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Hematology > Unit 9 - Exam Blood Smear & RBC Morphology > Flashcards

Unit 9 - Exam Blood Smear & RBC Morphology Flashcards

1
Q

What is the data collected in a PBS

A

Staining quality
Distribution of cells
WBC estimation
PLT estimation
RBC morphology
WBC morphology
WBC differential
nRBC per 100 WBC diff

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2
Q

Where are PBS evaluated

A

Monolayer

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3
Q

What do the cells look like at the edges of the smear

A

Too widely spaced
RBCs lose central pallor

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4
Q

What do cells look like in an area that’s too thick

A

Cells too close together
Can’t see detail
Distortion

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5
Q

Pan-

A

All

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6
Q

a-

A

Without

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7
Q

Hypo-

A

Under

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8
Q

Hyper-

A

Over

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9
Q

poly-

A

many

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10
Q

-cytosis

A

excess

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11
Q

-philia

A

increased

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12
Q

-penia

A

low

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13
Q

-cythemia

A

blood cells

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14
Q

Pancytopenia

A

Low amounts of all cell lines

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15
Q

Thrombocytosis

A

Excess platelets

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16
Q

Polycythemia

A

Elevation of many cell lines

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17
Q

How are WBC estimates done

A

High and dry (400x, 40x objective 10x eyepiece)
Total number of WBC in 5 fields
Calculation should match 25% of the automated WBC

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18
Q

WBC estimate formula

A

Total WBC in 5 fields/5 * 2,000/uL = 4.0x10^3 WBC/mcL

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19
Q

How are PLT estimates done

A

Oil immersion (1000x, 100x objective 10x eyepiece)
Count total number of PLT in 5 fields
Calculate

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20
Q

PLT estimate formula

A

Total PLT in 5 fields/5 * 15,000/uL = 150x10^3PLT/uL

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21
Q

How are RBCs evaluated

A

Always at 1000x
Only in monolayer

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22
Q

Anisocytosis

A

Excess size variability

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23
Q

What can anisocytosis indicate

A

More than one cell population like high retic + normal cells or transfused cells + microcytes

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24
Q

How should anisocytosis correlate with RDW

A

Std. Dev. of MCV
>14.5%

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25
Q

How to visually evaluate anisocytosis

A

Comparing the largest and smallest cell in a field

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26
Q

What does microcytosis indicate

A

Hgb production porblem

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27
Q

Microcytosis is often accompanied by

A

hypochromasia

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28
Q

Microcytosis is present in

A

Iron deficiency anemia
Hemoglobinopathies
Thalassemias
Sideroblastic anemias
Lead poisoning
Anemia of inflammation (chronic disease)

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29
Q

Macrocytosis indicates a problem with

A

DNA synthesis

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30
Q

Macrocytosis causes cells to undergo

A

Megaloblastic changes (asynchronism)
Hgb synthesis okay , DNA not
Nucleus and Cytoplasm out of sync

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31
Q

Macrocytosis present in

A

Normal newborns
Megaloblastic Nutritional Anemias (B12, Folate, Pernicious anemia)
Megaloblastoid toxicity - DNA inhibitory drugs, chemo
High retic count (hemolytic anemia, acute blood loss)
Liver disease

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32
Q

Central pallor should be

A

1/3 of the cell

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33
Q

What is wrong in hypochrmasia

A

RBCs lack normal hemoglobin

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34
Q

Hypochromatic cells are usually also

A

Microcytic

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35
Q

Polychromasia indicates..

