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Color Atlas ofHematology
PracticalMicroscopic and Clinical Diagnosis
Harald Theml, M.D.
Professor, Private Practice
Munich, Germany
Heinz Diem,M.D.
Institute of Clinical Chemistry
Munich, Germany
Torsten Haferlach,M.D.
Professor, KlinikumGrosshadern
Laboratory for Leukemia Diagnostics
Munich, Germany
2nd revised edition
262 color illustrations
32 tables
Stuttgart · New York
Library of Congress Cataloging-in-Publica-
tion Data is available from the publisher
Important note: Medicine is an ever-
changing science undergoing continual
development. Research and clinical ex-
perience are continually expanding our
knowledge, in particular our knowledge of
proper treatment and drug therapy. Insofar
as this book mentions any dosage or appli-
cation, readers may rest assured that the
authors, editors, and publishers have made
every effort to ensure that such references
are in accordance with the state of knowl-
edge at the time of production of the
Nevertheless, this does not involve, imply,
or express any guarantee or responsibility
on the part of the publishers in respect to
any dosage instructions and forms of appli-
cations stated in the book. Every user is re-
quested to examine carefully the manu-
facturers’ leaflets accompanying each drug
and to check, if necessary in consultation
with a physician or specialist, whether the
dosage schedules mentioned therein or the
contraindications stated by the manufac-
turers differ from the statements made in
the present book. Such examination is par-
ticularly important with drugs that are
either rarely used or have been newly re-
leased on the market. Every dosage
schedule or every form of application used
is entirely at the user’s own risk and re-
sponsibility. The authors and publishers re-
quest every user to report to the publishers
any discrepancies or inaccuracies noticed.
Some of the product names, patents, and
registered designs referred to in this book
are in fact registered trademarks or pro-
prietary names even though specific refer-
ence to this fact is not always made in the
text. Therefore, the appearance of a name
without designation as proprietary is not to
be construed as a representation by the
publisher that it is in the public domain.
This book, including all parts thereof, is le-
gally protected by copyright. Any use, ex-
ploitation, or commercialization outside
the narrow limits set by copyright legisla-
tion, without the publisher’s consent, is ille-
gal and liable to prosecution. This applies in
particular to photostat reproduction, copy-
ing, mimeographing, preparation of micro-
films, and electronic data processing and
This book is an authorized revised
translation of the 5th German edition
published and copyrighted 2002 by
Thieme Verlag, Stuttgart, Germany.
Title of the German edition:
Taschenatlas der Hämatologie
Translator: Ursula Peter-Czichi PhD,
Atlanta, GA, USA
1st German edition 1983
2nd German edition 1986
3rd German edition 1991
4th German edition 1998
5th German edition 2002
1st English edition 1985
1st French edition 1985
2nd French edition 2000
1st Indonesion edition 1989
1st Italian edition 1984
1st Japanese edition 1997
! 2004 Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart,
Thieme New York, 333 Seventh Avenue,
New York, NY 10001 USA
Cover design: Cyclus, Stuttgart
Typesetting and printing in Germany by
Druckhaus Götz GmbH, Ludwigsburg
ISBN 3-13-673102-6 (GTV)
ISBN 1-58890-193-9 (TNY) 1 2 3 4 5
Our Current Edition
Although this is the second English edition of our hematology atlas, this
edition is completely new. As an immediate sign of this change, there are
now three authors. The completely updated visual presentation uses dig-
ital images, and the content is organized according to themost up-to-date
morphological classification criteria.
In this new edition, our newly formed team of authors from Munich
(the “Munich Group”) has successfully shared their knowledge with you.
Heinz Diem and Torsten Haferlach are nationally recognized as lecturers
of the diagnostics curriculum of the German Association for Hematology
and Oncology.
Most physicians are fundamentally “visually oriented.” Apart from imme-
diate patient care, the microscopic analysis of blood plays to this prefer-
ence. This explains the delight and level of involvement on the part of
practitioners in the pursuit of morphological analyses.
Specialization notwithstanding, the hematologist wants to preserve
the opportunity to performgroundbreaking diagnostics in hematology for
the general practitioner, surgeon, pediatrician, theMTA technician, and all
medical support personnel. New colleagues must also be won to the
cause. Utmost attention to the analysis of hematological changes is es-
sential for a timely diagnosis.
Even before bone marrow cytology, cytochemistry, or immunocyto-
chemistry, information based on the analysis of blood is of immediate rel-
evance in the doctor’s office. It is central to the diagnosis of the diseases of
the blood cell systems themselves, which make their presence known
through changes in blood components.
The exhaustive quantitative and qualitative use of hematological diag-
nostics is crucial. Discussions with colleagues from all specialties and
teaching experience with advanced medical students confirm its impor-
tance. In cases where a diagnosis remains elusive, the awareness of the
next diagnostic step becomes relevant. Then, further investigation
through bonemarrow, lymphnode, or organ tissue cytology can yield firm
results. This pocket atlas offers the basic knowledge for the use of these
techniques as well.
Reflecting our goals, the inductive organization proceeds from simple to
specialized diagnostics. By design, we subordinated the description of the
bone marrow cytology to the diagnostic blood analysis (CBC). However,
we have responded to feedback from readers of the previous editions and
have included the principles of bone marrow diagnostics and non-
ambiguous clinical bone marrow findings so that frequent and relevant
diagnoses can be quickly made, understood, or replicated.
The nosology and differential diagnosis of hematological diseases are
presented to you in a tabular form. We wanted to offer you a pocketbook
for everyday work, not a reference book. Therefore, morphological curi-
osities, or anomalies, are absent in favor of a practical approach to mor-
phology. The cellular components of organ biopsies and exudates are
briefly discussed, mostly as a reminder of the importance of these tests.
The images are consistently photographed as they normally appear in
microscopy (magnification 100 or 63 with oil immersion lens, oc-
casionally master-detail magnification objective 10 or 20). Even though
surprising perspectives sometimes result from viewing cells at a higher
magnification, the downside is that this by nomeans facilitates the recog-
nition of cells using your own microscope.
Instructions for the Use of this Atlas
The organization of this atlas supports a systematic approach to the study
of hematology (see Table of Contents). The index offers ways to answer
detailed questions and access the hematological terminology with refer-
ences to the main description and further citations.
The best way to become familiar with your pocket atlas is to first have a
cursory look through its entire content. The images are accompanied by
short legends. On the pages opposite the images youwill find correspond-
ing short descriptive texts and tables. This text portion describes cell phe-
nomena and discusses in more detail further diagnostic steps as well as