Peripheral Blood Film Examination Flashcards
An important component in the evaluation of an anemia is examination of the__________________, with particular attention to RBC diameter, shape, color, and inclusions.
peripheral blood film
It also serves to verify the results produced by automated analyzers
peripheral blood film
Normal RBCs on a Wright-stained blood film are nearly uniform, ranging from ________ in diameter
7 to 8um
Small or microcytic cells are less than _______ in diameter
6um
Large or macrocytic RBCs are greater than _________ in diameter
8um
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
shape abnormalities, RBC inclusions
Cell description: Abnormal variation in RBC volume or diameter
Commonly Associated disease states: Hemolytic, megaloblastic, iron deficiency anemias
RBC abnormality: Anisocytosis
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
RBC abnormality: Macrocyte
Cell description: Large oval RBC
Commonly Associated disease states: Megaloblastic anemia
RBC abnormality: Oval macrocyte
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
RBC abnormality: Microcyte
Cell description: Abnormal variation in RBC shape
Commonly Associated disease states: Severe anemia; certain shapes helpful diagnostically
RBC abnormality: Poikilocytosis
Cell description: Small, round, dense RBC with no central pallor
Commonly Associated disease states:
- Hereditary spherocytosis
- Immune hemolytic anemia
- Extensive burns (along with schistocytes)
RBC abnormality: Spherocyte
Cell description: Elliptical (cigar-shaped), oval (egg-shaped) RBC
Commonly Associated disease states:
- Hereditary elliptocytosis or ovalocytosis
- Iron deficiency anemia
- Thalassemia major
- Myelophthisic anemias
RBC abnormality: Elliptocyte, ovalocyte
Cell description: RBC with slit-like area of central pallor
Commonly Associated disease states:
- Hereditary stomatocytosis
- Rh deficiency syndrome
- Acquired stomatocytosis (liver disease, alcoholism)
RBC abnormality: Stomatocyte
Cell description: Thin, dense, elongated RBC pointed at each end; may be curved
Commonly Associated disease states:
- Sickle cell anemia
- Sickle cell-B-thalassemia
RBC abnormality: Sickle cell
Cell description: Hexagonal crystal of dense hemoglobin formed within the RBC membrane
Commonly Associated disease states: Hb C disease
RBC abnormality: Hb C crysta
Cell description: Finger-like or quartz-like crystal of dense hemoglobin protruding from the RBC membrane
Commonly Associated disease states: Hb SC disease
RBC abnormality: Hb SC crysta
Cell description: RBC with hemoglobin concentrated in the center and around the periphery resembling a target
Commonly Associated disease states:
- Liver disease
- Hemoglobinopathies
- Thalassemia
RBC abnormality: Target cell (codocyte)
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)
RBC abnormality: Schistocyte (schizocyte)
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)
RBC abnormality: Helmet cell (keratocyte)
Cell description: RBC with membrane folded over
Commonly Associated disease states:
- Hb C disease
- Hb SC disease
RBC abnormality: Folded cell
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)
RBC abnormality: Acanthocyte (spur cell)
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
RBC abnormality: Burr cell (echinocyte)
Cell description: RBC with a single pointed extension resembling a teardrop or pear
Commonly Associated disease states:
- Primary myelofibrosis
- Myelophthisic anemia
- Thalassemia
- Megaloblastic anemia
RBC abnormality: Teardrop cell (dacryocyte)
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
Inclusion: Diffuse basophilia
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
Inclusion: Basophilic stippling
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
Inclusion: Howell-Jolly body
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
Inclusion: Heinz body
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
Inclusion: Pappenheimer bodies
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
Inclusion: Cabot ring
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
Inclusion: Hb H
a review of the _____________ and platelets may help show that a more generalized bone marrow problem is leading to the anemia
white blood cells
______________ can be seen in vitamin B12 or folate deficiency, whereas ______________ may be an indication of acute leukemia
hypersegmented neutrophils, blast cells and decreased platelets
It is indicated for a patient with an unexplained anemia associated with or without other cytopenias, fever of unknown origin, or suspected hematologic neoplasm
Bone marrow examination
It evaluates hematopoiesis and can determine whether
there is an infiltration of abnormal cells into the bone marrow
Bone marrow examination
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.
- abnormal cellularity
- evidence of ineffective erythropoiesis and megaloblastic changes
- lack of iron on iron stains of bone marrow
- the presence of granulomata, fibrosis, infectious agents, and tumor cells
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).
immunophenotyping of membrane antigens by flow cytometry, cytogenetic studies, and molecular analysis