A

RBC immaturity
Active BM

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36
Q

Macrocytic cell with no central pallor is usually

A

a reticulocyte (polychromatic cell)

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37
Q

Definitive reticulocyte identification done with

A

Supravital stain

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38
Q

Increased Retics means

A

Body trying to compensate for blood loss or hemolysis

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39
Q

Decreased retics means

A

Something wrong with bone marrow production

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40
Q

Variation of RBC shape

A

Poikilocytosis

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41
Q

Poikilocytosis

A

Excess shape variability

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42
Q

Spherocytes appear

A

Small, dark, round, no central pallor

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43
Q

Spherocytes caused by

A

Defect in or loss of cell membrane

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44
Q

Spherocytes are usually also

A

Microcytic

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45
Q

MCHC in spherocytes

A

May be greater than 36 g/dL

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46
Q

Conditions causing spherocytes

A

Newborns
Normal RBC aging
Hereditary spherocytosis
Hemolysis
Burns
Post transfusion

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47
Q

Acanthocytes also called

A

Spurr cells

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48
Q

What do acanthocytes look like

A

Spiky, long, irregular projections

49
Q

What causes acanthocytes

A

Specific mech. unknown

50
Q

Acanthocytes associated with..

A

Abnormal membrane lipids (cholesterol)

51
Q

Conditions associated with acanthocytes

A

Liver disease
Abetalpoproteinemia
(Lipid and liver disorders)

52
Q

Burr cells also known as

A

Echinocytes

53
Q

Burr cells look like

A

Small blunt evenly spaced projections

54
Q

Burr cells caused by

A

Change in tonicity of IV fluid (dehydration & azotemia)
Aged specimens

55
Q

Conditions causing burr cells

A

Uremia
Liver disease
Burns
Anemias

56
Q

Stomatocytes look like

A

Central pallor is a slot or mouth shape

57
Q

What causes stomatocytes

A

Exact formation mechanism unknown

58
Q

Conditions causing stomatocytes

A

Artifact
Hereditary stomatocytosis
Liver disease

59
Q

Schistocytes look like

A

Fragmented RBCs/damaged membranes

60
Q

Conditions associated with schistocytes

A

Disseminated IV coagulation (DIC)
Thrombotic thrombocytopenia purpura
Hemolytic Uremic Syndrom (HUS)
Hemolysis

61
Q

Schistocytes usually caused by

A

Physical damage

62
Q

Target cells also known as

A

Codocytes

63
Q

What causes target cells

A

Increased membrane lipid causing
Increased surface area or decreased hgb

64
Q

Conditions associated with target cells

A

Liver disease
Anemias
Almost every hgb abnormality

65
Q

Tear drop cells also known as

A

Dacryocytes

66
Q

Tear drop cells caused by

A

Not really known

67
Q

Conditions associated with dacryocytes

A

Formation from inclusion containing RBCs
Myelofibrosis

68
Q

Sickle Cells also known as

A

Drepanocytes

69
Q

Sickle cell caused by

A

Polymerized Hgb S
Decreased oxygen tension cells take on this form

70
Q

Conditions associated with drepanocytes

A

Sickle Cell Anemia
Hgb SC disease
hgb S - Thalassemia

71
Q

Ovalocytes and Elliptocytes caused by

A

not sure

72
Q

Conditions associated with ovals and ellipts

A

Hereditary elliptocytosis
Iron deficiency anemia
Megaloblastic anemias
Thalassemias
Myelofibrosis/Myelodisplastic syndromes

73
Q

When are nRBCs counted

A

With 100 WBC diff for correction

74
Q

Howell Jolly bodies are

A

Round nuclear remnant of DNA on periphery of cell

75
Q

Howell Jolly Body caused by

A

accelerated or abnormal erythropoiesis

76
Q

Conditions associated with HJ body

A

Hemolytic and megaloblastic anemias
Thalassemias
Splenectomy

77
Q

How many Howell Jolly bodies must be present

A

1-2, any more is something different

78
Q

Heinz bodies associated with

A

Bite or blister cells in G6PD

79
Q

How do Heinz bodies appear

A

Little specks on periphery in SUPRAVITAL STAIN

80
Q

Are Heinz bodies visible on wright stain

A

No, only supra vital because of the DNA

81
Q

Crystal cells caused by

A

Condensation of abnormal Hgb C

82
Q

Conditions with Crystal cells

A

Hgb C disease (HgbC-C)
Hgb SC disease (Hgb SC)

