Hema 1 Part 2 1 Flashcards by E A

PURPOSES OF BLOOD FILM EXAMINATION

• To differentiate mature from immature blood cells
• To assess morphology of the blood cells
• To perform manual differential count

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AS THE BLOOD CELL MATURES…

Chromatin Pattern

Nucleoli

N:C Ratio (Nucleus:Cytoplasm Ratio)

Cell Size

Cytoplasmic Basophilia

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RECALL QUESTION: What is the most reliable indicator of maturity?

Chromatin pattern

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RBC MORPHOLOGY
• Normal size of RBC:
• Normal RBC shape:
• Normal RBC color/pallor:

RBC MORPHOLOGY
• Normal size of RBC: 6-8 um in diameter
• Normal RBC shape: Discocyte / Biconcave Disc
• Normal RBC color/pallor: 1/3 central pallor

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Variation in the size of RBCs

ANISOCYTOSIS

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Anisocytosis can be assessed using

RDW (Red Cell Distribution Weight)

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MACROCYTES diseases ( ↑ MCV)

• Megaloblastic Anemia
• Liver Disease
• Shift Cells

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MICROCYTES ( ↓ MCV)

• Iron Deficiency
Anemia (IDA)
• Thalassemia
• Chronic Blood Loss
→ Due to
gastrointestinal
bleeding

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Major site of hematology

Bone marrow:

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Parameter that will give an idea if there are macrocytes present

MCV

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Variation in the shape of RBCs

POIKILOCYTOSIS

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Variation in the color/pallor of RBCs

ANISOCHROMIA

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Hematopoietic stem cell marker:

CD34

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Regulated by erythropoietin, which is produced by the

kidneys

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Main site of adult hematopoiesis or blood cell production are the following:

→ Vertebrate
→ Ribs
→ Sternum
→ Skull
→ Proximal ends of the femur and humerus

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• “Spur cells”
• Large, irregular, blunt projections

Acanthocyte

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Acanthocyte Found in patients with:

→ Abetalipoproteinemia (Bassen–Kornzweig
Syndrome)
→ McLeod phenotype (Kell Blood Group System)
▪ Rare phenotype

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• “Burr cells”
• Projections are not as big as acanthocytes
• Spicules are more pointed and evenly distributed

Echinocytes

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Echinocytes seen in

RECALL QUESTION: Seen in:
→ Uremia
→ Kidney problems

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Teardrop RBCs

Dacrocytes

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Dacrocytes Found in cases of:

Myeclotibosis / Myeloid metaplasia

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“Sickle cell”
• Crescent, Banana shaped

Drepanocytes

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Drepanocytes seen in

Hbs positive individuals

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Hemolyzed RBC fragments / Debris

Schizocytes

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Schizocytes Found in

→ Hemolytic anemia → Burns

Horn-like / Helmet-like RBC

Keratocytes

Keratocytes Found in:

Hemolytic Anemia

Mouth-like or slit-like appearance on top view; bowl-like appearance on side view since it has a depression and not an opening

Stomatocytes

Stomatocytes Seen in:

Hereditary stomatocytosis Individuals with liver disease Rh null phenotype

Target cells; Mexican hat cell → Dartboard appearance since it has an alternating RBCs take in without staining characteristics. ▪ Dartboard appearance is due to the multiple curves of the codocytes

Codocytes

Codocytes seen in

→ Thalassemia → Hemoglobinopathy

Ovalovutes are seen in

→ Parasitic Infection ▪ Plasmodium infections (P. ovale) → Megaloblastic anemia

Which poikilocyte is found on a. Macrocyte b. Macro-ovalocyte

• RBCs that lacks central pallor

Spherocytes

Spherocytes conditions

Conditions: → Hereditary spherocytosis → Autoimmune hemolysis anemia (AIHA) → HDN - ABO shows the presence of spherocytes → HTR

Made up of DNA fragments

Howell Jolly bodies

Howell Jolly bodies test

Feulgen stain positive

Howell Jolly bodies Seen in condition in patients with:

Megaloblastic Anemia (Impaired DNA synthesis)

• Denatured Hgb • Supravital stain (Crystal violet)

Heinz bodies

Heinz bodies are found in

• Found in people with G6PD deficiency • Unstable Hgb → People with sensitive Hgb • Oxidizing agent (naphthalene balls)

• Siderotic granules (iron granules) • Demonstrated by Perl’s Prussian blue stain

Pappenheimer bodies

Seen in Sideroblastic anemia

Pappenheimer bodies

Aggregates of ribosomes

Basophilic stippling

Basophilic stipplingg is seen in

Seen in lead poisoning and pyrimidine 5-nucleotidase deficiency → Both conditions are board exam recall questions

Remnants of mitotic spindle fibers

Cabot rings

Reddish-violet in color, figure 8 or infinity appearance

Cabot rings

Cabot rings are seen in

Megaloblastic anemia

Seen in patients with Megaloblastic Anemia:

→ Macroovalocytes → Howell-Jolly Bodies → Cabot Rings

Stain for polychromasia

Polychromasia – If you applied a Wright’s stain.

