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Diagnostic Studies > Diagnosis of Anemias > Flashcards

Diagnosis of Anemias Flashcards

1
Q

Normal RBC

(diameter, volume, shape)

A
  • *žDiameter:** 6 - 8 µ
  • *žVolume:** 90 fL
  • *žShape:**
  • Biconcave disk
  • žArea of central pallor: 1/3 of cell
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2
Q

Identify

A

Normal red blood cells. Note small mature lymphocyte nucleus as “ruler” for RBC size

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3
Q

RBC Assessment

(6 steps)

A
  1. —Appropriate Size
  2. —Appropriate Color
  3. —Appropriate Shape
  4. —Appropriate Inclusions
  5. Appropriate —Distribution
    • žIs the abnormality uniformly distributed?
  6. žIs the abnormality likely to be artifact?
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4
Q

RBC Size categories

(3, causes, term for when they coexist)

A

Sizes

  1. žNormocytic
  2. žMacrocytic
    • —Impaired DNA synthesis (B12/folate deficiency)
    • —Accelerated erythropoiesis (hemolysis)
    • —Increased cholesterol and lecithin (liver disease)
  3. žMicrocytic
    • —Ineffective Fe utilization
    • —Decreased or defective globin synthesis

**Mixed (pathologic) **Ansiocytosis

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5
Q

Identify

A

Ansiocytosis

  • Identifying factors:*
  • Increased red cell distribution width (RDW)
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6
Q

Identify

A

Macrocytosis

  • Identifying factors*
  • RBC diameter > small mature lymphocyte diameter
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7
Q

Identify

A

Microcytosis

  • Identifying factor*
  • RBC diameter < small mature lymphocyte nucleus diameter
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8
Q

RBC Colors

(3, causes, pathology when mixed)

A

Colors

  1. Normochromic
  2. žHypochromic
    • —Fe deficiency, thalassemia, Pb poisoning
  3. žHyperchromic
    • —Spherocytes

Patholgy of mixed shades

Polychromasia

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9
Q

Identify

A

Hyperchromic RBCs

Identifying Factors:

  • Dark comparative color
  • Loss of central pallor
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10
Q

Identify

A

Hypochromic RBC

Identifying Factors

  • light colored cells, especially compared to lymphocyte
  • central pallor > 1/3 cell
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11
Q

Describe the RBCs

A

Hypochromic (MCHC)

Microcytic (MCV)

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12
Q

Identify and explain significance

A

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
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13
Q

Identify

A

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
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14
Q

Cell shapes

(10 shapes, condition of multiple shapes)

A

Shapes

  1. Target cells
  2. Spherocytes
  3. Elliptocytes
  4. Ovalocytes
  5. Stomatocytes
  6. Sickle cells
  7. Acanthocytes
  8. Echinocytes/Burr cells
  9. Schistocytes (fragmented cell)
  10. Teardrop cells

Condition - Poikilocytosis

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15
Q

Identify

(plus 4 common causative conditions)

A

Target Cells

  • Identifying Factors*
  • Central pallor c darkened center
  • Associated Conditions (always a board question)*
  1. Hemoglobinopathies
  2. Thallasemia
  3. Liver disease
  4. Fe Deficiency
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16
Q

Identify

(plus three associated conditions)

A

Spherocytes

Identifying Factors

  • Mycrocytic
  • Hyperchromic

Associated Conditions

  1. ​Immune hemolytic anemias (sections holding antigens removed from RBC membrane when passing thru spleen, make RBC smaller but does not signficantly decrease hemoglobin concentration)
  2. Post-transfusion (inability to regulate osmotic pressure)
  3. Hereditary

Note

  • Fragile cells
  • Tested for with direct (or indirect) Coomb’s test
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17
Q

Describe the probable cell shape

A

Spherocytosis

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18
Q

Identify

(plus three common causative conditions)

A

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)
19
Q

Identify

(plus 2 common causative conditions)

A

Ovalocytes

  • Identifying Factors*
  • Oval shape
  • Causative Conditions*
  • Myelodysplastic syndrome
  • Megaloblastic anemia
20
Q

Identify

(plus three common causative conditions)

A

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
21
Q

Identify

(plus one common causative agent)

A

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
22
Q

Identify

(plus three common causative agents)

A

Acanthocytes

  • Identifying Factors:*
  • Irregular spicuoles
  • Causative Conditions (liver or lipid)*
  • Inherited lipid disorders
  • Alocholic cirrhosis
  • Neonatal hepatitis
23
Q

Identify

(plus 4 common causative conditions)

