Peripheral Blood Smear Flashcards
The area of central pallor in a normal RBC should be about ____ of total RBC diameter
1/3
Anisocytosis:
red cells which vary widely in size
The RDW mathematically measures the:
range of red cell sizes (standard deviation of the sizes)
Microcytosis refers to:
red cells that are small
You can use the _____ as a visual RBC size reference, or you can use the ____
Lymphocyte nucleus; MCV
Differential diagnosis of microcytosis includes:
Iron deficiency
Thalassemias
Lead poisoning
Sideroblastic anemia
Anemia of chronic disease (usually normocytic)
Hemoglobin C disease and trait
Macrocytosis refers to:
large red cells.
Differential diagnosis of macrocytosis includes:
–B12/folate deficiency
–Liver disease
–Thyroid disease
–Chemotherapy (hydrea in particular)
–Anti-retrovirals (AZT)
–Aplastic anemia
–MDS
–Elevated reticulocyte count
What is shown in the photo?
Macrocytic RBCs
Most MDS patients are ____cytic, but MDS is a potential cause of ____cytosis.
Most MDS patients are NORMOCYTIC, but MDS is a potential cause of MACROCYTOSIS.
Hypochromasia:
refers to red cells that have too little hemoglobin.
In Hypochromasia, the area of central pallor is more than ___ the total red cell diameter
1/3
Hypochromasia is measured by ____
the MCH
Macrocytosis is measured with
MCV
What is shown in this image?
Hypochromasia
What is shown in this image?
Polychromasia
Polychromasia:
refers to red cells that have more of a bluish tinge
Polychromasia cells are generally LARGER/SMALLER and are probably _____
larger; reticulocytes
What is shown in this image?
Poikilocytosis
Poikilocytosis:
refers to red cells that vary widely in shape
What is the difference between poikilocytosis and anisocytosis?
- Poikilocytosis refers to red cells that vary widely in shape.
- Anisocytosis refers to red cells that vary widely in size.
What is shown in this image?
Target Cells (which often look like bullseyes)
Differential diagnoses of Target Cells:
–Liver disease
–Thalassemias
–Hemoglobin C
–After splenectomy
What is shown in this image?
Spherocytes (have loss of central pallor)
What diseases are characterized by spherocytes?
–Hereditary spherocytosis
–Autoimmune hemolysis
If presence of spherocytes is due to ________ (disease), the cells are smaller (i.e. _______)
If due to autoimmune hemolysis;
cells are smaller (microspherocytes)
What is shown in this image?
Schistocytes (red cell fragments with sharp edges)
Schistocytes are the hallmark of _________
Microangiopathic Hemolytic Anemia (MAHA)
What is shown in this image?
Sickle Cells
(although this slide also contains target cells)
What is shown in this image?
Echinocytes, or burr cells
have small, regular projections
Echinocytes are also called
Burr Cells
Echinocytes or Burr Cells are often seen in _____ disease
renal
Acanthocytes are also called what?
Spur Cells
Acanthocytes or Spur Cells are see in ___ disease
liver
What is shown in this image?
Acanthocytes; have larger, irregular projections
Teardrop cells are seen in ______, which are diseases of ________
Teardrop cells are seen in MYELOPHTHISIC PROCESSES, which are diseases of MARROW INFILTRATION
What is shown in this image?
Teardrop cells
Teardrop cells can be seen in what diseases? (5)
- Myelofibrosis
- Tumor metastatic to marrow
- Granulomatous diseases
- Leukemias and lymphomas
- Sometimes in massive splenomegaly
What is shown in this image, and what are they?
Howell-Jolly bodies;
peripheral, small, round, purple inclusions within red cells that represent nuclear remnants
When are Howell-Jolly bodies seen?
After splenectomy or after cases of splenic hypofunction
What abnormal RBC types are seen after splenectomy?
Howell-Jolly bodies, target cells, acanthocytes, schistocytes, nucleated red cells
What is shown in this image?
Rouleaux - linear arrangements of red cells
What disorders can lead to rouleaux formation?
- They are typically seen in disorders with increased levels of immunoglobulin, such as Multiple Myeloma or Waldenstrom’s macroglobulinemia.
- Severe hypo-albuminemia can also lead to rouleaux formation
What is shown in this image?
Red cell agglutination, which occurs when the red cells are coated with IgM.
Unlike rouleaux, the red cell clumbs are not orderly and linear
Red cell agglutination occurs when the red cells are coated with _____
IgM (which is large enough to bridge two red cells and cause agglutination)
What is disease is indicated in this image?
Iron deficiency anemia
(characterized by hypochromic, microcytic cells, as well as increased number of platelets)
What is shown in this image?
Iron deficiency anemia
What are A-E in this image?
A. Target cells
B. Howell-jolly body
C. Nucleated red cell
D. Schistocyte
E. Basophilic stippling
•Teardrops can also be seen
What disease is suggested by this peripheral blood smear?
Beta-thalassemia major
What is shown in this image?
Megaloblastic anemia;
- Red cells are macrocytic
- Hypersegmented neutrophils can be seen
What is shown in this image?
Autoimmune Hemolytic Anemia (AIHA)
- Polychromasia (black arrows)
- Microspherocytes (green arrows)
What disease is indicated by this peripheral blood smear?
Microangiopathic Hemolytic Anemia (MAHA)