• Increases in acute infections → Sudden onset

NEUTROPHIL

• Most predominant WBC in blood • Has 3-5 lobes with fine lilac granules

NEUTROPHIL

• Most predominant WBC in blood • Has 3-5 lobes with fine lilac granules

NEUTROPHIL

• Most predominant WBC in blood • Has 3-5 lobes with fine lilac granules

NEUTROPHIL

• Has orange-red granules; lobulated • Suppresses allergic reactions

EOSINOPHIL

Least common WBC in the circulation: 0-1% → Deep purple granules (Major components: Heparin & Histamine)

BASOPHIL

• Ground glass appearance • Horseshoe shaped nucleus

MONOCYTE

Largest WBC that is normally found in the blood

MONOCYTE

• Smallest WBC, second most predominant • Increased in most cases of viral infection

LYMPHOCYTE

Bacterial infections that can cause Increased lymphocyte (Lymphocytosis) → Pertussis (whooping cough, Bordetella pertussis) → Tuberculosis (Mycobacterium tuberculosis) → Brucellosis

3 types of Lymphocytes

→ T cell → B cell → NK cell or null lymphocyte/ LGL (Large granular lymphocyte)

3 types of Lymphocytes

→ T cell → B cell → NK cell or null lymphocyte/ LGL (Large granular lymphocyte)

• Mediators of immune response; antibody production • Robin egg blue cytoplasm, compact nucleus

LYMPHOCYTE

Hyposegmentation; <3 lobes

PELGER-HUET ANOMALY

Bilobed or pince-nez appearance (eyeglass)

PELGER-HUET ANOMALY

>5 lobes; found in megaloblastic anemia

HYPERSEGMENTATION

Large, thickened granules, indicate infection

TOXIC GRANULATION

Similar to toxic granulation; related to mucopolysaccharidosis

ALDER-REILLY BODIES

• Golden-brown granules • defective lysosomes

CHEDIAK-HIGASHI

• related to partial albinism • Bead-like inclusions

CHEDIAK-HIGASHI

• related to partial albinism • Bead-like inclusions

CHEDIAK-HIGASHI

• Similar to Dohle bodies; but found in all types of WBC

MAY-HEGGLIN BODIES

• Similar to Dohle bodies; but found in all types of WBC

MAY-HEGGLIN BODIES

• Remnants of lymphocytes • Has faded appearance

SMUDGE CELLS

• Remnants of lymphocytes • Has faded appearance

SMUDGE CELLS

Remnants of neutrophils

BASKET CELLS

Neutrophil with ingested nuclear body/nucleus

LE CELL

Monocyte with ingested nuclear body/nucleus

TART CELL

Crumpled tissue appearance of monocytes / macrophages.

GAUCHER CELLS

Related to glucocerebrosidase deficiency (Gaucher disease).

Related to glucocerebrosidase deficiency

GAUCHER CELLS

Related to sphingomyelinase deficiency (Niemann-Pick disease)

FOAM CELLS

• Larger (more cytoplasm) and have nucleoli in their nuclei. • The cytoplasm tends to be indented by the surrounding RBCs.

ATYPICAL / VARIANT / REACTIVE LYMPHOCYTES / DOWNEY CELLS / TURK’S IRRITATION CELLS

• Larger (more cytoplasm) and have nucleoli in their nuclei. • The cytoplasm tends to be indented by the surrounding RBCs.

ATYPICAL / VARIANT / REACTIVE LYMPHOCYTES / DOWNEY CELLS / TURK’S IRRITATION CELLS

Multinucleated giant cell with owl’s eye appearance; lacunar histiocytes

REED-STERNBERG CELLS •

• Associated with Hodgkin’s Lymphoma

REED-STERNBERG CELLS •

Checks the ability of the red blood cells to take up fluid without lysing

ERYTHROCYTE OSMOTIC FRAGILITY TEST (EOFT)

ERYTHROCYTE OSMOTIC FRAGILITY TEST (EOFT) primary factor

Primary factor: SHAPE OF THE RBC

Specimen for EOFT

Specimen: Heparinized blood or defibrinated blood

Increased EOFT

• Spherocytes • Senile/old RBCs

Decreased EOFT

• Sickle cells (drepanocytes) • Target cells (codocytes/leptocytes) • Hypochromic cells • Reticulocytes