CBC and Peripheral Blood Cell Morphology Flashcards
What are the specimen requirements for a CBC?
EDTA anti coagulated blood (purple cap)
What cells are counted in a CBC?
WBCs; RBCs; platelets
In a CBC, the WBC count is reported in what unit?
thousands of cells/microliter ( x 10^3 / uL)
In a CBC, the RBC count is reported in what unit?
millions of cells/microliter (x 10^6 / uL)
In a CBC, the platelet count is reported in what unit?
thousands of cells/microleter (x 10^3 / uL)
In a CBC, Hemoglobin is reported in what unit?
grams per deciliter (g/dl)
In a CBC, Hematocrit is reported in what unit?
%
In a CBC, Mean cellular volume (MCV) is reported in what unit?
femtoliters, fl
In a CBC, Red cell distribution width (RDW) is reported in what unit?
RDW-CV is in %; RDW-SD in in fl
How do hematology analyzers sort RBC, WBC, and platelets?
by size, via electrical impedence or light scattering
When are manual methods of hematology analyzation used?
only when there is an abnormality flagged by the instrument as needing review (ex: platelet clump) or when the lab values don’t match the clinical situaiton
Hemoglobin uses ____ method for measurement
cyanmethemoglobin
note: gives the total hemoglobin concentration in a give volume of blood
____ is the percentage of the volume of whole blood that is comprised of RBCs
hematocrit
What is the equation for Hematocrit calculation?
Hct = MCV x RBC
In normal individuals with normal cell morphology, hematocrit is roughly ___X the hemoglobin, which is roughly __X the RBC count
3; 3
Mean cell volume (MCV) is the average volume of the RBCs. What is the equation for MCV?
MCV = Hct x 1000/RBC
In what evaluation is MCV useful
anemia
Mean cellular hemoglobin (MCH) is the weight of hemoglobin in the average RBC. What is the equation for MCH?
MCH = Hgb/RBC
Mean cellular hemoglobin concentration is the concentration of hemoglobin in the average RBC. What is the equation for this?
[MCH] = (Hgb/Hct) x 100
Red blood cell distribution width (RDW) is a measurement of what?
variation in size of the RBCs
Mean platelet volume is a measurement of what?
variation in size of platelets - indirect measure of the age of platelets
Differential (percentages) give you relative numbers, not absolute. Absolute cell counts are what matter. How are they calculated?
by multiplying % on the manual differential by the total WBC count
ex: Total WBC is 10.0 with 65% neutrophils, 10% lymphocytes, and 25% monocytes
absolute cell count: 6.5 (normal); 1.0 (normal), 2.5 (high)
What is thrombocytosis?
increased platelets
What is polycythemia?
increased RBCs
What is leukocytopenia?
decreased WBCs
What is anemia?
decreased RBCs
What does microcytic mean? macrocytic?
smaller than normal; larger than normal
What does Anisocytosis mean?
variation in size
What does Poikilocytosis mean?
variation in shape
What does anisopoikilocytosis mean?
variation in size AND shape
What does normocytic mean?
normal amount of hemoglobin
What does hypochromic mean?
decreased hemoglobin with pale staining
What does polychromasia mean?
increased immature RBC; blue-gray cytoplasm due to residual RNA; normal amount of hemoglobin
Each RBC has how many hemoglobin molecules?
650 million
What is the purpose of the disc shape of the RBC?
to be able to pass through capillaries
These cells are small and pale. Their zone of central pallor is > 1/3 the diameter of the cell. They are seen in iron deficiency, anemia, lead poisoning, and thalassemia.
microcytic hypochromic cells
These cells are larger than normal (>8.5 um); well hemoglobinized; seen with young cells and in abnormal maturation states like megaloblastic anemia (B12 deficiency) and meylodysplastic syndromes
macrocytic cells
These cells are smaller in diameter than normal, but spherical, with loss of central pallor. Bone marrow produces normal biconcave red cells, but these lose membrane during passage through the spleen. These cells have a shortened life span and are destroyed prematurely in the spleen.
spherocytes
note: can be caused by heredity or acquired through hemolytic anemia, burns, and post-transfusion
What causes the hereditary and acquired forms of elliptocytosis/ovalocytosis?
heriditary: cytoskeleton abnormalities (defects in ankyrin, spectrin)
acquired: iron deficiency, thalassemia, megaloblastic anemia, myelodysplastic syndromes
These are large, floppy cells with redundant cytoplasmic membrane compared to the volume of the cell. May be thinner than normal. Bell-shaped in bloodstream
target cells
What are the causes of target cells?
macrocytic: liver disease
microcytic: thalassemia, iron deficiency
normocytic: sickling disorders, hgbE
These are amoeboid cells with unevenly distributed spicules over the RBC surface, of unequal length
acanthocytes
What causes acanthocytes? (inherited and acquired causes)
inherited: abetalipoproteinemia
acquired: liver disease, myelodysplastic syndromes, malnutrition
These cells have evenly distributed spicules over the entire RBC surface, which are short and blunt. Resemble the echinoderms (sea urchins) with spiny projections.
echinocytes
What causes echinocytes?
storage artifact
liver disease or renal failure
enzyme deficiencies
These are “mouth cells”. Central zone of pallor is narrow, not round. Occasionally seen in healthy patients. Commonly associated with alcohol excess and alcoholic liver disease.
