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Hematology > Peripheral Blood Film Examination > Flashcards

Peripheral Blood Film Examination Flashcards

1
Q

An important component in the evaluation of an anemia is examination of the__________________, with particular attention to RBC diameter, shape, color, and inclusions.

A

peripheral blood film

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2
Q

It also serves to verify the results produced by automated analyzers

A

peripheral blood film

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3
Q

Normal RBCs on a Wright-stained blood film are nearly uniform, ranging from ________ in diameter

A

7 to 8um

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4
Q

Small or microcytic cells are less than _______ in diameter

A

6um

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5
Q

Large or macrocytic RBCs are greater than _________ in diameter

A

8um

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6
Q

Certain _____________ of diagnostic value (such as sickle cells, spherocytes, schistocytes, and oval macrocytes) and ___________ (such as malarial parasites, basophilic stippling, and Howell-Jolly bodies) can be detected only by studying the RBCs on a peripheral blood film

A

shape abnormalities, RBC inclusions

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7
Q

Cell description: Abnormal variation in RBC volume or diameter

Commonly Associated disease states: Hemolytic, megaloblastic, iron deficiency anemias

A

RBC abnormality: Anisocytosis

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8
Q

Cell description: Large RBC (>8um in diameter), MCV > 100 fL

Commonly Associated disease states:
- Megaloblastic anemia
- Myelodysplastic syndromes
- Chronic liver disease
- Bone marrow failure
- Reticulocytosis

A

RBC abnormality: Macrocyte

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9
Q

Cell description: Large oval RBC

Commonly Associated disease states: Megaloblastic anemia

A

RBC abnormality: Oval macrocyte

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10
Q

Cell description: Small RBC (<6um in diameter), MCV < 80 fL

Commonly Associated disease states:
- Iron deficiency anemia
- Anemia of chronic inflammation
- Sideroblastic anemia
- Thalassemia/Hb E disease and trait

A

RBC abnormality: Microcyte

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11
Q

Cell description: Abnormal variation in RBC shape

Commonly Associated disease states: Severe anemia; certain shapes helpful diagnostically

A

RBC abnormality: Poikilocytosis

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12
Q

Cell description: Small, round, dense RBC with no central pallor

Commonly Associated disease states:
- Hereditary spherocytosis
- Immune hemolytic anemia
- Extensive burns (along with schistocytes)

A

RBC abnormality: Spherocyte

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13
Q

Cell description: Elliptical (cigar-shaped), oval (egg-shaped) RBC

Commonly Associated disease states:
- Hereditary elliptocytosis or ovalocytosis
- Iron deficiency anemia
- Thalassemia major
- Myelophthisic anemias

A

RBC abnormality: Elliptocyte, ovalocyte

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14
Q

Cell description: RBC with slit-like area of central pallor

Commonly Associated disease states:
- Hereditary stomatocytosis
- Rh deficiency syndrome
- Acquired stomatocytosis (liver disease, alcoholism)

A

RBC abnormality: Stomatocyte

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15
Q

Cell description: Thin, dense, elongated RBC pointed at each end; may be curved

Commonly Associated disease states:
- Sickle cell anemia
- Sickle cell-B-thalassemia

A

RBC abnormality: Sickle cell

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16
Q

Cell description: Hexagonal crystal of dense hemoglobin formed within the RBC membrane

Commonly Associated disease states: Hb C disease

A

RBC abnormality: Hb C crysta

17
Q

Cell description: Finger-like or quartz-like crystal of dense hemoglobin protruding from the RBC membrane

Commonly Associated disease states: Hb SC disease

A

RBC abnormality: Hb SC crysta

18
Q

Cell description: RBC with hemoglobin concentrated in the center and around the periphery resembling a target

Commonly Associated disease states:
- Liver disease
- Hemoglobinopathies
- Thalassemia

A

RBC abnormality: Target cell (codocyte)

19
Q

Cell description: Fragmented RBC caused by rupture in the peripheral circulation

Commonly Associated disease states:
- Microangiopathic hemolytic anemia (along with microspherocytes)
- Macroangiopathic hemolytic anemia
- Extensive burns (along with microspherocytes)

A

RBC abnormality: Schistocyte (schizocyte)

20
Q

Cell description: RBC fragment in shape of a helmet

Commonly Associated disease states:
———–same as schistocyte————–
- Microangiopathic hemolytic anemia (along with microspherocytes)
- Macroangiopathic hemolytic anemia
- Extensive burns (along with microspherocytes)

A

RBC abnormality: Helmet cell (keratocyte)

21
Q

Cell description: RBC with membrane folded over

Commonly Associated disease states:
- Hb C disease
- Hb SC disease

A

RBC abnormality: Folded cell

22
Q

Cell description: Small, dense RBC with few irregularly spaced projections of varying length

Commonly Associated disease states:
- Severe liver disease (spur cell anemia)
- Neuroacanthocytosis (abetalipoproteinemia, McLeod syndrome)

A

RBC abnormality: Acanthocyte (spur cell)

23
Q

Cell description: RBC with blunt or pointed, short projections that are usually evenly spaced over the surface of cell; present in all fields of blood film but in variable numbers per field

