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Haematology > Lab Investigation of the FBC > Flashcards

Lab Investigation of the FBC Flashcards

1
Q

Where are blood cells produced?

A

Bone Marrow

Long bones

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2
Q

Where do blood cells mature?

A

Maturation occurs in BM

Mature cells within peripheral blood

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3
Q

Outline the investigations of a full blood count (RBC results)

A 
Hb: concentration of Haemoglobin
Hct: Percentage of blood volume as RBC
MCV: Average size of RBC
MCH: Average haemoglobin content of RBC
RDW: Range of deviation around RBC size
Reticulocyte count
Blood film
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4
Q

Describe the wbc results of a FBC

A

WHITE BLOOD CELL RESULTS

  • Total WBC and differential
  • Neutrophils, lymphocytes, monocytes,
  • Basophils, eosinophils
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5
Q

What info do we obtain on platelets from a FBC?

A

Platelet count and size

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6
Q

What is the use of a blood film?

A

Blood films can confirm numbers of cells and their morphology – are the cells ‘normal’
Are there cells present that shouldn’t be?

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7
Q

Outline all the info we can obtain on RBCs from a blood film

A

Size - big / small (anisocytosis)

Colour - Hb count

Shape - round, TDP, irregular, elliptocytes, poikilocytosis

Polychromasia
Inclusions

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8
Q

Outline the info a blood film tells us about WBCs

A

Numbers - too many / few

Normal morphology - dysplastic features

Immature cells - myelocytes, precursors

Abnormal Cells - blasts, atypical lymphoid cells

Inclusions

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9
Q

What does a purple blood test tube indicate?

A

Purple lid - contains EDTA to stop blood clotting, FBC taken

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10
Q

What is the meaning of a yellow blood test tube lid?

A

Rust (yellow) lid - biochemistry samples; contain clotted gel at the bottom (tests for renal function etc.)

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11
Q

Describe what is meant by a turquoise blood test tube lid

A

Turquoise lid - citrate sample acts as an anticoagulant; threshold line on the tube to ensure correct amount of blood sampled

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12
Q

What does a pink blood test tube lid indicate?

A

Pink - EDTA used for transfusion and crossmatch (have to be handwritten)

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13
Q

What is the consequence of storing blood sample in the wrong tube?

A

If blood is put in the wrong tube, it can’t be used due to contamination risk

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14
Q

How are patient blood samples in test tubes identified?

A

Each sample gets a lab no. and barcode to identify

We process >1600 FBC samples/ day

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15
Q

What happens to a blood test sample once in a lab?

A

The sample is analysed and plotted based on light refraction and size

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16
Q

How are abnormal cells identified from the blood sample?

A

The machine changes these plots into quantitative numbers and alerts us to any abnormal cell presence

17
Q

How can we identify a normal WBC distribution?

A

by size and staining can see where all the different types of cells sit normally on a plot

18
Q

How are blood films prepared?

A

Blood films are prepared and stained using a staining machine and then analysed under a microscope

19
Q

Diagnose a 65 y/o lady with the following sings and symptoms:

  • tired
  • shortness of breath on exertion
  • ankle swelling

High neutrophil count
Low MCV
V. Low Hb

A

(IDA) Iron deficiency anaemia

20
Q

Describe the blood film of IDA

A

Area of central pallor in most cells is much larger compared to normal cells
Decreased cell number

Elliptocytes seen in iron deficiency (really skinny elliptocytes known as ‘pencil’ cells)

21
Q

Diagnose the following 50 y/o male patient:

History: gastrectomy due to cancer 20 yrs ago

Hb: v low (4.6)
MCV: very large 140 (normal range <95)

A

Macrocytic megaloblastic anaemia

Patient had gastrectomy so doesn’t contain parietal gastric cells; unable to produce IF and likely require B12 supplements → B12 deficiency

22
Q

Describe the blood film of a macrocytic megaloblastic anaemia such as B12 deficiency

A

Oval shaped and debris present

Some very large RBCs; feature of macrocytic anaemias

23
Q

What is the diagnosis of an 80+ male with:

Signs & symptoms: anaemia, jaundice and splenomegaly

Hb: low (5.7)
MCV: really large
WBCs: slightly higher

A

Acquired haemolytic anaemia due to development of antibodies destroying own RBCs
Splenomegaly due to absorption of faulty RBCs

Haemolysis - bone marrow still produces RBCs but they die too quickly (as reticulocytes) ⇒ polychromasia and spherocytosis

Jaundice due to intravascular breakdown of RBCs releasing bilirubin

24
Q

Describe the blood film of an acquired haemolytic anaemia

A

Purple colour - polychromasia as reticulocytes contain RNA still
spherocytosis

Most RBCs in this blood film don’t have a central pallor and are v round - spherocytes

25
Q

Describe the blood film of a SCA patient

A 
Evident abnormal sickle cells present 
Target cells (central pallor with spot in the middle)

May be due to HbSS or HbSc
Polychromasia occurring due to early cell death

26
Q

When are poikilocytes seen on a blood film?

A

Tear drop poikilocytes – seen in myelofibrosis (bone marrow scarring) or bone marrow infiltration with malignant disease

27
Q

What are the potential diagnoses of a patient with plethora (red faced), splenomegaly, microcytic hypochromic anaemia with poikilocytes

A

Neutrophil leucocytosis -
V. closely packed, too many WBCs and RBCs due to infection and dehydration

Myeloproliferative process - genetic disorder where immune system produces excess WBC and RBCs

28
Q

Diagnose the following patient with bruising, recent infection slow to clear

WBC: v.v. high (190 normal range (5-10))
Differentiation of WBCs is normal - something else is being counted as a WBC by machine
Platelet count: v low
Hb: low

A

Acute myeloblastic leukaemia - blast cells present
Machine counted blast cells as WBCs as they also contain nuclei and are of a similar size

This patient is unable to produce any normal healthy cells - leukaemia

29
Q

What is the cause of this patient presenting with a painful foot, left sided discomfort ?

WBC: v.v. high (mostly flagging up as neutrophils)

A

Chronic granulocytic leukaemia – all stages of cell maturation represented

30
Q

Describe the blood film of a patient with Chronic granulocytic leukaemia

A

Neutrophils with granulation present alongside myelocytes and promyelocytes (all stages of maturation occurring) - CM

31
Q

What is the unusual diagnosis of this young man returning from kenya with a fever

Hb: normal
Platelet count: v.v.low

A

Malarial parasitization of red cells stained for

Visualized using blood film as not picked up by analyser

32
Q

What test is carried out for malaria confirmation?

A

Malarial Antigen Test

Carried out to confirm diagnosis

Haematology (8 decks)

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