Blood film

Question 1

Smudge cells

Answer 1

CLL

Question 2

Hairy Cell

Answer 2

= Hairy cell leukaemia

Question 3

Auer rods

Answer 3

= AML

Question 4

Red Cell Ghosts (black arrows)

Answer 4

Red Cell Ghosts - RBCs w/o Hb indicate intravascular lysis
Associations
-fulminant bacterial infections eg clostridium perfringens

Question 5

Normocyte/Nucleated RBC

Answer 5

Not normal in peripheral blood
Association - severe haemolysis, hypoxaemia, myelofibrosis

Question 6

Reticulocytes

Answer 6

Reticulocytes
Normally 1% of blood film
Increased when RBC turnover and creation is high - bleeding, haemolysis
Decreased when BM is suppressed - aplastic anaemia, systemic chemo

Question 7

Teardrop/Dacrocyte

Answer 7

Associations - signify extramedullary haematopoiesis

• *- primary myelofibrosis**
• thalassaemia

Question 8

Dohle Bodies

Answer 8

Associations

• infection
• inflammation

Question 9

Hypersegmented neutrophil (>5 lobes)

Answer 9

Association

• Megaloblastic anaemia (B12, Folate)
• Rarely, iron deficiency anaemia

Question 11

Rouleaux Formation

Answer 11

Associations:

• Infection
• *- Multiple myeloma**
• Waldenstrom’s macroglobulinemia
• Inflammatory and connective tissue disorders
• Malignancy
• *- DM** (a causative factor for microvascular occlusion in diabetic retinopathy)

Question 12

Basophilic Stippling

Answer 12

Associations

• Toxic injury to BM, such as lead or heavy metal poisoning.
• Severe anemia
• Thalassaemia
• Alcohol abuse

Question 14

Polychromasia - premature release of RBCs

Answer 14

Associations
- anaemia, various causes

Question 15

Spherocytes

Answer 15

Associations

• Warm and cold autoimmune hemolytic anemia
• Acute and delayed hemolytic transfusion reactions
• Hereditary spherocytosis
• Hypophosphatemia
• Bartonellosis
• Snake bite
• Hyposplenism
• Severe burns

Question 16

Blister Cells - precursor of bite cells (aka basket cells, half-ghost cells)

Answer 16

Associations:

• G6PD deficiency
• Unstable hemoglobins

Question 17

Stomatocytes

Answer 17

Association:

• Artifact (due to slow drying in humid environment)
• Liver disease
• Alcoholism
• Rh-null disease
• Obstructive lung disease

Question 19

Bite Cell/Degmacyte

Answer 19

Associations

• *- G6PD deficiency
• Oxidative stress**
• Unstable haemoglobins
• Congenital heinz body anaemia

Question 21

Burr Cells

Answer 21

Association

• In-vitro artifact following prolonged storage or slow drying of the smear due to high humidity
• *- Uraemia
• Malnutrition**

Question 22

Schistocyte

Answer 22

Association = INTRAVASCULAR HAEMOLYSIS

• *- DIC
• TTP
• HUS**

Question 23

Target Cells

Answer 23

Association

• Sickle cell disease
• Haemoglobin C trait/haemoglobin CC disease
• *- Thalassemias**
• Iron deficiency
• Liver disease (cholestasis)
• Asplenia

Question 24

Sickle Cell

Answer 24

Association
-Sickle Cell Anaemia

Question 30

Howell-Jolly Bodies

Answer 30

Associations

• *- Asplenia**
• Other: amyloidosis, severe hemolytic anemia, megaloblastic anemia, hereditary spherocytosis, and MDS

Question 33

Metamyelocyte

Answer 33

• Cell undergoing granulopoiesis, derived from a myelocyte, and leading to a band cell.
• bent nucleus, cytoplasmic granules, and the absence of visible nucleoli

Question 38

Pencil Cells

Answer 38

Association
- Iron deficiency

Question 40

Spur cells/Acanthocytes

Answer 40

Associations:

• Liver disease
• Renal failure
• • Abetalipoproteinaemia*
• Spur cell anaemia
• Pyruvate kinase deficiency