A

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)

24
Q

Identify

(Plus four common causative agents)

A

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
25
Q

Identify

(plus four common causative conditions)

A

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

26
Q

RBC Inclusions revealed on Wright Stain

(8)

A
  1. žHowell-Jolly bodies
  2. žBasophilic stippling
  3. žSiderotic granules
  4. Pappenheimer bodies
  5. žNucleated RBC
  6. žCabot rings
  7. žHemoglobin C crystals
  8. žParasites (malaria, etc.)
27
Q

Identify

A

Howell Jolly Bodies

  • Identifying Factors*
  • small dark dots inside the RBC
  • Note - nuclear fragmetns due to karyorrexis*
28
Q

Identify

A

Basophilic Stippling

  • Identifying Factors*
  • Bluish/gray spots or granulations inside RBC
  • Common Causative Conditions*
  • Thalassemia
  • Defective heme synthesis
  • Pb poisining (coarse)
29
Q

Identify

A

Pappenheimer Bodies

  • Identifying Factors*
  • clusters of small round inclusions - grape clusters
  • Common Causative Conditions​*
  • žSideroblastic anemia - extra iron
  • žHemoglobinopathies - excess iron in peripheral blood post transfusion
  • žThalassemia
  • žPost-splenectomy
  • žHemochromatosis - hereditary disorder of iron disposition

​

30
Q

Identify

(plus two common causative conditions)

A

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
31
Q

Identify

(one common causative condition)

A

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)
32
Q

Identify

(one common causative agent)

A

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)*
33
Q

Methods of Peripheral Blood Smear Examination

(three microscope settings)

A
  1. žLow Power Scan (x10X)
  2. žHigh Power Exam (x40X)
  3. žOil Immersion Examination (x100X)
34
Q

Low Power Scan Uses

(3)

A
  1. Evaluate žStain quality
  2. žDistribution
    • —Agglutination
    • —Rouleaux
  3. žOptimal area for differential and morphology
35
Q

Identify

A

RBC Agglutination

RBC has cold agglutinin

36
Q

Identify

(one causative agent, pathophys)

A

Rouleaux Formation

  • Pathophysiology*
  • excess protein on RBC membrane causes chain-like sticking
  • Common Causative Condition*
  • multiple myeloma
37
Q

Oil Immersion Examination

(3 Uses)

A
  1. ž100 WBC differential count
    • —WBC morphology
    • —Nucleated RBC correction
  2. žRBC Morphology
  3. žPlatelet Estimate
38
Q

Anemia Classification Schemes

(2, describe groups - each classification has three)

A
  1. žFunctional Classification
    1. —Maturation​
      • Cytoplasmic
      • Nuclear
    2. —Hypoproliferative
      • Decreased EPO
      • Iron Depletion
      • Marrow damage
    3. —Hemolysis or hemorrhage
  2. ​žMorphologic classification
    1. —Microcytic
    2. —Normocytic
    3. —Macrocytic
39
Q

Microcytic Anemia

(Two physiologic causes, 2 and 4 associated conditions)

A
  • žDecrerased serum Fe
    • —Iron deficiency
    • —Anemia of chronic disease (cant get iron out of macrophages)
  • žNormal or increased serum Fe
    • —Thalassemia syndromes
    • —Sideroblastic anemia
    • —Lead poisoning
    • —Porphyrias
40
Q

Normocytic Anemia

(two physiologic causes, 2 and 3 specifics)

A

žInceased reticulocyte production

  • —Acute blood loss
  • —Hemolytic anemia
    • Immune
    • Non- immune (intrinsic vs extrinsic)

žNormal or decreased reticulocyte production

  • —Bone marrow failure (aplastic anemia)
  • —Infection
  • —Malignancy
41
Q

Macrocytic Anemia

(2 physiologic categories, 1 and 4 specifics)

A

žWith increased reticulocyte production

  • —Hemolytic anemias with marked reticulocytosis

žWith normal or decreased reticulocyte production

  • —Megaloblastic anemia
  • —Myelodysplastic syndromes
  • —Liver disease
  • —Medication or chemotherapy
42
Q

Peripheral Blood Smear

(3 uses)

A
  1. žCoexisting leukopenia or thrombocytopenia
  2. žSize and shape of RBC
  3. žRBC inclusions
43
Q

Bone Marrow Examination

(5 uses)

A
  1. žMaturation of RBC and WBC
  2. žPresence of megakaryocytes
  3. žM:E Ratio
  4. žIron stores
  5. žPresence of abnormal elements

Diagnostic Studies (11 decks)

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