Peripheral Blood Films

Question 1

Describe Acanthocytes

Answer 1

RBCs that show many spicules

Question 2

What conditions result in Acanthocytes

Answer 2

Liver Disease
Hyposplenism
(Abetalipoproteinaemia)

Question 3

Describe Basophilic RBC stippling

Answer 3

Accelerated erythropoiesis or defective Hb synthesis
Small dots (rRNA) seen at periphery of RBCs

Question 4

What conditions result in Basophilic RBC stippling?

Answer 4

Lead poisoning
Megaloblastic anaemia
Myelodysplasia
Liver disease
Haemoglobinopathy e.g. thalassaemia

Question 5

Describe Burr cells (echinocytes)

Answer 5

Like a sea urchin with regular spicules

Question 6

What conditions result in Burr cells

Answer 6

Often artefact if blood has sat in EDTA prior to film being made

Uraemia
Renal failure
GI bleeding
Stomach carcinoma

Question 7

What are Heinz bodies?

Answer 7

Inclusions on the very edge of RBCs due to denatured Hb

Question 8

What conditions result in Heinz bodies?

Answer 8

G6PD deficiency (glucose-6-phosphate dehydrogenase)
Chronic liver disease

Question 9

What do Howell-Jolly bodies look like?

Answer 9

Purple spots in RBCs
(Basophillic)

Question 10

What are Howell-Jolly Bodies?

Answer 10

Nuclear remnants in RBCs

(If RBC is nucleated, purple spot will be much bigger)

Question 11

What conditions result in Howell-Jolly bodies?

Answer 11

Post-splenectomy
Hyposplenism (e.g. sickle cell disease, coeliac disease, congenital, UC/Crohn’s, myeloproliferative disease, amyloid)
Megaloblastic anaemia
Hereditary spherocytosis

Question 12

What does describing a peripheral blood film as Leucoerythroblastic mean?

Answer 12

There are nucleated red blood cells AND myeloid precursors in the peripheral blood

Question 13

What conditions result in a leucoerythroblastic peripheral blood film?

Answer 13

Bone marrow infiltration i.e. myelofibrosis
Malignancy

Question 14

Describe Pelger Huet cells

Answer 14

Hyposegmented neutrophils - 2 lobes like a dumbell

Question 15

What are Pseudo-Pelger Huet cells?

Answer 15

Hyposegmented neutrophils that are hypogranular

Question 16

What conditions result in Pelger Huet cells?

Answer 16

Can be congenital (lamin B receptor mutation)
or acquired
Myelogenous leukaemia

Question 17

What conditions result in pseudo-pelger huet cells?

Answer 17

Myelodysplastic syndromes

Question 18

What are polychromatic cells caused by?

Answer 18

Presence of DNA in RBCs
They are usually reticulocytes

Question 19

Describe polychromatic cells

Answer 19

Bluish red blood cells

Question 20

What conditions result in increased polychromasia?

Answer 20

Usually increased in response to a shortened RBC lifespan
e.g. Haemolytic anaemia

Question 21

What conditions result in reduced polychromasia?

Answer 21

Aplastic anaemia
Chemo

Question 22

What is right shift?

Answer 22

Increased ratio of Hypermature white cells - polysegmented polymorphs (>5 lobed nuclei)

Question 23

What causes right shift?

Answer 23

Megaloblastic anaemia
Uraemia
Liver disease

Question 24

What is left shift?

Answer 24

Increase in the ratio of immature white cells - unsegmented ‘band’ nuclei

Question 25

What does a left shift indicate?

Answer 25

The reserve pool of cells is being released from the bone marrow in response to increased consumption of the circulating mature cells e.g. in infection

Question 26

What is Rouleaux formation?

Answer 26

Red cells stacked on top of each other like chips in a casino

Question 27

What causes Rouleaux formation?

Answer 27

Chronic inflammation Paraproteinaemia Myeloma

Question 28

What are Schistocytes?

Answer 28

Fragmented parts of RBCs Typically irregularly shaped with sharp edges and no central pallor

Question 29

What conditions result in formation of schistocytes?

Answer 29

Microangiopathic anaemia e.g. DIC Haemolytic uraemic syndrome Thrombotic thrombocytopenic purpura Pre-eclampsia

Question 30

Describe spherocytes

Answer 30

Spherical RBCs - often a little smaller

Question 31

What conditions result in spherocytes?

Answer 31

Hereditary spherocytosis Autoimmune haemolytic anaemia

Question 32

Describe stomatocytes

Answer 32

RBCs where a rod or slit-like pattern replaces the central zone of pallor

Question 33

What conditions result in stomatocytes?

Answer 33

Can be preparation artefact Hereditary stomatocytosis High alcohol intake Liver disease

Question 34

Describe target cells

Answer 34

Bull's-eye appearance in central pallor

Question 35

What conditions result in target cells?

Answer 35

Liver disease Hyposplenism Thalassaemia Iron deficiency anaemia

Question 36

What is the common name for codocytes?

Answer 36

Target cells