Peripheral blood flim

Question 1

Acanthocytes (spur/spike cells) - describe, underlying path (2)

Answer 1

• RBCs show many spicules
• Abetalipoproteinamiae, liver disease, hyposplenism

So either due to alteration in membrane lipids or severe liver disease

Question 2

Basophilic RBC stippling: description, underlying path (3)

Answer 2

Accellerated erythopoeisis OR defective HB synthesis - see small dots at the periphery (rRNA)

1. megaloblastic anaemia
2. thalassemia
3. lead poisoning
4. liver disease
5. myelodysplasia

Question 3

Burr cells (Echinocyte) - describe, causes (3)

Answer 3

Irregularly shaped cells

1. uraemia
2. GI bleeding
3. stomach cancer

Question 4

Heinz bodies - descibe, cause

Answer 4

Inclusions within RBCs of denatured Hb

• G6PD def, also liver disease

Question 5

Howell jolly bodies - describe, causes (3)

Answer 5

Basophilic nuclear remnants (purple) in RBCs (normally should be expelled - indicate spleen damage)

• Post-splenectomy/ hyposplenism e.g. SCD, coeliac, amyloid
• megaloblastic anaemia
• hereditary spherocytosis

Question 6

Leucoerythroblastic anaemia: describe, casue (1)

Answer 6

RBCs with nuclei + primitive WBCs enter the blood - due to marrow infiltration e.g. malignancy, myelofibrosis

Question 7

Pelger Huet Cells - descibre, causes (2)

Answer 7

hyposegmented neutrophil

• congenital - lamin B receptor mutation
• acquired - myelogenous leukaemia, myelodysplastic syndrome

Question 8

Polychromasia (sign of reticulocytosis) - describe, cause

Answer 8

RBCs of different shades - blue/grey; due to varying amounts of HB; this is a result of premature/inappropriate release from BM

Question 9

Reticulocytes - describe, when are they increased? decreased?

Answer 9

Immature RBCs - increased in haemolytic anaemias, decreased in aplastic anaemia

Ribosomal RNA becomes visible wth methylene blue

Question 10

Right shift - describe, cause

Answer 10

hypermature WBCs - hypersegmented neutrophils

• megaloblastic anaemia
• uraemia, liver disease

Question 11

Schistocytes - describe, causes (3)

Answer 11

fragmented parts of RBCs

• microangiopathic anaemia e.g. DIC, HUS, TTP

Question 12

Spherocytes - describe, cause (2)

Answer 12

Sphere shaped RBC

1. hereditary spherocytosis
2. Autoimmune haemolytic anemia

Question 13

Stomatocytes - describe, causes (2)

Answer 13

Central pallor is curved/ rodshaped, RBCs appear as ‘smiling faces’ or ‘fish mouth’

Causes

1. hereditary stomatocytosis - membrane defect causing K+ and Na+ leakage
2. high alcohol & liver disease

Question 14

Target cells (codocyte) - describe, causes (3)

Answer 14

Bull’s eye appearance in central pallor

• IDA
• thalassemia
• hyposplenism
• liver disease

Question 15

Auer rods

Answer 15

clumps of granular material seen in cytoplasm of luekemic blasts