SM_244b: Intro to CBC Flashcards
Blood is composed of ___, ___, and ___
Blood is composed of plasma (55%), RBC (45%), and WBC / platelet
- Plasma: water (93%), protein, others

If CBC shows abnormal WBC count, ___ is done
If CBC shows abnormal WBC count, WBC differential is done

Mean corpuscular volume (MCV) is ___
Mean corpuscular volume (MCV) is average red cell size / volume

Hematocrit (HCt) is ___
Hematocrit (HCt) is volume of RBCs over blood volume

Mean corpuscular hemoglobin (MCH) is ___
Mean corpuscular hemoglobin (MCH) is hemoglobin content in an RBC

Mean corpuscular hemoglobin concentration is ___
Mean corpuscular hemoglobin concentration is average hemoglobin concentration in total RBCs

Red cell distribution width (RDW) is ___
Red cell distribution width (RDW) is degree of variation in size of RBCs

Falsely high RBC count may occur when there is ___ or ___
Falsely high RBC count may occur when there is marked leukocytosis (> 100 K/UL) or giant platelets

Falsely low RBC count may occur when there is ___ or ___
Falsely low RBC count may occur when there is RBC agglutination (cold agglutinin) or microcytosis

Hemoglobin may be falsely high if there is ____ due to ____, ____, ____, or ____
Hemoglobin may be falsely high if there is increased sample turbidity due to HLD, hyperbilirubinemia, high protein, or marked leukocytosis

Low MCV indicates ____ that may occur due to ____
Low MCV indicates microcytosis that may occur due to iron deficiency anemia

High MCV indicates ____ that may occur due to ____
High MCV indicates macrocytosis that may occur due to B12 / folate deficiency

Falsely high MCV may occur due to ____, ____, or ____
Falsely high MCV may occur due to
- RBC agglutination
- Osmotic abnormalities (hyperglycemia, hypernatremia)
- Significantly increased young RBCs: larger than older RBCs

Red cell agglutination and hyperglycemia may lead to a ____ MCV
Red cell agglutination and hyperglycemia may lead to a falsely elevated MCV

Falsely low platelet count may occur when ____, ____, or ____
Falsely low platelet count may occur when
- Clotted sample: platelets trapped in blood clots
- Platelet clumping: cannot be counted as an individual platelet
- Frequent giant platelets: may be counted as WBC or RBC because of large size

Describe CBC interference
CBC interference

Describe cells of a normal peripheral blood smear
Normal peripheral blood smear

Describe morphologic evaluation of RBC
Morphologic evaluation of RBC
- Distribution: Rouleaux formation, agglutination
- Size and shape: microcytic / normocytic / macrocytic, RBC morphology associated with hemolysis, others
Rouleaux formation is when RBCs look like a ____ due to ____
Rouleaux formation is when RBCs look like a stack of coins due to increased plasma proteins

In lymphoplasmacytic lymphoma, RBC rouleaux formation results from ____
In lymphoplasmacytic lymphoma, RBC rouleaux formation results from a high level of monoclonal IgM produced by lymphoma cells

_____, _____, _____, and _____ are associated with RBC rouleaux formation
Multiple myeloma, some lymphomas, chronic inflammation / infection, and other are associated with RBC rouleaux formation

RBC aggultination is when ____
RBC aggultination is when RBCs form clumps

RBC aggultination is associated with ____ resulting from ____
RBC aggultination is associated with cold agglutinin disease resulting from antibodies (IgM) against RBCs

Describe cold agglutinin disease
Cold agglutinin disease
- Clinical symptoms related to exposure to cold, hemolytic, and antibodies (most commonly IgM) directed against polysaccharide antigens on the RBC surface that cause agglutination of RBCs at low temperatures
Cold agglutinin disease may present with ___, ___, or ___
Cold agglutinin disease may present with anemia, acrocyanosis, and hemoglobinuria
Cold agglutinin disease may result from ____, ____, or ____
Cold agglutinin disease may result from infection, lymphoma, or non-lymphoid malignancy
- Mycoplasma pneumoniae, infectious mononucleosis
Microcytic hypochromic RBC and low iron indicate ____
Microcytic hypochromic RBC and low iron indicate iron deficiency anemia

Hypochromic cell is ___
Hypochromic cell is iron deficiency anemia

Ovalocyte (elliptocyte) is ___
Ovalocyte (elliptocyte) is hereditary elliptocytosis

Target cell is ____
Target cell is liver disease

Burr cell (symmetric short sharp projections) is ___
Burr cell (symmetric short sharp projections) is kidney disease

