CBC and Peripheral Blood Cell Morphology

Question 1

What tube is used for a CBC? Which cells are counted?

Answer 1

EDTA anticoagulated blood (purple tube)

-leukocytes, erythrocytes, and thrombocytes

Question 2

Hemoglobin gives the total hemoglobin concentration in a ______ not _____.

Answer 2

given volume of blood, not per cell

Question 3

What is the percent of volume of whole blood that RBC comprise?

Answer 3

Hematocrit (Hct)

Question 4

What is the average volume of RBC correlating with average RBC size?

Answer 4

MCV- mean corpuscular volume- useful in evaluating anemia

Question 5

What is the weight of hemoglobin in average RBC? This is calculated from the total hemoglobin concentration and RBC total count.

Answer 5

MCH- mean corpuscular hemoglobin

Question 6

What is the concentration of hemoglobin in average RBC measured in g/dL?

Answer 6

MCHC- mean corpuscular (cellular) hemoglobin concentration.

Question 7

What is the variation in size of RBC?

Answer 7

RDW- RBC distribution width

Question 8

What is the variation in size of platelets? This is an indirect measure of the age of platelets where newer more immature platelets are ____.

Answer 8

MPV- mean platelet volume

newer are larger

Question 9

Leukocyte differential gives you what counts?

Answer 9

granulocytes, lymphocytes, monocytes, eosinophils, and basophils

Question 10

What does the leukocyte differential analyze?

Answer 10

cell size, cytoplasmic granularity, nuclear size, and complexity

Question 11

What is not calculated in a leukocyte differential? What makes it inaccurate?

Answer 11

no bands

inaccurate when abnormal WBC pop. are present

Question 12

The differential (percentage) gives you the _____ numbers, not the _____.

Answer 12

gives relative, not absolute

ABSOLUTE CELL COUNTS ARE WHAT MATTER

Question 13

increased WBC

Answer 13

leukocytosis

Question 14

increased neutrophils

Answer 14

neutrophilia

Question 15

increased eosinophils

Answer 15

eosinophilia

Question 16

increased basophils

Answer 16

basophilia

Question 17

increased monocytes

Answer 17

monocytosis

Question 18

increased lymphocytes

Answer 18

lymphocytosis

Question 19

increased platelets

Answer 19

thrombocytosis (thrombocythemia)

Question 20

increased RBC

Answer 20

polycythemia

Question 21

decreased WBC

Answer 21

leukocytopenia

Question 22

decreased neutrophils

Answer 22

neutropenia

Question 23

decreased lymphocytes

Answer 23

lymphocytopenia or lymphopenia

Question 24

decreased monocytes

Answer 24

monocytopenia

Question 25

decreased platelets

Answer 25

thrombocytopenia

Question 26

decreased RBC

Answer 26

anemia

Question 27

smaller than normal RBC

Answer 27

microcytic (microcytosis)

Question 28

large than normal RBC

Answer 28

macrocytic (macrocytosis)

Question 29

variation in size of RBC (abnormality)

Answer 29

anisocytosis

Question 30

variation in shape of RBC (abnormality)

Answer 30

poikilocytosis

Question 31

variation in size and shape of RBC (abnormality)

Answer 31

anisopoikilocytosis

Question 32

normal amt of hemoglobin with nml staining on peripheral blood smear

Answer 32

normocytic

Question 33

decreased hemoglobin with pale staining

Answer 33

hypochromic

Question 34

increased immature RBC (reticulocytes), blue-gray cytoplasm due to residual RNA, nml amt of hemoglobin

Answer 34

polychromasia

Question 35

Small, pale, zone of central pallor, iron deficiency, anemia of chronic disease, sideroblastic anemia, lead and heavy meatal poisoning, thalassemia

Answer 35

microcytic hypochromic cells

Question 36

Larger than nml, well hemoglobinized, young cells and in abnormal maturation states (megaloblastic anemia and myelodysplastic)

