Diagnosis of Anemias Flashcards
Normal RBC
(diameter, volume, shape)
- *Diameter:** 6 - 8 µ
- *Volume:** 90 fL
- *Shape:**
- Biconcave disk
- Area of central pallor: 1/3 of cell
Identify
Normal red blood cells. Note small mature lymphocyte nucleus as “ruler” for RBC size
RBC Assessment
(6 steps)
- Appropriate Size
- Appropriate Color
- Appropriate Shape
- Appropriate Inclusions
- Appropriate Distribution
- Is the abnormality uniformly distributed?
- Is the abnormality likely to be artifact?
RBC Size categories
(3, causes, term for when they coexist)
Sizes
- Normocytic
- Macrocytic
- Impaired DNA synthesis (B12/folate deficiency)
- Accelerated erythropoiesis (hemolysis)
- Increased cholesterol and lecithin (liver disease)
- Microcytic
- Ineffective Fe utilization
- Decreased or defective globin synthesis
**Mixed (pathologic) **Ansiocytosis
Identify
Ansiocytosis
- Identifying factors:*
- Increased red cell distribution width (RDW)
Identify
Macrocytosis
- Identifying factors*
- RBC diameter > small mature lymphocyte diameter
Identify
Microcytosis
- Identifying factor*
- RBC diameter < small mature lymphocyte nucleus diameter
RBC Colors
(3, causes, pathology when mixed)
Colors
- Normochromic
- Hypochromic
- Fe deficiency, thalassemia, Pb poisoning
- Hyperchromic
- Spherocytes
Patholgy of mixed shades
Polychromasia
Identify
Hyperchromic RBCs
Identifying Factors:
- Dark comparative color
- Loss of central pallor
Identify
Hypochromic RBC
Identifying Factors
- light colored cells, especially compared to lymphocyte
- central pallor > 1/3 cell
Describe the RBCs
Hypochromic (MCHC)
Microcytic (MCV)
Identify and explain significance
Polychromasia
Identifying Factors
- multiple shades of WBC
- variable central pallor size
Explaination
- Polychromasia implying presence of reticulocytes (need special stain for discrete ID) should exist in 1% of the cell population
- Excess polychromasia likely indicates there is an increase in ciruculating immature RBC, a sign of functioning bone marrow with dysfunctioning RBC or RBC monitoring mechanism. Usually a hemolytic anemia
Identify
Reticulocytes
Identifying Factors
- Presence of supernormal stain - only place retics can be positively identified (although they can be implied with polychromasia in a typical stain)
- Granulations (RNA) within RBCs
Cell shapes
(10 shapes, condition of multiple shapes)
Shapes
- Target cells
- Spherocytes
- Elliptocytes
- Ovalocytes
- Stomatocytes
- Sickle cells
- Acanthocytes
- Echinocytes/Burr cells
- Schistocytes (fragmented cell)
- Teardrop cells
Condition - Poikilocytosis
Identify
(plus 4 common causative conditions)
Target Cells
- Identifying Factors*
- Central pallor c darkened center
- Associated Conditions (always a board question)*
- Hemoglobinopathies
- Thallasemia
- Liver disease
- Fe Deficiency
Identify
(plus three associated conditions)
Spherocytes
Identifying Factors
- Mycrocytic
- Hyperchromic
Associated Conditions
- Immune hemolytic anemias (sections holding antigens removed from RBC membrane when passing thru spleen, make RBC smaller but does not signficantly decrease hemoglobin concentration)
- Post-transfusion (inability to regulate osmotic pressure)
- Hereditary
Note
- Fragile cells
- Tested for with direct (or indirect) Coomb’s test
Describe the probable cell shape
Spherocytosis
Identify
(plus three common causative conditions)
Elliptocytes
- Identifying Factors*
- 2 sides of RBC are parallel
- Causative Conditions*
- Hereditary (most cells will be elliptocytes)
- Fe Deficiency (not predominating, “squeezed” cells)
- Myelofibrosis (not predominating, “squeezed” cells)
Identify
(plus 2 common causative conditions)
Ovalocytes
- Identifying Factors*
- Oval shape
- Causative Conditions*
- Myelodysplastic syndrome
- Megaloblastic anemia
Identify
(plus three common causative conditions)
Stomatocytes
Identifying Factors
- “stoma” or “mouth-like” slits in RBC
- cells that appear folded over on themselves
Causative Conditions
- Artifact (won’t be reported)
- Acute alcoholism
- Malignancies
Identify
(plus one common causative agent)
Sickle Cells
- Identifying Factor*
- Long, pointed, sickle-like cells
- Common Causative Agent*
- Sickle Cell Disease
- Note*
- Shape change due to rigid tactoids of hemoglobin S in the presence of hypoxia
Identify
(plus three common causative agents)
Acanthocytes
- Identifying Factors:*
- Irregular spicuoles
- Causative Conditions (liver or lipid)*
- Inherited lipid disorders
- Alocholic cirrhosis
- Neonatal hepatitis
Identify
(plus 4 common causative conditions)
Burr Cells (Echinocytes)
- Identifying Factors*
- star-like projections out of round RBC
- Causative Conditions*
- Artifact (poor drying conditions, prolonged storage)
- Renal insufficiency
- Severe dehydration
- Burns
Note - will only be reported if significant, not artifact)
Identify
(Plus four common causative agents)
Schistocytes (cell fragments)
- Identifying*
- irregular, variable sized cell fragments mixed c regular RBCs
- Common Causative Conditions - Micropathic hemolytic anemias*
- Disseminated Intravascular Coagulation
- Thrombotic Thrombocytopenic Purpura (TTP)
- Hemolytic Uremic Syndrome (HUS)
- Traumatic hemolytic anemia
Notes
- Blocked vessel or interfered flow in vessel
- TTP and HUS have fibrin strands projecting into vessel that disturb RBC (chain linked fence)
- Traumatic hemolytic anemia and microangiopathic hemolytic anemia can be due to prosthetic heart valve
Identify
(plus four common causative conditions)
Teardrop Cells
- Identifying Factors*
- One pointed projection, tear drop looking
- Common Causative Conditions*
- Extramedullary hematopoiesis
- Megaloblastic anemia
- Thallasemia
- Hypersplenism
Note - these cells are usually produced by secondary hematopoietic locations, usually spleen or liver. They have to squish through the capillaries so they are shaped differently
RBC Inclusions revealed on Wright Stain
(8)
- Howell-Jolly bodies
- Basophilic stippling
- Siderotic granules
- Pappenheimer bodies
- Nucleated RBC
- Cabot rings
- Hemoglobin C crystals
- Parasites (malaria, etc.)
