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
2
Q
Where are PBS evaluated
A
Monolayer
3
Q
What do the cells look like at the edges of the smear
A
Too widely spaced
RBCs lose central pallor
4
Q
What do cells look like in an area that’s too thick
A
Cells too close together
Can’t see detail
Distortion
5
Q
Pan-
A
All
6
Q
a-
A
Without
7
Q
Hypo-
A
Under
8
Q
Hyper-
A
Over
9
Q
poly-
A
many
10
Q
-cytosis
A
excess
11
Q
-philia
A
increased
12
Q
-penia
A
low
13
Q
-cythemia
A
blood cells
14
Q
Pancytopenia
A
Low amounts of all cell lines
15
Q
Thrombocytosis
A
Excess platelets
16
Q
Polycythemia
A
Elevation of many cell lines
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
18
Q
WBC estimate formula
A
Total WBC in 5 fields/5 * 2,000/uL = 4.0x10^3 WBC/mcL
19
Q
How are PLT estimates done
A
Oil immersion (1000x, 100x objective 10x eyepiece)
Count total number of PLT in 5 fields
Calculate
20
Q
PLT estimate formula
A
Total PLT in 5 fields/5 * 15,000/uL = 150x10^3PLT/uL
21
Q
How are RBCs evaluated
A
Always at 1000x
Only in monolayer
22
Q
Anisocytosis
A
Excess size variability
23
Q
What can anisocytosis indicate
A
More than one cell population like high retic + normal cells or transfused cells + microcytes
24
Q
How should anisocytosis correlate with RDW
A
Std. Dev. of MCV
>14.5%
25
How to visually evaluate anisocytosis
Comparing the largest and smallest cell in a field
26
What does microcytosis indicate
Hgb production porblem
27
Microcytosis is often accompanied by
hypochromasia
28
Microcytosis is present in
Iron deficiency anemia
Hemoglobinopathies
Thalassemias
Sideroblastic anemias
Lead poisoning
Anemia of inflammation (chronic disease)
29
Macrocytosis indicates a problem with
DNA synthesis
30
Macrocytosis causes cells to undergo
Megaloblastic changes (asynchronism)
Hgb synthesis okay , DNA not
Nucleus and Cytoplasm out of sync
31
Macrocytosis present in
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
32
Central pallor should be
1/3 of the cell
33
What is wrong in hypochrmasia
RBCs lack normal hemoglobin
34
Hypochromatic cells are usually also
Microcytic
35
Polychromasia indicates..
RBC immaturity
Active BM
36
Macrocytic cell with no central pallor is usually
a reticulocyte (polychromatic cell)
37
Definitive reticulocyte identification done with
Supravital stain
38
Increased Retics means
Body trying to compensate for blood loss or hemolysis
39
Decreased retics means
Something wrong with bone marrow production
40
Variation of RBC shape
Poikilocytosis
41
Poikilocytosis
Excess shape variability
42
Spherocytes appear
Small, dark, round, no central pallor
43
Spherocytes caused by
Defect in or loss of cell membrane
44
Spherocytes are usually also
Microcytic
45
MCHC in spherocytes
May be greater than 36 g/dL
46
Conditions causing spherocytes
Newborns
Normal RBC aging
Hereditary spherocytosis
Hemolysis
Burns
Post transfusion
47
Acanthocytes also called
Spurr cells
48
What do acanthocytes look like
Spiky, long, irregular projections
49
What causes acanthocytes
Specific mech. unknown
50
Acanthocytes associated with..