Stomatocytes
These are RBC fragments formed as a result of mechanical disruption in the microvasculatrue by fibrin strands, platelet strands, toxins, burns, vasculitis, or mechanical heart valves.
schistocytes
Homozygosity for hemoglobin S variant of beta chain of hemoglobin with a point mutation at position 6 (valine is substituted for glutamate) causes what disease?
SCA
In regards to sickle cells, the spleen is ___ early in childhood but by adulthood is ____
enlarged; small
Homozygosity for hemoglobin C variant of beta chain of hemoglobin with a point mutation at position 6 (glutamate replaced by lysine) causes what?
hemoglobin C disease
Bite cells have the appearance of having a bite taken out of them. They are formed after ___ bodies are “plucked” out of the RBCs by the reticuloendothelial cells of the spleen
heinz
Bite cells are typical of what type of deficiency?
Glucose-6-phosphate DH
note: doesn’t result in anemia unless the person is introduced to oxidant stress
These cells are seen as a result of marrow fibrosis
teardrop cells
This indicates reticulocytosis. Blue-gray color of RBCs is due to residual ribosomal material within the cytoplasm. seen in any condition that induces premature release of immature cells from the marrow.
polychromasia
RBC inclusion: has small nuclear remnants, typically single, seen in post-splenectomy states, hemolytic anemias, megaloblastic anemia
Howell-Jolly bodies
RBC inclusion: iron-containing mitochondrial remnants, seen in sideroblastic anemias, post-splenectomy states, lead poisoning, and reticulocytes, occur in small clusters near the periphery of the cell
pappenheimer granules
RBC inclusion: composed of RNA, aggregates of ribosomes, seen in thalassemia, megaloblastic anemia, liver disease, lead poisoning, hemolytic anemia, dyserythropoietic states
basophilic stippling
RBC inclusion: nuclear remnant versus microtubules, seen in post-splenectomy states, hemolytic anemias, megaloblastic anemia
cabot ring
RBC abnormality: stacking of RBCs like coins, seen in high profile states like multiple myeloma
rouleaux
Leukocyte: most abundant, multi lobular, fights bacterial infection
neutrophil
leukocyte: largest, blue-gray cytoplasm, bilobed (horseshoe), seen in chronic inflammatory states
monocytes
Leukocyte: spectrum of sizes, cytoplasm is agranular
lymphocytes
note: most peripheral are T cells
Leukocyte: granulocyte, seen in parasitic infections, large round, bilobed
eosinophils
Leukocyte: least abundant, dark cytoplasmic granules, seen in neoplastic conditions
basophils
Abnormal leukocyte: inherited benign anomaly of failure of normal nuclear segmentation, bilobed nuclei, normal neutrophilic function
pelger-huet anomaly (hyposegmented neutrophil)
Abnormal leukocyte: acquired abnormality seen in myelodsysplastic syndromes with bilobed or monologged nuclei, do not usually function as normal neutrophils
pseudo-pelger-huet (hyposegmented neutrophil)
Abnormal leukocyte: seen with megaloblastic anemia, myelodysplastic syndromes, in some infections, and effects of some medications
hypersegmented neutrophils
Abnormal leukocyte: coarse cytoplasmic granules seen in neutrophils in response to infection; due to presence of primary granules in cytoplasm
toxic granulation
Abnormal leukocyte: inconspicuous geryish-blue areas in the cytoplasm that represent residual ribosomes; seen in infections
Dohle bodies
Abnormal leukocyte: most commonly seen in response to acute viral infections; large lymphocytes with abundant blue pale cytoplasm, occasional fine red cytoplasmic granules
atypical lymphocytes
rare autosomal dominant condition with abnormal condensations of RNA appearing as pale blue cytoplasmic inclusions in neutrophils, resemble Dohle bodies; large/giant platelets and thrombocytopenia, usually with no bleeding problems
May-Hegglin anomaly
austosomal recessive disorder with abnormally large granules within leukocytes; partial oculocutaneous albinism, photophobia, immune deficiency, frequent pyogenic infections, and neurologic defects
Chediak-Higashi
austosomal receissve disorder with no significant clinical abnormalities in most; deep purple granules in granulocytes, monocytes, and lymphocytes
Alder-Reily
Autosomal recessive deficiencies of enzymes involved in breakdown of acid mucopolysaccharides; abnormal granulation of blood granulocytes and monocytes with lymphocyte vacuolation
Mucopolysacharidosis
