Blood Film Interpretation

Question 0

Poikilocytosis

Answer 0

Abnormal variation in shape RBC

Question 1

Spherocyte

Answer 1

Hereditary soherocytosis

AutoImmune haemolytic anaemia

Question 2

Elliptocyte/ovalocyte

Answer 2

Hereditary elliptocytosis

Megaloblastic anaemia

Question 3

Schistocytes/fragmented cells/helmet cells

Answer 3

Prosthetic heart valve

Microangiopathic haemolytic anaemia (TTP DIC vasculitis or glomerulonephritis)

Question 4

Sickle cell

Answer 4

Sickle shaped due to polymerisation of HbS

Sickle cell disorders HbSC or HbSS

Question 5

Target cells

Answer 5

Liver disease
HbS and C
Thalassemia
Iron def
Asplenia

Question 6

Teardrop AKA poikilocyte

Answer 6

Myelofibrosis
Or
Tumour infiltration

Question 7

Spur cell aka acanthocyte

Answer 7

Distorted RBC with irregular thorny projections due to lipid membrane abnormality
Severe liver disease

Question 8

Echinocyte aka burr cell

Answer 8

Numerous regularly spaced spiny projections
Uraemia
Artifact

Question 9

Roleaux formation

Answer 9

Artifact

Paraprotein eg macroglobulinaemia or MM

Question 10

Nucleated RBC

Answer 10

Immature RBC
Extra medullary haematopoiesis
Hypoxia
Haemolysis

Question 11

Howell-Jolly bodies

Answer 11

Small nuclear remnant

• post splenectomy
• hyposplenism
• haemolytic anaemia
• megaloblastic anaemia

Question 12

Heinz bodies

Answer 12

Denatured and precipitated Hb
In G6PD def
alpha thal
asplenia

Question 13

Reed-Sternberg cell

Answer 13

Giant malignant multinucleated B lymphocyte indicative of Hodgkin’s disease

Question 14

Basophilic stippling

Answer 14

Pathological aggregation of ribosomes
Coarse: sideroblastic and megaloblastic
Fine: on artifact
BETA THAL

Question 15

Hyper segmented neutrophil

Answer 15

More than five lobes suggest megaloblastic process or iron def

Question 16

Inclusions

Answer 16

Malaria
Babesiosis
Bartonella
(Non immune haemolytic anaemia due to systemic disease)

Question 17

Blister or bite cells

Answer 17

Presence of oxidant induced damage to cell membrane in G6pd deficiency

Question 18

Pencil cells

Answer 18

iron def

Question 19

retic count in ACD?

Answer 19

Inappropriately LOW

Question 20

Ovoid

Answer 20

megaloblastic

Question 21

If someone mentions…Donath Landsteiner Ab?

Answer 21

Paroxysmal cold haemoglobinuria

IgG to P binds red cells at low temps and then upon warming there is intravascular haemolysis

Splenomegaly doesnt work
Cold avoidance

Question 22

What test for hered spherocytosis?

Answer 22

Eosin-5-maleimide binding - reduced fluoresence as not as much band 3 to bid with