Commonly Associated disease states:
- Uremia
- Pyruvate kinase deficiency

A

RBC abnormality: Burr cell (echinocyte)

24
Q

Cell description: RBC with a single pointed extension resembling a teardrop or pear

Commonly Associated disease states:
- Primary myelofibrosis
- Myelophthisic anemia
- Thalassemia
- Megaloblastic anemia

A

RBC abnormality: Teardrop cell (dacryocyte)

25
Q

Appearance in Supravital Stain: Dark blue granules and
filaments in cytoplasm (seen in reticulocytes)

Appearance in Wright Stain: Bluish tinge throughout cytoplasm; also called polychromasia (seen in
polychromatic erythrocytes)

Composition of inclusion: RNA

Associated Diseases/Conditions:
- Hemolytic anemia
- After treatment for iron, vitamin
- B12, or folate deficiency

A

Inclusion: Diffuse basophilia

26
Q

Appearance in Supravital Stain: Dark blue-purple, fine or coarse punctate granules distributed throughout cytoplasm

Appearance in Wright Stain: Dark blue-purple, fine or coarse punctate granules distributed throughout cytoplasm

Composition of inclusion: Precipitated RNA

Associated Diseases/Conditions:
- Lead poisoning
- Thalassemias
- Hemoglobinopathies
- Megaloblastic anemia
- Myelodysplastic syndromes

A

Inclusion: Basophilic stippling

27
Q

Appearance in Supravital Stain: Dark blue-purple dense, round granule; usually one per cell; occasionally multiple

Appearance in Wright Stain: Dark blue-purple dense, round granule; usually one per cell; occasionally multiple

Composition of inclusion: DNA (nuclear fragment)

Associated Diseases/Conditions:
- Hyposplenism
- Postsplenectomy
- Megaloblastic anemia
- Hemolytic anemia
- Thalassemia
- Myelodysplastic syndromes

A

Inclusion: Howell-Jolly body

28
Q

Appearance in Supravital Stain: Round, dark blue-purple granule attached to inner RBC membrane

Appearance in Wright Stain: Not visible

Composition of inclusion: Denatured hemoglobin

Associated Diseases/Conditions:
- Glucose-6-phosphate
- dehydrogenase deficiency
- Unstable hemoglobins
- Oxidant drugs/chemicals

A

Inclusion: Heinz body

29
Q

Appearance in Supravital Stain: Irregular clusters of small, light to dark blue granules, often near periphery of cell

Appearance in Wright Stain: Irregular clusters of small, light to dark blue granules, often near periphery of cell

Composition of inclusion: Iron

Associated Diseases/Conditions:
- Sideroblastic anemia
- Hemoglobinopathies
- Thalassemias
- Megaloblastic anemia
- Myelodysplastic syndromes
- Hyposplenism
- Postsplenectomy

A

Inclusion: Pappenheimer bodies

30
Q

Appearance in Supravital Stain: Rings or figure-eights

Appearance in Wright Stain: Blue rings or figure-eights

Composition of inclusion: Mitotic spindle remnant

Associated Diseases/Conditions:
- Megaloblastic anemia
- Myelodysplastic syndromes

A

Inclusion: Cabot ring

31
Q

Appearance in Supravital Stain: Fine, evenly dispersed, dark blue granules; imparts “golf ball” appearance to RBCs

Appearance in Wright Stain: Not visible

Composition of inclusion: Precipitated B-globin
chains of hemoglobin

Associated Diseases/Conditions: Hb H disease

A

Inclusion: Hb H

32
Q

a review of the _____________ and platelets may help show that a more generalized bone marrow problem is leading to the anemia

A

white blood cells

33
Q

______________ can be seen in vitamin B12 or folate deficiency, whereas ______________ may be an indication of acute leukemia

A

hypersegmented neutrophils, blast cells and decreased platelets

34
Q

It is indicated for a patient with an unexplained anemia associated with or without other cytopenias, fever of unknown origin, or suspected hematologic neoplasm

A

Bone marrow examination

35
Q

It evaluates hematopoiesis and can determine whether
there is an infiltration of abnormal cells into the bone marrow

A

Bone marrow examination

36
Q

Important findings in bone marrow that can point to the underlying cause of the anemia include:
1. ______________ (e.g., hypocellularity in aplastic anemia);
2. _______________ (e.g., folate/vitamin B12 deficiency or myelodysplastic syndromes);
3. _______________ (the gold standard for diagnosis of iron deficiency); and
4. _______________________ that may be inhibiting normal erythropoiesis.

A
  1. abnormal cellularity
  2. evidence of ineffective erythropoiesis and megaloblastic changes
  3. lack of iron on iron stains of bone marrow
  4. the presence of granulomata, fibrosis, infectious agents, and tumor cells
37
Q

Other tests that can assist in the diagnosis of anemia can be performed on a bone marrow specimen as well, including _____________, ______________, and ___________ to detect specific genetic mutations and chromosome abnormalities in leukemia cells (Chapter 29).

A

immunophenotyping of membrane antigens by flow cytometry, cytogenetic studies, and molecular analysis

Hematology (6 decks)

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