Veja grátis o arquivo ATLAS DE HEMATOLOGIA (McDONALD) enviado para a disciplina de Hematologia Categoria: Aulas – 18 – Atlas de hematologia, – ,-~,. 1r6logo (Ie b pl”imcra t,-dicioll_ _ Prcfacio de b quinta ec:lici6n._ _ Prcf{lcio de ]a pl;mcra edicibn t. “. Title, Atlas de hematología. Authors, George A. McDonald, J. Paul, Bruce Cruickshank. Edition, 5, illustrated, reprint. Publisher, Médica Panamericana,

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Atlas de Hematologia : Bruce Cruickshank :

The expression Gumprecht shadows historically refers to lymphocyte lysates commonly observed in patients with chronic lymphocytic leukemia CLL. A literature review revealed that this term is restricted to CLL cases, and should not be applied to mcdknald conditions. Inappropriate use of this term can cause great anxiety in individuals receiving their blood count results, as well as in their families.

In a web search engine commonly used to clear doubts on medical terms, there are countless pages where Gumprecht shadows are associated with CLL. Gumprecht; chronic lymphocytic leukemia; viruses. The expression Gumprecht shadows derived from the German researcher Ferdinand Adolph Gumprecht 42as he observed the blood films of patients with chronic lymphocytic leukemia CLL Figure.

CLL is a relatively rare lymphoproliferative disorder. It is benign in comparison to other leukemias, shows slow evolution and marked leukocytosis in the blood Most of the times, CLL is unexpectedly diagnosed by a routine blood test.

Atlas de hematología – George A. McDonald, J. Paul, Bruce Cruickshank – Google Books

However, only the morphological aspects of lymphocytes do not allow differentiation between B- and T-CLL type. More sophisticated techniques are required for the proper classification CLL is suspected when the blood film reveals an expressive increase in uniform-appearing lymphocytes and the presence of destroyed lymphocytes. The ruptured lymphocytes, stained in pink, show themselves irregular and constitute the Gumprecht shadows The microscopic examination of blood cells is surely an essential atllas for the diagnosis of CLL: Although more sophisticated methods, such as flow cytometry and cytogenetics, are currently used to refine this diagnosis 29the initial suspicion comes from cell morphology dde in the blood film.

Flow cytometry allows identification of cluster differentiation CD specific to B lymphocytes CD14, CD20, and CD23 and, as a result, characterizes the clonal origin of these lymphocytes Cytogenetics helps to detect abnormalities,especially in chromosomes 11 and Besides, serum determination of lactate dehydrogenase LDHbilirubin, immunoglobulins, and antiglobulins composes the test panel currently used to diagnose CLL 6.


An extensive literature review demonstrated that the expression Gumprecht shadows gradually lost importance in the CLL diagnosis, as mcdoald precise methods were established for that purpose. Thus, the most frequently used textbooks in English or Portuguese5,15,in our setting do not refer to this term, although older literature values Gumprecht shadows for the diagnosis of CLL.

It is known that viral conditions present with a high number of circulating lymphocytes, which are also susceptible to lysis. In the blood film, lymphocyte lysates, resulting from viral infection, present similar aspects to those described by Gumprecht to refer to lymphocyte lysates at CLL A search in the PubMed database using terms Gumprecht chronic lymphocytic leukemia revealed just five hdmatologia 4, 12, 13, 36, 37what confirms that the term has fallen into disuse.

The World Health Organization WHO describes CLL as a neoplasm of small B lymphocytes, with slightly irregular membrane present in peripheral blood, bone marrow, spleen and lymph nodes, along with prolymphocytes and paraimmunoblasts that proliferate in the infiltrated tissues The serum levels of immunoglobulins CD20 and CD79b are significantly reduced in comparison to normal B-lineage cells.

On the other hand, in lymphomas, although cells express B-lymphocyte and CD5 surface antigens, they normally do not express CD Before begining immunosuppressive therapy, the following is recommended: Additional tests may be arlas, such as bone marrow biopsy for exclusion of idiopathic cytopenias; detection of genetic abnormalities, principally of a deletion of chromosomes 17 [del 17p ] and 11 [del 11q ]; flow cytometry to evaluate ZAP and CD38 expression, whose presence indicates poor prognosis; and computed tomography CT for the staging of the disease Since the presence of viroses may cause the appearance of images similar to those observed in CLL because of lymphocyte lysis, a literature review was undertaken by searching the word Gumprecht referring to images of lymphocyte lysates that occur in viral diseases.

After a thorough and careful search, only a doctoral dissertation was found, in the area of Veterinary Medicine, where this term was used However, a search in a web search engine using the term Gumprecht and lymphocytes revealed innumerable hemahologia where it is associated with CLL.

In face of the ambiguous use of the term Gumprecht shadows in clinical situations of distinct prognosis and evolution, it would be quite pertinent to keep using it in cases of CLL, principally knowing that absolute lymphocytosis in peripheral blood is not always a sign of malignancy.


Since hyperplasia of lymphoid tissues and lymphocytosis may occur in other infectious processes, especially viral diseases, and in chronic inflammatory processes, such as arthritis, lupus erythematosus, vasculitis, sarcoidosis, etc.

It atlsa be noted that the mechanisms of lymphocyte destruction in CLL and in viral diseases are distinct. In viral diseases, the ruptured lymphocytes are younger normal-appearing cells that go through lysis as a consequence of viral infection.

In CLL, this process is due to cell aging. In this case, lymphocytosis occurs when old cells accumulate, because hematologiq apoptosis mechanism is impaired The expression Gumprecht shadows must be used only for cases of CLL, not to describe ruptured lymphocytes present in other situations with lymphocytosis, associated with either viral diseases or other causes.

The inappropriate use of this term may cause great anxiety in individuals who receive this observation in their blood count, as well as to their families, since information on the internet hematolofia available to any person and is frequently used to clear doubts on medical terms.

Atlas de Hematologia

Basket cells or shadow cells of Gumprecht: Blood Cellsv. ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncologyv.

Escola paulista de medicina. Annales de Biologie Cliniquev. Relevance of cytological and immunophenotypical analysis for the diagnosis of B-cell chronic lymphocytic leukaemia. Ann Biol Clinv. Hemxtologia for the diagnosis and treatment of chronic lymphocytic leukemia: Manual de hematologia de Williams.

Manual of clinical hematology. Rev Bras Hematol Hemotv. To the nucleolar bodies nucleoli in cells of the lymphocytic lineage in patients suffering from B-chronic lymphocytic leukemia. World Health Organization classification of tumours of haematopoietic and lymphoid tissues.

International Agency for Research on Cancer, A dictionary of medical eponyms. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. How to cite this article.