Peripheral Blood Morphology

Question 1

What does peripheral blood smear observe?

Answer 1

feathered edge

Question 2

What is the next step after peripheral blood smearing?

Answer 2

stain with Wright Giemsa

Question 3

Characteristics of Normal Peripheral Blood

Answer 3

1. RBC size = lymphocyte nucleus size
2. RBC central pallor is 1/3 of total RBC diameter
3. White cells and platelets are present

Question 4

Red cells which vary widely in size are referred as

Answer 4

anisocytosis

Measured by RDW

Question 5

Red cells that are small

Answer 5

microcytosis

Measured by MCV or compare with lymphocyte as a visual reference

Question 6

What are the differential diagnosis of microcytosis?

Answer 6

• Iron deficiency
• thalassemias
• lead poisoning
• sideroblastic anemia
• anemia of chronic disease (usually normocytic)
• hemoglobin C disease and trait

Question 7

Red cells that are large

Answer 7

Macrocytosis

Measured by MCV or compare with lymphocyte as a visual reference

Question 8

What are the differential diagnosis of macrocytosis?

Answer 8

• B12/folate deficiency
• liver disease
• thyroid disease
• chemotherapy
• anti-retrovirals
• aplastic anemia (usually normocytic)
• MDS (usually normocytic)
• elevated reticulocyte count

Question 9

Refers to red cells that have too little hemoglobin.

Answer 9

Hypochromasia

Measured by MCH

Question 10

Refers to red cells that have more of a bluish tinge and are probably reticulocytes

Answer 10

Polychromasia

Question 11

refers to red cells that vary widely in shape

Answer 11

Poikilocytosis

Question 12

These cells look like bulls-eyes and are associated with:
Liver disease
Thalassemias
Hemoglobin C
After splenectomy

Answer 12

Target cells

Question 13

These cells have a loss of central pallor and can be seen in diseases such as: Hereditary spherocytosis and Autoimmune hemolysis

Answer 13

Spherocytes

Question 14

Red cell fragments with sharp edges that are a hallmark of Microangiopathic Hemolytic Anemia (MAHA)

Answer 14

Schistocytes

Question 15

These cells have bites taken out of them and are a hallmark of Heinz Body hemolytic anemia due to 2 conditions (1. G6PD deficiency-most common; 2. Hemoglobin H disease)

Answer 15

Bite Cells

Question 16

Cells that are seen in sickle cell anemia.

Answer 16

Sickle cells

Question 17

These cells have small, regular projections and are seen in renal disease

Answer 17

Echinocytes, or burr cells,

Question 18

These cells have have large, irregular projections, and are seen in liver disease.

Answer 18

Acanthocytes, or spur cells

Question 19

These cells are seen in myelophthisic processes and can be seen in:
Myelofibrosis
Tumor metastatic to marrow
Granulomatous diseases
Leukemias and lymphomas
Sometimes in massive splenomegaly

Answer 19

Teardrop cells

Question 20

Diseases of marrow infiltration are known as?

Answer 20

Myelophthisic processes

Question 21

These cells are peripheral, small, round, purple inclusions within red cells that represent nuclear remnants usually seen after splenectomy, or in cases of splenic hypofunction

Answer 21

Howell-Jolly Bodies

Question 22

Linear arrangements of red cells typically described as “piles of coins on a plate”

Answer 22

Rouleaux

Question 23

These RBC are typically seen in disorders with increased levels of immunoglobulin, such as Multiple Myeloma, Waldenstrom’s macroglobulinemia, and Severe hypo-albuminemia due to a change in the charge of the RBC

Answer 23

Rouleaux

Question 24

Occurs when the red cells are coated with IgM.

Answer 24

agglutination

Not orderly and linear as Rouleaux

Question 25

Patients with this disease have a blood smear that has hypo chromic cells, microcytic cells and an increased number of platelets.

Answer 25

Iron Deficiency Anemia

Question 26

In this condition, Red cells are macrocytic and hypersegmented neutrophils can be seen. It usually results from a deficiency in Vitamin B12 or folate

Answer 26

Megaloblastic Anemia

Question 27

A patient whose blood smear shows Polychromasia and Microspherocytes most likely has which condition?

Answer 27

Autoimmune Hemolytic Anemia (AIHA)

Question 28

A patient whose blood smear shows schistocytes most likely has which condition?

Answer 28

Microangiopathic Hemolytic Anemia (MAHA)