Identify
Howell Jolly Bodies
- Identifying Factors*
- small dark dots inside the RBC
- Note - nuclear fragmetns due to karyorrexis*
Identify
Basophilic Stippling
- Identifying Factors*
- Bluish/gray spots or granulations inside RBC
- Common Causative Conditions*
- Thalassemia
- Defective heme synthesis
- Pb poisining (coarse)
Identify
Pappenheimer Bodies
- Identifying Factors*
- clusters of small round inclusions - grape clusters
- Common Causative Conditions*
- Sideroblastic anemia - extra iron
- Hemoglobinopathies - excess iron in peripheral blood post transfusion
- Thalassemia
- Post-splenectomy
- Hemochromatosis - hereditary disorder of iron disposition
Identify
(plus two common causative conditions)
Nucleated RBC
- Identifying Factors*
- looks like lymphocyte, but there is significant cytoplasm to one side of cell
- Causative*
- Normal finding in infants
- Erythroid hyperplasia in adults
- Note*
- Will increase polychromasia/retic count
Identify
(one common causative condition)
Hemoglobin C Crystals
Identifying Factors
- dark, rectangular central pallor
- shown here in rectangular cells, but could also exist in rounded cells. The rest of the cell will show pallor
- Common Causative Condition*
- Hemoglobin C disease post splenectomy (spleen will destroy them normally)
Identify
(one common causative agent)
Parasitemia
- Identifying factors*
- small dark granuoles inside RBC
- Common Causative Condition*
- malaria
- Note - try not to get confused if there is a platelet on top of the RBC (pictured)*
Methods of Peripheral Blood Smear Examination
(three microscope settings)
- Low Power Scan (x10X)
- High Power Exam (x40X)
- Oil Immersion Examination (x100X)
Low Power Scan Uses
(3)
- Evaluate Stain quality
- Distribution
- Agglutination
- Rouleaux
- Optimal area for differential and morphology
Identify
RBC Agglutination
RBC has cold agglutinin
Identify
(one causative agent, pathophys)
Rouleaux Formation
- Pathophysiology*
- excess protein on RBC membrane causes chain-like sticking
- Common Causative Condition*
- multiple myeloma
Oil Immersion Examination
(3 Uses)
- 100 WBC differential count
- WBC morphology
- Nucleated RBC correction
- RBC Morphology
- Platelet Estimate
Anemia Classification Schemes
(2, describe groups - each classification has three)
-
Functional Classification
- Maturation
- Cytoplasmic
- Nuclear
- Hypoproliferative
- Decreased EPO
- Iron Depletion
- Marrow damage
- Hemolysis or hemorrhage
- Maturation
-
Morphologic classification
- Microcytic
- Normocytic
- Macrocytic
Microcytic Anemia
(Two physiologic causes, 2 and 4 associated conditions)
- Decrerased serum Fe
- Iron deficiency
- Anemia of chronic disease (cant get iron out of macrophages)
- Normal or increased serum Fe
- Thalassemia syndromes
- Sideroblastic anemia
- Lead poisoning
- Porphyrias
Normocytic Anemia
(two physiologic causes, 2 and 3 specifics)
Inceased reticulocyte production
- Acute blood loss
- Hemolytic anemia
- Immune
- Non- immune (intrinsic vs extrinsic)
Normal or decreased reticulocyte production
- Bone marrow failure (aplastic anemia)
- Infection
- Malignancy
Macrocytic Anemia
(2 physiologic categories, 1 and 4 specifics)
With increased reticulocyte production
- Hemolytic anemias with marked reticulocytosis
With normal or decreased reticulocyte production
- Megaloblastic anemia
- Myelodysplastic syndromes
- Liver disease
- Medication or chemotherapy
Peripheral Blood Smear
(3 uses)
- Coexisting leukopenia or thrombocytopenia
- Size and shape of RBC
- RBC inclusions
Bone Marrow Examination
(5 uses)
- Maturation of RBC and WBC
- Presence of megakaryocytes
- M:E Ratio
- Iron stores
- Presence of abnormal elements
