Data interpretation: Blood Film Flashcards
In a blood film, what 3 cell types should you look for?
Erythrocytes
Leukocytes
Platelets
In a blood film, which 6 types of erythrocyte abnormalities should you look for?
Size
Number
Colour
Shape
Arrangement
Inclusion bodies
In a blood film, how can you identify whether the size of the erythrocytes is normal or abnormal?
MCV value in full blood count
Normocytic MCV: 80-100 fl
Macrocytic MCV: Over 100 fl
Microcytic MCV: Less than 80 fl
What is the MCV range of macrocytic erythrocytes, and give 10 pathologies (ABCDEF)?
MCV range: Over 100 fl
A: Alcohol and liver disease
B: B12 deficiency, pernicious anaemia
C: Compensatory reticulocytosis: Haemolysis
D: Dsyplasia eg. MDS
E: Endocrine eg. hypothyroidism
F: Folate deficiency, fetus (pregnancy)
What is the typical shape of macrocytic erythrocytes when due to megaloblastic anaemia or myelodysplasia?
Oval macrocytosis
What is the typical shape of macrocytic erythrocytes when due to liver disease or alcohol?
Round macrocytosis
What is the MCV range of microcytic erythrocytes, and give 6 pathologies (TRAILS)?
MCV range: Less than 80 fl
T: Thalassaemia
R: Rheumatoid arthritis
A: Anaemia of chronic disease
I: Iron-deficiency anaemia
L: Lead poisoning
S: Sideroblastic anaemia and SCA
What is sideroblastic anaemia, and what is the hallmark blood film finding?
Sideroblastic anaemia: Disorder where the body produces enough iron but is unable to put it into the haemoglobin
Blood film finding: Ringed siderocytes with pappenheimer bodies (cytoplasmic iron granules)
What are the 4 ways of classifying colours of erythrocytes, and what FBC reading do you use to confirm this?
Normochromic
Hyperchromic
Hypochromic
Polychromic
Look at Mean Cell Haemoglobin (MCH) value
In a blood film, which type of anaemia generally also causes hypochromic erythrocytes?
Microcytic anaemia due to TRAILS
In a blood film, what do polychromatic erythrocytes look like and why, and what FBC value does this correlate with?
Polychromasia: Blue-purple uniform discoloured cells amongst normal cells
Blue/purple colour due to stained blue RNA in reticulocytes (needed for last stage of erythropoiesis) and red haemoglobin
Elevated reticulocyte count
Give 4 associated pathologies with polychromatic erythrocytes?
Indicates haemolysis or bone marrow stress:
Post-haemorrhage
Haemolytic anaemia
Treated deficiency anaemia
dyserythropoiesis
What kind of anaemia generally also causes hyperchromatic erythrocytes?
Macrocytic due to liver disease, alcohol, hypothyroidism, aplastic anaemia, MDS
In a blood film, how do you recognise hyperchromic erythrocytes?
Erythrocytes have loss of central pallor, but still have red colour
Give 9 types of shape abnormalities to look for in a blood film, when looking at erythrocytes?
Reticulocytes
Nucleated RBCs
Spherocytes
Elliptocytes
Pencil cells
Target cells
Helmet cells/schistocytes
Sickle cells
Acanthocytes
In a blood film, what do reticulocytes look like and give 3 associated pathologies?
Blue, large cells with RNA granules
Occur due to high bone marrow activity:
Haemolytic anaemia
Polycythemia Vera and secondary Polycythemia
Recovery post-chemotherapy
In a blood film, what do spherocytes look like and why do they occur?
Rounded RBCs
Lost biconcave shape due to structural membrane loss, so they become spheres
Give 4 conditions associated with spherocytes?
DIC
AIHA: Partial phagocytosis by macrophages causes RBCs to lose normal structure
Hereditary spherocytosis: Congenital haemolytic anaemia where gene mutation of a structural membrane protein
G6PD deficiency
In a blood film, what do pencil cells look like and give 2 associated pathologies?
Thin, rod-shaped erythrocytes that stain purple
Iron-deficiency anaemia
Thalassaemia
In a blood film, what do target cells look like and give 5 associated pathologies (HASTI)
Central darkness, with pale middle border and dark outer border (like a target)
H: Haemaglobinopathies
A: Asplenia
S: SCD
T: Thalassaemia
I: Iron-deficiency anaemia
In a blood film, what do schistocytes/helmet cells look like and what is the most significant pathology associated with this?
Fragmented erythrocytes that are damaged by being removed by spleen
Common in microangiopathic haemolytic anaemia
MHA is present in DIC, TTP, valvular haemolysis
What do sickle cells look like on a blood film?
S-shaped, thin erythrocytes
In a blood film, what do acanthocytes look like and give 3 associated pathologies?
Spiky RBCs
Asplenia
Alpha thalassaemia
MHA eg. In DIC, TTP, HUS
What 2 arrangement abnormalities should you look for in erythrocytes, in a blood film?
Rouleux
Agglutination
In a blood film, what do rouleaux cells look like and which haematological disease is it associated with?
Stacking and loose agglutination of erythrocytes (that resembles stack of coins)
Multiple myeloma
In a blood film, what does erythrocyte agglutination look like and what haematological condition is it associated with?
Cold AIHA, milder in warm AIHA
What haematological condition causes teardrop erythrocytes and why?
Myelofibrosis
They are squeezed out of the bone marrow due to bone marrow infiltration in myelofibrosis.
In a blood film, what 4 erythrocyte inclusion bodies should you look for?
Basophilic stippling
Heinz bodies
Howell-jolly bodies
Pappenheimer bodies
What does basophilic stippling look like in a blood film?
Small blue granules diffused in RBC cytoplasm
What do heinz bodies look like in a blood film, and what causes them?
Small stained dot at edge of RBC that looks like a nose
Denatured Haemoglobin due to oxidative damage/unstable Hb, is removed by spleen to form bite cells
What do Howell-jolly bodies look like in a blood film, and what causes them?
Single dot in RBC that stains purple
Nuclear DNA remnant after RBC matures (shouldn’t normally be seen
What do pappenheimer bodies look like in a blood film?
Iron granules found on one side of RBC cytoplasm
Describe the characteristic blood film of myelofibrosis?
Dacrocytes (teardrop-shaped)
Leukoerythroblastic cells
Describe the characteristic blood film of Hodgkin’s lymphoma?
Reed-Stenberg cells
Eosinophilia
Describe the characteristic blood film of AML?
Auer rods
Describe the characteristic blood film of CLL?
Smudge/smear cells (ruptured lymphocytes with irregular cytoplasm border)