83
Q

Hemoglobin C crystals

A

Hgb C abnormal
Look like fat cigars

84
Q

Hemoglobin SC crystals

A

More blunt, Washington monument shaped
Can be curved or have projections
RBC crystals reported but source not specified

85
Q

Basophilic Stippling on PBS

A

Blue dots evenly throughout cytoplasm on wright stain

86
Q

Basophilic Stippling caused by

A

Ribosomes
Remnant m/RNA
Reticulocyte

87
Q

Conditions with Basophilic Stippling

A

Defected or accelerated heme synthesis
Compensatory process (blood loss hemolysis)
Thalassemia syndromes
Coarse stippling associated with lead poisoning

88
Q

Course stippling is seen throughout a red cell.. what would we suspect caused this?

A

Lead poisoning

89
Q

Cabot rings look like

A

Very fine single or double thread loops, may be seen in ring or figure 8

90
Q

Cabot rings caused by

A

Nuclear membrane remnant
Precipitated, denatured hgb due to oxidative injury

91
Q

Cabot rings are associated with these inclusions

A

Nucleated red cells
Howell Jolly bodies

92
Q

Conditions associated with cabot rings

A

G6PD deficiency
Unstable hemoglobins

93
Q

How to definitively identify Cabot RIngs

A

Supravital stains
Not visible with wright stains

94
Q

Pappenheimer bodies look like

A

Small, irregular blue granules near periphery

95
Q

Pappenheimer bodies made up of

A

Granules of iron

96
Q

Pappen heifer bodies caused by

A

Ineffective utilization or excess of iron

97
Q

Pappenheimer bodies require __ to confirm

A

Prussian Blue

98
Q

Pappenheimer bodies when confirmed under Prussian Blue are called

A

Siderotic granules

99
Q

Conditions associated with pappenheimer bodies

A

Sideroblastic anemias
Hemochromatosis
Hemoglobinopathies
Thalassemias

100
Q

Rouleaux typically caused by

A

Plasma proteins or immunoglobulins
(Paraproteins!)

101
Q

How to fix rouleaux for PBS

A

Replace plasma with saline

102
Q

Conditions associated with rouleaux

A

Multiple Myeloma (IgG)
Waldenstrom’s macroglobulinemia (IgM)

103
Q

Agglutination when micro clots are ruled out are usually due to

A

RBC antibody

104
Q

Conditions associated with agglutination under PBS

A

Cold agglutinin
Immune hemolytic anemias
Clotted specimen

105
Q

Toxic granulation

A

Granules prominent and bluer
Associated with infection

106
Q

Dohle bodies

A

Sky blue inclusion
Associated with infection

107
Q

Pelger Huet Anomaly

A

Hyposegmentation of the nucleus
Benign genetic variant

108
Q

HYpersegmented. neutrophils

A

More than 5 lobes
Associated with B12 or folic acid deficiency

109
Q

Necrobiotic neutrophil

A

Dying neutrophil
Apoptotic or pyknotic nucleus

110
Q

If many necrobiotic neutrophils are present, what might you suspect?

A

Old specimen

111
Q

Morulae

A

Seen in tick-born infection Erlichiosis
Organism multiplying in phagosome

112
Q

When are plasma cells seen in the peripheral blood

A

Multiple myeloma because they’re not typically in the PBS

113
Q

Formula corrected for nRBCs

A

(WBC count * 100) / (100 + #nRBCs) = WBC count

114
Q

IF clumping or satelliting is present, what must you do?

A

Hold PLT count results until the issue is resolved

115
Q

How to fix satelliting or PLT clumping

A

Thorough mixing
Recollecting in citrate and correcting for the different anticoagulant dilution

116
Q

What is the correction for using citrate

A

1.1

117
Q

Large number of smudge cells usually indicates

A

Poor slide making technique
Abnormal fragile cells (leukemia)

118
Q

Water artifacts can be caused by

A

Blood not dry before stain applied
Re-make smear to fix

119
Q

Stain precipitate caused by

A

Dried out stain
Filter the stain to fix

Hematology (12 decks)

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