras, halo, granula campuran eosinof-basopfil
• Inti ; ukuran besar, multiple bercelah ( cleft) , ber lekuk-lekuk ( convulated), ratio inti sitoplasa >, hipo/hipergranulasi
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Granulasi toksik dalam neutrofilGranulasi toksik dalam neutrofil
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Neutrofils:VacuolisasiNeutrofils:Vacuolisasi
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Monoblas
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Promonosit
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• Kelainan morfologi lekosit biasanya dijumpai pada leukemia
• Kelainan hematologis dengan ciri khas adanya proliferasi abnormal dan berlebihan dan/ atau prekursornya
• Adanya lekosit neoplastik di darah tepi• Causa: Ignota, Neoplasia, Infeksi,
Radiasi, Genetik, Bahan kimia
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A. Lama Perlangsungan A. Akut : survival beb mgg-bln B. Kronis: survival beb tahun
B. Jenis sel dominan (pengecatan sitokimiawi) A. MIELOID B. LIMFOID
C. Jumlah sel lekosit A. Alekemik/ Sublekemik B. Lekemik
KLASIFIKASI
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TRIAS LEKEMIATRIAS LEKEMIAANEMIA
LEKOSITOSIS
TROMBOSITOPENIA
ANEMIA
LEKOSITOSIS
TROMBOSITOSIS / N
AKUT
KRONIS
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LEKEMIA AKUTLEKEMIA AKUT
* Peningkatan Immaturitas, blast 30%* Diferensiasi sukar
Insidensi
• 50% kasus Lekemia • LLA insiden tertinggi pada umur 3-4 tahun, • AML : semua umur puncaknya +/- 20 tahun (dewasa muda)
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Lekemia limfoblastik akut
L1
L2
L3
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L2 L3
Acute Lymphoblastic Leukemia (ALL)
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M1 and M2
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LEUKEMIA AKUT
• Peningkatanimaturitas blast > 30%
• Differensiasi sukar
Insidensi
• 50% kasus leukemia
• ALL insiden tertinggi umur 3-4 tahun
• AML semuaumur puncaknya dewasa muda ( umur + / - 20 tahun )
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AML M3 (Promyelocytic)AML M3 (Promyelocytic)
Brunning, RD, McKenna, RW. Tumors of the bone marrow. Atlas of tumor pathology (electronic fascicle), Third series, fascicle 9, 1994, Washington, DC. Armed Forces Institute of Pathology.
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CHRONIK MIELOSITIK LEUKEMI (CM[)CHRONIK MIELOSITIK LEUKEMI (CM[)atauatau
LEKEMI GRANULOSITIK KRONIKLEKEMI GRANULOSITIK KRONIK(LGK)(LGK)
• Suatu kelainan mieloproliferatif kronik dengan ciri khas adanya proliferasi klon sel mieloid sehingga mengakibatkan peningkatan sel granulosit dalam jumlah besar• Semua tahap maturasi granulosit• Spektrum mieloid lengkap
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CMLCML• 20 % kasus lekemia• 20-60 tahun• Abnormalitas kromosom (kromosom Philadelphia): translokasi bagian dari kromosom 22 - kromosom 9
gangguan pematangan granulositik, eritrositik dan megakariositik disumsum tulang• Median survival : 2 - 4 tahun• Kematian oleh karena:
- fase akut terminal- perdarahan- infeksi
• 20 % penderita dapat bertahan 10 tahun atau lebih
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Lekemia Limfositik Kronik LLK / CLL
Mature-like lymphocyte
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Chronic Lymphocytic Leukemia
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Morfologi ThrombositMorfologi Thrombosit
• Ukuran dan bentuk• Jumlah ; throbositopeni, thrombositosis• Kelainan lain tidak berhubungan dengan
morfologi adalah kelainan fungsi
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