RBC MORPH Flashcards
SUMMARY OF STEPS REQUIRED TO PERFORM THE COMPLETE PERIPHERAL SMEAR
CHECK SLIDE IDENTIFICATION
PERFORM PATIENT SPECIMEN
ORIENTATION
PERFORM LOW POWER (x10) SCAN OF THE BLOOD FILM
PERFORM OIL EXAMINATION (100x) OF THE BLOOD FILM
PERFORM LOW POWER (x10) SCAN OF THE BLOOD FILM
Check feather edge for fibrin threads
Examine film edges for excessive leukocytes
Very acceptable number of leukocytes
Verify stain quality
Examine RBC distribution patterns and shapes
PERFORM OIL EXAMINATION (100x) OF THE BLOOD FILM
Prepare blood film with oil
Estimate platelet count
Estimate leukocyte count
Perform leukocyte differential
Classify 100 leukocytes
Classify 100 leukocytes
Report results as percentages of all leukocyte counted
Keep separate counts of nucleated red blood cells
Note and report abnormal leukocyte morphology
Grade abnormal erythrocyte morphology
Identify miscellaneous abnormal cells
CHECK THE SLIDE IDENTIFICATION
Check blood smear identification to ensure that the film and the AUTOMATED COUNT REPORT match
-
-
Compare the actual findings on the blood film
Any extreme discrepancy should be investigated and resolved before the report is generated.
Number of leukocytes
Number of platelets
The erythrocyte indices
CHECK FEATHERY EDGE FOR ____
FIBRIN THREADS
PERFORM LOW POWER (x10) SCAN OF THE BLOOD FILM
Fibrin threads to entrap ____ and are accompanied by ___
Neither a differential count or a platelet estimate should be attempted on these blood films
leukocytes
platelet clumps
A PROPERLY MADE PUSH WEDGE PERIPHERAL BLOOD FILM SHOWING THE BATTLEMENT PATTERN FOR LEUKOCYTE DIFFERENTIAL PROCEDURE
FEATHERY EDGE
LATERAL EDGE
EXAMINATION AREA
ORIGIN
The edges of even the best prepared films have accumulations of _ and _
Edges should contain __ more leukocytes than the number present in the body of the film
granulocytes and monocytes
<2-3x
VERIFY ACCEPTABLE NUMBER OF LEUKOCYTES
In a total leukocyte count of not less than ____, the acceptable working area should contain at least __ leukocytes
4.0 x 109/L
300
VERIFY STAIN QUALITY
The stain should clearly distinguish between ___ ___ ___ ___ and __-___ ___
dark purple nuclear material and red-orange erythrocytes
EXAMINE RBC DISTRIBUTION, PATTERNS, AND SHAPES
RBCs normally repel one another
RBCs should be distributed evenly (or just slightly overlapping)
Cells should not be distorted
Indicates presence of abnormal serum globulins MULTIPLE MYELOMA
ROULEAUX FORMATION
Presence of certain antibodies to RBC surface antigens
AGGLUTINATION
Normal red cells should be:
Circular with smooth edges
Uniform in shapes and size and hemoglobin concentration
Normal diameter = 7-8mm
Diameter of the central pale area should not be > 1/3 of the cell diameter
No inclusions
HYPERCHROMIC
NORMOCHROMIC
HYPOCHROMIC
MCHC = >37 g/dL
Seen in Spherocytosis
MCHC = 31-37 g/dL
MCHC = <31 g/dL
Seen in IDA, thalassemias, etc
Term used to describe the variation in Hb content when both hypochromic and normochromic cells are present
ANISOCHROMASIA
RED CELL SIZE
MACROCYTIC
NORMOCYTIC
MICROCYTIC
100fL
MEAN CORPUSCULAR VOLUME (MCV)
Expressed in SI units as __
1 fL = —
NV: —-
Indicates the average volume of a single erythrocyte in a given blood sample
FEMTOLITERS
10-15/L
80-100fL
MCV =
RBC (1012/L)
ERYTHROCYTE INDICES
Discussed in relation to __ AND ___
Increased in ____, ____, ____, and ______
A ___ population yields a normal MCV
Increased _____ may increase MCV
Discussed in relation to anemia and hematologic disorders
Increased in megaloblastic anemias, chronic hemolytic anemias, liver disease, and hypothyroidism
A DIMORPHIC population yields a normal MCV
Increased reticulocytes may increase MCV
MEAN CORPUSCULAR HEMOGLOBIN (MCH)
Expressed in SI as ___ (1pg = ___)
NV: ___
Should correlate well with __ and ___
Indicates the average WEIGHT of Hb per erythrocyte
PICOGRAMS
(1pg = 10-12g)
26-34pg
MCV and MCHC
MCH =
RBC (1012/L)
MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC)
Expressed in SI units as __ (formerly in %)
NV : __
MCHC formula
Indicates the average concentration of Hb in the erythrocytes of any specimen
g/L
31-37 g/L
HCT%
MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC)
“___” is NOT used as an actual description of RBC morphology
RBC cannot accommodate Hgb — therefore, a result of — should be —-
Hyperchromia
>37g/dL\
recalculated
Variation in red cell population size or diameter
Should be estimated semi-quantitatively: _, _, _.
