peripheral smear

Question 1

Smear of CLL

Answer 1

Question 2

hereditary spherocytosis

Answer 2

spherocytes on smear -seen in autoimune hemolytic anemia, clostridial sepsis, snake bites, and G6PD deficency and MAHA

Question 3

pancytopenia

Answer 3

causes of pancytopenia

Question 4

Bite cells are

Answer 4

secondary to phagocytes extracting denatured or bad hemoglobulin

They literally take a “bite” out of the RBC to remove bad proteins.

Think alpha thalassemia and G6PD deficiency

Question 5

where do you see spherocytes?

Answer 5

hereditary spherocytosis

autoimmune hemolysis

The splenic macrophages are partially phagocytosizing pieces off the RBC so the excessive surface area of RBC membrane is lost. See spherocyte as a result.

Need to confirm with a Coomb’s test - look for IgG or complement on RBC surface.

Question 6

teardrop shaped RBC (dacryocyte) is associated with

Answer 6

extramedullary hematopoiesis

seen with myelofibrosis - fibroblasts are filling the bone marrow up and major thalassemia

Question 7

hypersegmented neutrophils

Answer 7

B12 deficiency or ETOH

will have elevated MCV

Question 8

where do you see howell Jolly bodies?

Answer 8

seen with asplenia or splenic hypofunction or even seen with thalassemia, or heavy metal poisoning like lead.

RBC inclusions are due to precipitates of neuclear or cytoplasmic ribosomes.

think sickle cell dx (not trait) pts who will have auto infarcted spleens by the time they are adults.

Question 9

where do you see basophilic stippling in the RBC cytoplasm

Answer 9

thalassemias, iron deficiency anemia

ETOH abuse

lead and heavy metal poisoning.

Question 10

CLL may also see lots of spherocytes on peripheral smear because

Answer 10

CLL is associated with an autoimune hemolytic anemia in 11% of pts.

Question 11

Difference between Heinz bodies and Bite Cells?

Answer 11

Bite cells in G6PD and thalassemia