Answer 36

macrocytic cells

Question 37

Smaller in diameter than nml, SPHERICAL, loss of central pallor, lose membrane during passage through spleen, short lifespan, destroyed in spleen prematurely, ABNORMALITIES OF CYTOSKELETAL PROTEINS

Answer 37

spherocytes

Question 38

OVAL/ELLIPTICAL results in anemia; hereditary caused by cytoskeleton abnormalities; acquired forms caused by iron deficiency (more pale), thalassemias, megaloblastic anemia, myelofibrosis, myelodysplastic syndrome

Answer 38

elliptocytosis/ovalocytosis

Question 39

Large, FLOPPY cells with redundant cytoplasmic membrane compared to vol. of cell, thinner, BELL-SHAPED - macrocytic- liver disease, megaloblastic anemia - microcytic- thalassemia, iron deficiency - normocytic- sickling disorders, hgb E

Answer 39

target cells

Question 40

AMEBOID cells with unevenly distributed spicules over RBC surface - inherited- abetalipoproteinemia - acquired- liver disease, myelodysplastic syndrome, malnutrition

Answer 40

acanthocytes

Question 41

EVENLY distributed spicules | -storage artifact, liver disease or renal failure, enzyme deficiencies

Answer 41

echinocytes

Question 42

"mouth cells", central zone of pallor is NARROW, occasionally seen in healthy patients, commonly associated with alcohol excess and alcoholic liver disease

Answer 42

stomatocytes

Question 43

RBC FRAGMENTS formed as a result of mechanical disruption of RBC in microvasculature by fibrin strands (DIC), platelet strands, toxins, burns, vasculitis, or mechanical heart valves

Answer 43

schistocytes

Question 44

Caused by homozygosity for hemoglobin S variant of beta chain of hemoglobin OR heterozygosity for hemoglobin S in combination with other hemoglobin variants or thalassemias

Answer 44

sickle cells

Question 45

Caused by homozygosity for hemoglobin C variant of beta chain of hemoglobin OR heterozygosity for hemoglobin C and another variant of thalassemia -irregularly contracted cells, target cells, hemoglobin C crystals, spherocytes

Answer 45

Hemoglobin C disease

Question 46

Formed after Heinz bodies (denatured hemoglobin and membrane protein, adherent to membrane) are "plucked" out of the RBCs by reticuloendothelial cells of the spleen -Typical for G6PD deficiency (on the X chromosome)

Answer 46

Bite cell (degmacyte)

Question 47

Heinz bodies are only seen on ______ stains such as _____. They are not seen on _____ stained peripheral blood smears.

Answer 47

supravital stains such as new methylene blue, not seen on wright-stained peripheral blood smears

Question 48

Result of marrow fibrosis

Answer 48

tear drop cells (dacrocytes)

Question 49

Indicates reticulocytosis (true reticulocytes are only seen by methylene blue stain) - blue-gray color because of residual ribosomal material within the cytoplasm - any condition with premature release of immature cells from the marrow

Answer 49

polychromasia

Question 50

Small nuclear remnants, typically single, post-splenectomy states, hemolytic anemias, megaloblastic anemia, nml for neonates

Answer 50

Howell-Jolly bodies

Question 51

IRON-CONTAINING MITOCHONDRIAL REMNANTS, seen in sideroblastic anemias, post-splenectomy states, lead poisoning, and reticulocytes -occur in small clusters near periphery of cell

Answer 51

Pappenheimer granules

Question 52

Composed of RNA, AGGREGATES OF RIBOSOMES, in thalassemia, megaloblastic anemia, liver disease, lead poisoning, hemolytic anemia, dyserythropoietic states

Answer 52

Basophilic stippling

Question 53

nuclear remnant vs. microtubules, post-splenectomy states, hemolytic anemias, megaloblastic anemia

Answer 53

Cabot ring