___ vs ___
Correlated with the RED CELL DISTRIBUTION WIDTH (RDW)
ANISOCYTOSIS
SLIGHT, MODERATE, MARKED
MICROCYTES VS MACROCYTES
Normal RBCs show little or no shape variation
Recognition of various shapes or poikilocytes on the film is very helpful in the differentiation of ___
POIKILOCYTOSIS
anemia
Poikilocyte shape can be explained by: - - - - - -
Structural and biochemical changes in the membrane
Metabolic state of the cell
Hemoglobin molecule abnormalities
Abnormal microenvironment
Changes in the red cell’s ability to deform
Red cell age
OVAL MACROCYTES
Megaloblastic erythropoiesis
SPHEROCYTES
Hereditary spherocytosis
SPECTRIN
ELLIPTOCYTES
Hereditary elliptocytosis
ANKYRIN/BAND 4.1
ECHINOCYTES (CRENATED CELLS)
BURR CELLS
Uremia and Renal Insufficiency
ACANTHOCYTES (SPUR CELLS)
Abetalipoproteinemia,
alcoholic cirrhosis,
post- splenectomy cases,
hepatitis, etc
STOMATOCYTE
Alcoholism, cirrhosis, obstructive liver disease, Rh null disease, Hereditary stomatocytosis
TARGET CELLS (LEPTOCYTES/MEXICAN HAT CELLS)
Thalassemias, Hemoglobinopathies SS, CC, DD, EE, Obstructive liver disease, postsplenectomy, and IDA
SCHISTOCYTES/KERATOCYTES
Microangiopathic hemolytic anemia, severe burns, renal graft rejection, glomerulonephritis, vasculitis, TTP, and DIC
DACROCYTES (TEARDROP CELLS)
Myelofibrosis,
myelophthisic anemia,
b-thalassemia and
pernicious anemia
PYROPOIKILOCYTES
Burns,
Hereditary
Pyropoikilocytosis
DREPANOCYTES (SICKLE CELLS)
Sickle cell Disease and Sickle cell Trait
HEMOGLOBIN CC CRYSTALS
crystal daw
INCLUSIONS
POLYCHROMATOPHILIC RED CELLS HEINZ BODIES CABOT RINGS HEMOGLOBIN H INCLUSIONS MALARIA BABESIA
37C X 30 minutes in BCB
Multiple small dots in ALL cells
HEMOGLOBIN H INCLUSIONS
Blue ring with red dot Mitotic spindle (?)
CABOT RINGS
37C X 4H in acetylphenylhydrazine + crystal violet
N: 70% of cells
HEINZ BODIES
Diffuse basophilia
POLYCHROMATOPHILIC RED CELLS
Few irregular dots in periphery
(+) Iron Stain
PAPPENHEIMER BODIES
Dark, irregular dots
BASOPHILIC STIPPLING
Round, singlular, reddish-blue bodies
HOWELL-JOLLY BODIES
SEMIQUANTITATIVE REPORTS ON ABNORMALITIES IN ERYTHROCYTE MORPHOLOGY SHOULD BE FORMATTED TO PROMOTE BOTH _______ and _________
EFFECTIVE COMMUNICATION WITH THE PHYSICIAN AND LABORATORY REPRODUCIBILITY
SEMIQUANTITATIVE WAY OF REPORTING (DEGREE OF POIKILOCYTOSIS, ANISOCYTOSIS AND COLOR CONTENT)
SLIGHT (15%)
SEMIQUANTITATIVE WAY OF REPORTING (FOR PARTICULAR SIZE VARIATION OR VARIATION IN SHAPE)
OCCASIONAL (10%)
