Peripheral Blood Morphology Flashcards
Mean Corpuscle Volume (MCV)
- Measurement of the average volume of each RBC
Spherocytes
- Loss of central pallor and spherical in shape
If a patient has Howell-Jolly bodies after a splenectomy and then later is tested and does not have them, what could have occurred?
- The spleen has the ability to regenerate in various parts of the body so perhaps this is the case –> accessory spleen
Acanthocytes
- Spur cells
- Have larger, irregular projections
Polychromasia refers to
Red cells that have a more bluish tinge
If you see these cells, then it is an emergency and fatal in 80% of cases if left untreated after a few hours
- Schistocytes
** MAHA
If due to autoimmune hemolysis, the spherocytes are
- Smaller and referred to as microspherocytes
What would you use to measure hypochromasia?
- MCH
In normal peripheral blood, what cell types should be present?
WBCs, RBCs, and platelets
Differential diagnoses of macrocytosis
- B12/ folate deficiency
- Liver disease
- Thyroid disease
- Chemotherapy (hydrea in particular)
- Anti-retrovirals (AZT)
- Aplastic anemia
- MDS (myelodysplastic syndrome)
- Elevated reticulocyte count
When looking at a blood smear, what part are we interested in looking at for diagnostic purposes?
The feathered edge
Megaloblastic anemia
- Red cells are macrocytic
- Hypersegmented neutrophils
- Vit. B12 and folate deficiency will cause this
Autoimmune Hemolytic Anemia (AIHA)
- Polychromasia
- Microspherocytes
Poikolocytosis refers to
- Red cells that vary widely in shape
Howell- Jolly Bodies
- Small, peripheral, round, purple inclusions that are found within the red cells that are nuclear remnants
Echinocytes
- Burr cells
- Have small, regular projections
The overarching term for red cells that vary widely in size
-Anisocytosis
Most common cause of microcytosis
Iron deficiency anemia
A normal RBC should be about the size of
A lymphocyte nucleus
What lab value can you use to determine macrocytosis?
MCV
Hypochromasia refers to
- Red cells that have too little hemoglobin that results in them being less red when stained
Rouleaux
- Linear arrangements of red cells and are described as “piles of coins on a plate”
Which type of process should you think of when see spherocytes?
- Hemolytic process
Sickle cells are seen in which condition?
- Sickle cell anemia
Most likely, in polychromasia the large blue cells are actually what type of cell?
- Reticulocytes
Acathocytes are seen in what condition?
Liver disease
What are some cells that are present after a splenectomy?
- Howell- jolly bodies
- Target cells
- Acanthocytes –> spur cells
- Schistocytes
- Nucleated RBCs
Agglutination
- Occurs when RBCs are coated with IgM
- IgM is big enough to bridge 2 red cells and cause them to clump together
Teardrop cells
- Seen in myelophthisic processes, which are diseases of bone marrow infiltration
Different cell morphologies seen in liver disease
- Target cells
- Acanthocytes
- Macrocytosis
Beta- Thalassemia major
A- Target cells
B- Howell-jolly body
C- Nucleated red cell
D- Schistocyte
E- Basophilic stippling
** Teardrops can also be seen
RBC membranes have what charge overall and what causes them to form rouleaux?
- RBC membranes have a net positive charge and when there are negatively charged proteins present, that means that the RBCs will bind together
When are Howell-Jolly bodies seen?
- After splenectomy or in cases of splenic hypofunction
** May be seen in sickle cell disease and B-thalassemia major
Teardrop cells can be seen in which conditions?
- Myelofibrosis
- Tumor metastasis to the bone marrow
- Granulomatous diseases
- Leukemias and lymphomas
- Sometimes in massive splenomegaly
What disorders are rouleaux seen in?
- Mutliple myeloma
- Waldenstrom’s macroglobulinemia
- Severe hypo-albuminemia
The area of central pallor is ___ than the total red cell diameter in hypochromasia.
- More than 1/3 total red cell diameter
* Measured with MCH
What does the red cell distribution width (RDW) measure?
- Range of red blood cell sizes
How can you determine microcytosis?
- Looking at the lymphocyte nucleus as a reference in the blood smear
- Using the MCV, which measures the average volume of each RBC
Which type of cells will you see in a patient with sickle cell anemia along with sickle cells?
- Target cells
Differential diagnoses of target cells
- Liver disease
- Thalessemia
- Hemoglobin C disease
- After splenectomy
**LTHA
“Target cells are LiT, HA!”
Echinocytes are seen in what kind of disease?
- Renal disease
Schistocytes
- Red cell fragments that have sharp edges
Spherocytes may be seen in these 2 conditons
- Hereditary spherocytosis
- Autoimmune hemolysis
** HA
Microcytosis refers to
Red cells that are small
Macrocytosis refers to
- Large red cells
Most people with MDS are
Normocytic
Vit. B12 and folate deficiency will cause which type of anemia?
- Megaloblastic anemia
Shistocytes are a hallmark of what condition?
- Microangiopathic hemolytic anemia (MAHA)
Target cells look like ____
-Bulls-eyes
Differential diagnoses of microcytosis
- Iron deficiency
- Thalessemia
- Lead poisoning
- Anemia of chronic disease (usually normocytic)
- Sideroblastic anemia
- Hemoglobin C disease and trait
**ITLASH
The area of central pallor of a RBC should be about ____ of total RBC diameter
-1/3
Iron Deficiency Anemia
- Hypochromic, microcytic cells
- Increased number of platelets
- Increased RDW (so there is a wide range of sizes of RBCs)
- Decreased MCV (microcytic)
- Decreased MCH (low hemoglobin)
- Target cells
