Anemia/CBC/Blood smears Flashcards
Anemia
laboratory measurement indicating the red cell mass measurement (Hgb or Hct) in a patient is:
< than 2.5 percentile value of reference range
3 reasons to be anemic?
blood loss, hemolysis, decreased RBC production
microcytic, normocytic, macro?
MCV = mean cell volume
microcytic = 100
microcytic anemias?
iron defic.
anemia of CD
thalassemia
lead toxicity
“I love the CD’s”
normocytic anemias?
- hemolytic
- aplastic anemia
-hypersplenism
-acute bleeding
-anemia of CD- renal failure
-hemodilution
-uremia
-marrow -replacement/fibrosis
sickle cell anemia
macrocytic anemias?
B12 deficiency
Folate deficiency
alcoholic liver disease
MDS
MCHC
mean cell hgb. concentration
= : average hemoglobin concentration in a volume of red cells in grams/dL; surrogate measure of hemoglobin concentration within an average sized red cell.
Reference Range = 33 - 37 gm/dL
normochromic normocytic anemia?
think hemolytic anemia
retics?
Immature erythrocytes contain remnant endoplasmic reticulum & ribosomal RNA (Rough ER) that forms a reticulum (net) within RBC cytoplasm
**This remnant Ribosomal RNA reticulum stains blue with Methylene Blue (seen as blue speckles)
Retics circulate 2-3 days before all ribosomal structures are extruded - they are present normally in 2% of population
- provide a measure of the rate of production and release of red cells by the marrow into the peripheral blood
adults: .5-1.5%
kids: 3-7% retics
reticulocytosis
release of retics from marrow 3-4 days after an acute episode of hemorrhage
(reticulocyte count) should peak in 6-10 days
causes:
Acute blood loss or hemorrhage
Acute hemolysis
Hemolytic anemia
Response to therapy (Fe or other
nutritional correction of deficiency)
iron deficiency anemia vs. anemia of CD?
IDA:
- ferritin is low
- TIBC is high
- serum iron - low
- hepcidin low
ACD:
- ferritin is high
- TIBC is low
- serum iron is low
- hepcidin high
hemolytic anemia
retics: high coombs test: positive haptoglobin: low bilirubin: elevated (conj and unconj.) RDW: high peripheral smear: fragmented RBCs, spherocytes,
differentiating b/t cells
neutrophils = 3-5 lobes monocytes = kidney lobes lymphocytes: no lobes, just a circle eosinophils: 2 lobes basophils: just dots
normal number of RBCs?
4-6 x 106/μL
anisocytosis
variation in the SIZE of cells that are normally uniform, especially such a variation in red blood cells.
ex: Fe defic, sideroblastic anemia, MDS, B12/folate defic.
hypersegmented neutrophils?
B12 defic, folate defic.
Poikilocytosis
variations in RBC SHAPE
macroovalocytes
oval cells that are large - seen in megaloblastic anemia
schistocytes
fragmented erythrocytes
seen in TTP, DIC, HUS, defective heart valves, hemolytic anemias
acanthocyte
“burr cell”
RBC w/ irregularly spaced projections = liver disorders
Codocyte
“target cell” - seen in sickle cell and thalassemias
dacrocyte
tear drop cell- seen in myeloproliferative disorders, myelofibrosis, pernicious anemia and thalassemias
stomatocyte
folded RBC that mimcs lips/mouth/slit like appearance
seen in hemolytic anemias
2 classic poikilocytes of SSD?
sickle cells, target cells
hypochromic?
think thalassemia, IDA, sideroblastic anemia
decreased central pallor? more red?
hereditary spherocytosis
AI hemolytic anemia
rouleax
stack of coins - seen in MM
- due to elevated plasma fibrinogen/globulins
clumping of RBC/s?
due to cold agglutinins
pyknotic ?
dense nucleus seen in RBCs - these are immature RBC progenitors not normally seen in blood
indicates “stressed” bone marrow unable to meet increased red cell requirements. They are seen in patients undergoing hemolytic crises.
what do you think of if see retics and nucleated RBCs?
Indicative of hemolytic process, stress, hypoxemia, or myelofibrosis- Except in newborns
basophilic stippling
“inclusion bodies”
round, dark-blue granules in reticulocytes on smears stained with supra vital stains (brilliant cresyl blue).
granules are precipitated ribosomes and mitochondria. Classic finding in lead poisoning.
howell-jolly bodies
“inclusion bodies”
They are nuclear fragments of condensed DNA, 1-2 µm diameter, normally removed by the spleen. Seen in severe hemolytic anemias and in post-splenectomy patients (below).
normal WBC range?
4.0-10.9 x 103/ μL
neutrophils range?
50-60%
Elevated in bacterial infections, stress, corticosteroid therapy (see demargination)
Immature forms
often present with
elevated count
lymphocytes range?
30-40% of circulating WBCs
Elevated in viral infections (Epstein-Barr, etc.)
smudge cells?
Fragile lymphocytes (smudge or basket cells) are common in chronic lymphocytic leukemia (CLL)
atypical lymphocytes?
mono
eosinophils/basophils?
Eosinophils - < 5%
Elevated in parasitic infections, allergies
Basophils - < 1%
Elevated in chronic
myelogenous leukemia (CML)
left shift?
: increase in immature forms in peripheral blood due to increased production:
Infections, myeloid cancers
see predominance of band cells (immature) over segmented cells (mature cells)
dohle bodies
inclusions in neutrophils
seen in sepsis!
Seen in systemic infectious or inflammatory disease
Often accompanied by a left shift, toxic granulation and cytoplasmic vacuoles
hypersegmented neutrophils?
> 5 lobes
Can be seen in megaloblastic anemias
reduced lobulation of mature neutrophils?
Pelger-Huet anomaly
Often associated with myelodysplastic syndromes
blasts
indicate WBC neoplasia (myeloid= leukemia or lymphoid= lymphoma)
plasma cells
indicate lymphoid neoplasia (e.g., multiple myeloma)
normal platelet count?
150,000-450,000/μL
giant platelets in periphery?
Suggest marrow response secondary to increased platelet destruction or consumption
Congenital disorders
Immune destruction
Disseminated intravascular coagulation (DIC)
Hemolytic uremic syndrome (HUS)
Thrombotic thrombocytopenic purpura (TTP)
