Blood Cells Atlas Flashcards
Changes induced by hyperlipidemia
- Dissolution of granulocyte cell wall (can be alleviated with additional of albumin)
- Pale/smudged red cells (can be alleviated with additional of albumin)
Pyknotic WBCs
Occur more frequently with increased interval between collection and prep of smear and in atypical lymphocytes
Excess EDTA can cause
- Platelet clumping (collect sample in blue tube - citrate - to fix this; need to multiply by 1.1 because of dilution)
- Platelet satellitosis
- White cell clumping
- Shrunken white cells
- Echinocytes
- Target cells
Platelet satellitosis associated with?
Behcet disease
EDTA exces
Thromboembolism
Artifacts caused by excessive delay in preparing smear
Pseudo toxic granulation and vacuoles
Echinocytes
Artifacts in smears that dry slowly or in excessive humidity
Echinocytes
Vacuolated red cells (watermark artifact)
Target cells
Erythophagocytosis associated with?
Immune hemolytic anemia
Infection
Apoptotic bodies in granulocytes associated with?
MDS
Chemotherapy
AIDS
White cell clumping associated with?
Bacterial infections
Viral infections
Autoimmune disorders
Usually seen at the edges of the smear
Lymphocyte clumping associated with?
Lymphoproliferative disorders
Hypochromia associated with
IDA
ACD
Thalassemia
Hemoglobin Lepore (trait and disease)
Hemoglobinopathy-thalassemia syndromes
Lead poisoning
Sideroblastic anemia
Examples of hyperchromic red cells
Spherocytes
Acanthocytes
Irreversible sickled red cells
Normocytic hypochromic red cells
ACD
Early IDA
Sideroblastic anemia
Microcytic normochromic red cells associated with?
ACD
Early IDA
Thal minor
Hemoglobin C (trait and disease)
Hemoglobin E (trait and disease)
Rarely seen in Hemoglobin H disease
Microcytic hypochromic red cells associated with
IDA
Thal major
Thal minor
ACD
Hemoglobin E-thal
Hemoglobin E disease
Hemoglobin Lepore (trait and disease)
Lead poisoning
Sideroblastic anemia
Hemoglobin H disease
Normochromic round macrocytic red cells
Acute blood loss
Aplastic anemia
Postsplenectomy state
Hemolytic anemia
Alcoholism
Liver disease
AIDS
AIDS therapy
Hyperthyroidism
Hypothyroidism
Hypopituitarism
Malaria (P vivax)
MDS
Normocytic ovala macrocytic/macro-ovalocytes associated with?
- Vitamin B12 deficiency
- Folate deficiency
- Postchemotherapy
- Inherited abnormalities of DNA synthesis (e.g., orotic aciduria, MTHF transferase deficiency, transcobalamin II deficiency)
- MDS
- Chronic infections
Polychromasia is seen in
Newborns
Acute blood loss
Hematinic therapy
Homeostatic recovery of bone marrow after chemo or other suppressive factors
Target cells occur as a result of
Increased surface membrane to volume ratio (e.g.,
- excess lipid as in liver disease or
- decreased lipid loss during maturation in postsplenectomy state or
- by decreased and/or abnormal hemoglobin content as in thalassemia and hemoglobinopathies
Microcytic, normocytic, and macrocytic target cells associated with
- Microcytic
- thalassemia
- E thal
- C thal
- hemoglobinopathies (hemolgobin E disease and hemoglobin Lepore)
- thalassemia
- Normocytic
- Hb SS
- Hb CC
- Hb SC
- LCAT deficiency
- Postsplenectomy
- Macrocytic
- liver diease
Microspherocytes are associated with?
burns
MAHA
Feather edge of many smeres
Transfused cells
Acanthocytes are associated with?
- Lutheran blood group
- McLeod phenotype
- Postsplenectomy
- Abetalipoproteinemia
- Hypobetalipoproteinemia
- Vitamin E deficiency
- Amyotrophic chorea
- Myxedema
- Panhypopituitarism
- malnutrition
- MPN
Occur as a result of disproportionate cholesterol: sphingomyelin ratio (should be 1:1)
Echinocytes occur as a result of?
- Excess EDTA
- Slow drying
- Aged blood
- Increased pH
- Decreased albumin concentration
- “glass effect” which elevates pH
- Uremia
- Liver disease
- Vitamin E deficiency
- Pyruvate kinase deficiency
- Burns
- Heparin therapy
- GI disorders (peptic ulcer, carcinoma, Crohn)
- MPN
Stomatocytes
- Associated with
- Hereditary stomatocytosis (deficient somatin)
- acute alcoholism
- alcoholic cirrhosis
- obstructive liver disease
- Rh null disease
- Tangier disease
- cardiovascular disease
- Stewart syndrome
- acidic pH
- cationic detergents
- phenothiazine
- Artifactual causes of stomatocytes
- Humidity
- Slow air drying
- addition of albumin (prevents smudging, but causes stomatocytes)
- There is an abnormal cationic transport leading to increse in intracellular sodium and water with loss of potassium causing cells to swell and volume increases as MCHC decreases
Blister cells and blister-like cells
- Blister cells form as a result of oxidant stress (e.g., G6PD deficiency with bitten Heinz bodies) or from fibrin strands that disrupt the red cell membrane which then reattaches to itself
- Blister-like cells occur in acute chest syndrome in sickle cell disease
Heinz bodies
Denatured hemoglobin often on inner surface of RBC membrane
- not visible in Wright stain
- Seen on supravital stain with crystal violet, brilliant cresyl blue, or new methylene blue
- Associated with
- Hereditary Heinz body hemolytic anemia
- Dapsone, other oxidant drugs
- Chemicals (naphthalene, phenazopyridine)
- thalassemia major
- some hemolgobinopathies
- liver disease
- G6PD deficiency (mature red cells affected, whereas other conditions have bodies in mature and immature red cells)
Hemoglobin H inclusions
- Seen with supravital stain
- Looks like golf ball
- beta tetramers that occur in
- alpha thal
- MPN
- sideroblastic anemia
- MDS
Teardrop cells associated with
- Small number are seen in
- pernicious anemia
- hemolytic anemia
- IDA
- thalassemia
- anemia of renal disease
- More are seen in PMF or myelophthisic diseases
Basophilic stipling
- Fine stippling is an artifact from slow air drying
- Coarse stippling occurs with imparied RNA degradation (impaired Hb synth)
- lead poisoning
- pyrimidine 5’-nucleotidase deficiency
- thalassemia
- hemoglobinopathies
- sideroblastic anemia
- MDS
- congenital dyserythropoietic anemias
Cabot ring
Remnant of mitotic spindle often seen with basophilic stipling and associated with
- congenital dyserythropoietic anemias
- megaloblastic anemia
- MDS
- other severe anemias
Howell-Holly bodies
- Nuclear remnant
- Associated with
- postsplenectomy state
- hypofunctioning spleen
- severe hemolytic anemia
- megaloblatic anemia
- congenital dyserythropoietic anemias
Vacuolated cytoplasm may occur in cytoplasm of a pronormoblast or its progeny under what conditions?
- chloramphenicol
- ethanol abuse
- hyperosmolar coma
- deficiency of copper, phenylalanine, riboflavin
