Blood film findings

Question 1

what is basophilic stippling?

Answer 1

blue staining of ribosomes in the cytoplasm of RBCs

Question 2

what is BS seen in?

Answer 2

megaloblastic anaemia
thalassaemia
sideroblastic anaemia
alcohol abuse

Question 3

what does BS suggest?

Answer 3

disturbed rather than increased red cell production

Question 4

what are Howell-Jolly bodies?

Answer 4

small single peripherally located rounded inclusions in erythrocytes

Question 5

what does the presence of HJBs indicate?

Answer 5

HYPOSPLENISM

Question 6

where are functional and true HJBs found?

Answer 6

functional - within spleen
true - assc. with splenectomy

Question 7

what are shistocytes?

Answer 7

fragments of RBCs

Question 8

what does the presence of schistocytes indicate?

Answer 8

microangioplastic haemolytic anaemia (MAHA)

Question 9

what do shistocytes look like?

Answer 9

irregularly shaped, jagged, two pointed ends

Question 10

what is a left shift?

Answer 10

immature white cell

Question 11

what is left shift seen in?

Answer 11

acute infection
severe -> CML, myelofibrosis or AL

Question 12

what does right shift signify?

Answer 12

prevalence of hyper-mature neutrophils with more than 5 lobes

Question 13

what is right shift seen in?

Answer 13

chronic infections
G-CSF - meds
hyperpigmented neutrophils - megaloblastic anaemia

Question 14

what is reticulocytosis?

Answer 14

increase in reticulocytesw

Question 15

what are reticulocytes?

Answer 15

immature RBCs, just left bone marrow, RNA remnants, no nucleus

Question 16

when does reticulocytosis occur?

Answer 16

compensation for red cell loss -> bleeding, haemolysis
marrow starved -> iron, B12 or folate - anaemia, macrocytic anaemia, pernicious anaemia

Question 17

what are codocytes (target cells) seen in?

Answer 17

obstructive liver disease
haemoglobinopathies (thalassaemia and sickle cell)
post-splenectomy

Question 18

what is rouleaux formation?

Answer 18

stacks of aggregated (clumped) RBCs

Question 19

when does rouleaux formation occur?

Answer 19

when plasma conc is high

Question 20

what is RF seen in?

Answer 20

multiple myeloma
Waldenstrom’s macroglobulinaemia
inflammatory disorders
malignancies

Question 21

what is leukoerythroblastosis?

Answer 21

combined presence of immature RBCs and immature WBCs

Question 22

what is leukoerythroblastosis seen in?

Answer 22

marrow fibrosis
invasion
primary myelofibrosis
metastatic cancer
TB
Gaucher’s disease

Question 23

what is anisocytosis?

Answer 23

variation in RBC size - quantified by EC distribution risk

Question 24

what is common cause of anisocytosis with low MCV?

Answer 24

iron deficiency
sickle cell anaemia
anaemia of chronic disease
thalassaemia

Question 25

what is common causes of anisocytosis with high MCV?

Answer 25

megaloblastic anaemias haemolysis with reticulocytosis myelodysplasia liver disease

Question 26

what are acanthocytes (spur cells)?

Answer 26

RBCs spiked in film

Question 27

what doe spur cells occur due to?

Answer 27

altered lipid or protein composition of RBCs plasma membrane

Question 28

what are spur cells seen in?

Answer 28

liver disease neurocanthocytosis anorexia nervosa hypothyroidism myelodysplasia

Question 29

what are cabot rings?

Answer 29

rounded RBC inclusions, slender loops seen in cytoplasm

Question 30

what are cabot rings seen in?

Answer 30

megaloblastic anaemia severe anaemia lead poisoning leukaemia pernicious anaemia

Question 31

what are burr cells?

Answer 31

RBCs with small regularly distributed projections across cell surfacer

Question 32

what di burr cells occur due to?

Answer 32

extrinsic effect of changed in composition of plasma membrane

Question 33

what are burr cells seen in?

Answer 33

liver disease vitamin E deficiency end-stage renal disease pyruvate kinase deficiency