Acanthocyte (asymmetric, unequal long projections) is ____
Acanthocyte (asymmetric, unequal long projections) is chronic liver disease

Teardrop cell is ____
Teardrop cell is myelofibrosis

Sickle cell (curved RBC with sharp ends) is ___
Sickle cell (curved RBC with sharp ends) is sickle cell disease

Spherocyte (dark RBC with no central pallor) is ____
Spherocyte (dark RBC with no central pallor) is autoimmune hemolysis

Bite cell (bites in RBC) is ____ which may occur in ____
Bite cell (bites in RBC) is Heinz body hemolysis which may occur in G6PD deficiency

Schistocyte (irregularly shaped RBC fragments) occurs in ___ such as ___, ___, or ___
Schistocyte (irregularly shaped RBC fragments) occurs in microangiopathic hemolytic anemia such as disseminated intravascular coagulation, hemolytic uremic syndrome, and thrombotic thrombocytopenia purpura

____ are red cell fragments that occur in ____
Schistocytes are red cell fragments that occur in microangiopathic hemolytic anemia
- DIC, TTP, HUS, HELLP
- Artificial heart valve

Microangiopathic hemolytic anemia results from ____, ____, ____, and ____
Microangiopathic hemolytic anemia results from
- Disseminated intravascular coagulation (DIC)
- Thrombotic thrombocytopenia purpura (TTP)
- Hemolytic uremic syndrome (HUS)
- Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome
Describe disseminated intravascular coagulation
Disseminated intravascular coagulation
- Schistocytes
- Intravascular activation of coagulation cascade leading to intravascular deposition of fibrin thrombi
- Abnormal coagulation tests: prolonged PT and PTT, elevated D-dimer, decreased haptoglobin, and decreased fibrinogen
Describe thrombotic thrombocytopenia purpura
Thrombotic thrombocytopenia purpura
- Schistocyte
- Hemolytic anemia, thrombocytopenia, neurologic symptoms, renal failure, fever
- Decreased activity of ADAMTS13 (normally cleaves vWF) -> high mollecular vWF
- Diagnosis: thrombocytopenia and microangiopathic hemolytic anemia without another clinically apparent etiology
Describe hemolytic uremic syndrome
Hemolytic uremic syndrome
- Schistocytes
- Caused by E. coli O157:H7 infection
- Hemolytic anemia, acute renal failure, thrombocytopenia
- Shiga-toxin binds to glomerular endothelium -> platelet activation, also inactivates ADAMTS13 -> microthrombi formation
____ are small RBCs without central pallor
Spherocytes are small RBCs without central pallor

Spherocytes are associated with ____ and ____
Spherocytes are associated with hereditary spherocytosis and immune hemolytic anemia

Chronic lymphocytic leukemia patients may develop ___
Chronic lymphocytic leukemia patients may develop autoimmune hemolytic anemia

Describe causes of autoimmune hemolysis
Autoimmune hemolysis causes
- Viral infections
- Autoimmune and connective tissue diseases (e.g. lupus)
- Immune deficiency diseases (e.g. common variable immunodeficiency)
- Malignancies (e.g. lymphoma, particularly CLL)
- Drugs
- Others
____ look like they have had bites taken out of them
Bite cells look like they have had bites taken out of them

Bite cells indicate ____ that may occur with ____, ____, or ____
Bite cells indicate Heinz body hemolysis that may occur with G6PD deficiency, unstable hemoglobin, or oxidant drugs

Rasburicase is ___
Rasburicase is a recombinant urate oxidase used to protect renal function by promoting uric acid degradation to a more water-soluble compound
- Used to prevent tumor lysis syndrome in CLL
- An oxidative byproduct of uric acid breakdown (H2O2) can cause hemolytic potential in patients with G6PD deficiency

Describe abnormal RBC morphology associated with hemolysis
Abnormal RBC morphology associated with hemolysis
- Schistocytes
- Spherocytes
- Bite / blister cells

RBCs are ____
Most likely diagnosis is ____

RBCs are microcytic hypochromic RBC
Most likely diagnosis is iron deficiency anemia

CBC results indicate ___

CBC results indicate possible thalassemia

Peripheral blood smear from newborn girl who has jaundice and increased bilirubin. Possible cause is ___

Peripheral blood smear from newborn girl who has jaundice and increased bilirubin. Possible cause is immune-mediated hemolysis

Next step to evaluate thrombocytopenia is ____

Next step to evaluate thrombocytopenia is review of peripheral blood smear
