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ACP > Interpretation of CBC and Abnormal Cell Morphologies > Flashcards

Interpretation of CBC and Abnormal Cell Morphologies Flashcards

1
Q

Hb, MCV and MCH - interpretations

A

Hb (RR 11.9-15.1)

  • low = anaemia (many causes)
  • high = polycythaemia (uncommon) – can be primary or secondary
MCV = mean cell volume (RR 83-98)
MCH = mean cell Hb (colour) (RR 28-34)

==> create DDx for anaemia based on MCV and MCH

Microcytic hypochromic anaemia

  • Fe def anaemia
  • thalassemia

Macrocytic anaemia

  • megaloblastic anaemia due to Vit B12 or folate deficiency
  • alcoholism
  • liver disease
  • hypothyroidism (rare)
  • MDS

Normochromic normocytic anaemia

  • acute blood loss
  • anaemia of chronic disease
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2
Q

RBC, Hct, MCHC, RDW - interpretations

A

RBC
- increase RBC + anaemia = thalassemia trait

Hct = proportion of red cells in blood sample
- increase due to increase red cell mass e.g. polycythaemia or decreased plasma volume

MCHC = mean cell Hb concentration (not too useful)
- increase in spherocytosis (autoimmune or hereditary)

RDW = red cell distribution width
- increase if heterogenous red cell sizes e.g microcytic

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3
Q

Neutrophils - causes of increase/decrease

A

Neutrophilia

  • infection (bacterial, fungal), inflammation
  • malignancy

Neutropenia

  • commonly after chemotherapy
  • antibiotics
  • viral infection
  • immune causes
  • a/w risk of infection when severe (ANC <0.5x10^9/L)
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4
Q

Lymphocytes - causes of increase/decrease

A

Lymphopenia

  • immunosuppressive drugs
  • viral/bacterial infection
  • sepsis
  • autoimmune disease

Lymphocytosis

  • reactive
  • lymphoproliferative neoplasm e.g. CLL
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5
Q

Monocytes, eosinophils, basophils - causes of increase, decrease (for monocytes)

A

Monocytosis
- chronic infections or granulomatous processes

Monocytopenia:
- hairy cell leukaemia

Eosinophilia

  • secondary: parasite infection, allergy, asthma, drugs, lymphoma
  • primary (rare): myeloproliferative neoplasms

Basophilia (rare)
- myeloproliferative neoplasm e.g. CML

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6
Q

Platelets - caution, causes of increase/decrease

A

RR: 150-400

Thrombocytopenia
- always consider spurious result due to platelet clumping (check morphology!!) e.g. difficult blood taking, reaction to EDTA

  • drug, viral infection
  • ITP, TTP
  • hereditary (rare)

Thrombocytosis

  • secondary: Fe def, infection, chronic inflammation, malignancy, surgical asplenia
  • primary: essential thrombocythaemia (myeloproliferative neoplasm)
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7
Q

Purpose of analysing blood cell morphology

A

DDx of anaemia
DDx of thrombocytopenia
Identification and characterisation of leukaemia and lymphoma
Speedy diagnosis of certain specific infections e.g. malaria for quick Mx

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8
Q

Microcytic, hypochromic

A 
Microcytosis = smaller than nucleus of lymphocyte
Hypochromasia = pallor >1/3

DDx:
Fe deficiency anaemia
Thalassemia

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9
Q

Pencil cells

A

Fe deficiency anaemia

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10
Q

Target cells

A

Thalassemia
HbC and HbE disease
Liver disease
Fe deficiency

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11
Q

Tear drop cells

A 
Thalassemia
Marrow fibrosis (primary or secondary to infiltration)

In small amount, may also be due to Fe deficiency, megaloblastic anaemia etc –> r/o marrow fibrosis if large amounts

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12
Q

Macrocytic (oval macrocytes)

A

Megaloblastic:
Vit B12 deficiency
Folate deficiency

Non-megaloblastic:
Alcoholism, liver disease
MDS
Hypothyroid

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13
Q

Polychromasia (multiple colours)

A

Reticulocytosis - young RBC, bluish

  • -> due to HA, haemorrhage
  • -> indicates effective erythropoiesis
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14
Q

Nucleated RBC

A

Immature RBC normally in BM only

==> bone marrow damage/infiltration or stress

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15
Q

Spherocytosis

A

No central pallor and increased Hb content

Hereditary spherocytosis (membrane disorder)
Autoimmune HA
Alloimmune HA (e.g. haemolytic disease of newborn, delayed transfusion reaction)
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16
Q

Sickle cells

A

Malaria advantage

17
Q

Schistocytes

A

Red cell fragments due to shearing forces from damaged endothelium and platelet aggregation/fibrin deposition

Microangiopathic HA

  • disseminated cancer
  • DIC, HUS, TTP

Leaking prosthetic heart valves

18
Q

“Bite” cells/ keratocytes

A

G6PD deficiency

- oxidant induced haemolysis (impaired glutathione synthesis or pentose shunt)

19
Q

Red cell agglutination

A

Cold haemagglutination disease, atypical pneumonia

20
Q

Rouleaux

A

Hyperproteinaemias e.g. plasma cell myeloma, physiological during infection when Ig increases

21
Q

Howell Jolly bodies

A

Smooth single round inclusion which are remnant of nuclear chromatin

Post-splenectomy, functional hyposplenism
Megaloblastic anaemia
Abnormal erythropoiesis

22
Q

Basophilic stippling

A

Multiple bluish dots which are abnormal aggregates of ribosomes

Thalassemia
Lead poisoning

23
Q

Circulating granulocytic precursors

A

Reactive conditions e.g. stress

Bone marrow regeneration

24
Q

Neutrophils with toxic granules and cytoplasmic vacuoles

A

Sepsis

25
Q

Neutrophil hypersegmentation

A

> 6 lobes (normally 4-5)

Megaloblastic anaemia
Uraemia
Cytotoxic treatment

26
Q

Neutrophil hyposegmentation

A

1-2 lobes

Pelger-Heut (benign, inherited)
MDS (acquired, pseudo-Pelger cells)

27
Q

Reactive lymphocytes

A

Slightly larger nuclei with more open chromatin and abundant cytoplasm

Viral infection e.g. infectious mononucleosis

28
Q

Other examples of abnormal lymphoid cells in neoplasms

A

Irregular lobed/indented/ cleaved lymphoma cells
- follicular cell or mantle cell

Hairy cell
- hairy cell leukaemia

Lobulated lymphocytes ("clover")
- HTLV-1 infection, adult T cell lymphoma/leukaemia
29
Q

Blasts

A

Larger, finer nuclear chromatin (more transparent)

Leukaemia

30
Q

Giant platelets

A

As large as RBC

May-Hegglin anomaly (congenital thrombocytopenia with giant platelets)

31
Q

Leucoerythroblastic blood picture

A

Outpouring of immature forms e.g. nucleated RBC, circulating myelocyte
+ tear drop RBC

==> marrow fibrosis or infiltration which is idiopathic (primary MF) or reactive (e.g. cancer metastasis)

ACP (27 decks)

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