Abnormal membrane lipids (cholesterol)
51
Conditions associated with acanthocytes
Liver disease
Abetalpoproteinemia
(Lipid and liver disorders)
52
Burr cells also known as
Echinocytes
53
Burr cells look like
Small blunt evenly spaced projections
54
Burr cells caused by
Change in tonicity of IV fluid (dehydration & azotemia)
Aged specimens
55
Conditions causing burr cells
Uremia
Liver disease
Burns
Anemias
56
Stomatocytes look like
Central pallor is a slot or mouth shape
57
What causes stomatocytes
Exact formation mechanism unknown
58
Conditions causing stomatocytes
Artifact
Hereditary stomatocytosis
Liver disease
59
Schistocytes look like
Fragmented RBCs/damaged membranes
60
Conditions associated with schistocytes
Disseminated IV coagulation (DIC)
Thrombotic thrombocytopenia purpura
Hemolytic Uremic Syndrom (HUS)
Hemolysis
61
Schistocytes usually caused by
Physical damage
62
Target cells also known as
Codocytes
63
What causes target cells
Increased membrane lipid causing
Increased surface area or decreased hgb
64
Conditions associated with target cells
Liver disease
Anemias
Almost every hgb abnormality
65
Tear drop cells also known as
Dacryocytes
66
Tear drop cells caused by
Not really known
67
Conditions associated with dacryocytes
Formation from inclusion containing RBCs
Myelofibrosis
68
Sickle Cells also known as
Drepanocytes
69
Sickle cell caused by
Polymerized Hgb S
Decreased oxygen tension cells take on this form
70
Conditions associated with drepanocytes
Sickle Cell Anemia
Hgb SC disease
hgb S - Thalassemia
71
Ovalocytes and Elliptocytes caused by
not sure
72
Conditions associated with ovals and ellipts
Hereditary elliptocytosis
Iron deficiency anemia
Megaloblastic anemias
Thalassemias
Myelofibrosis/Myelodisplastic syndromes
73
When are nRBCs counted
With 100 WBC diff for correction
74
Howell Jolly bodies are
Round nuclear remnant of DNA on periphery of cell
75
Howell Jolly Body caused by
accelerated or abnormal erythropoiesis
76
Conditions associated with HJ body
Hemolytic and megaloblastic anemias
Thalassemias
Splenectomy
77
How many Howell Jolly bodies must be present
1-2, any more is something different
78
Heinz bodies associated with
Bite or blister cells in G6PD
79
How do Heinz bodies appear
Little specks on periphery in SUPRAVITAL STAIN
80
Are Heinz bodies visible on wright stain
No, only supra vital because of the DNA
81
Crystal cells caused by
Condensation of abnormal Hgb C
82
Conditions with Crystal cells
Hgb C disease (HgbC-C)
Hgb SC disease (Hgb SC)
83
Hemoglobin C crystals
Hgb C abnormal
Look like fat cigars
84
Hemoglobin SC crystals
More blunt, Washington monument shaped
Can be curved or have projections
RBC crystals reported but source not specified
85
Basophilic Stippling on PBS
Blue dots evenly throughout cytoplasm on wright stain
86
Basophilic Stippling caused by
Ribosomes
Remnant m/RNA
Reticulocyte
87
Conditions with Basophilic Stippling
Defected or accelerated heme synthesis
Compensatory process (blood loss hemolysis)
Thalassemia syndromes
Coarse stippling associated with lead poisoning
88
Course stippling is seen throughout a red cell.. what would we suspect caused this?
Lead poisoning
89
Cabot rings look like
Very fine single or double thread loops, may be seen in ring or figure 8
90
Cabot rings caused by
Nuclear membrane remnant
Precipitated, denatured hgb due to oxidative injury
91
Cabot rings are associated with these inclusions
Nucleated red cells
Howell Jolly bodies
92
Conditions associated with cabot rings
G6PD deficiency
Unstable hemoglobins
93
How to definitively identify Cabot RIngs
Supravital stains
Not visible with wright stains
94
Pappenheimer bodies look like
Small, irregular blue granules near periphery
95
Pappenheimer bodies made up of
Granules of iron
96
Pappen heifer bodies caused by
Ineffective utilization or excess of iron
97
Pappenheimer bodies require __ to confirm
Prussian Blue
98
Pappenheimer bodies when confirmed under Prussian Blue are called
Siderotic granules
99
Conditions associated with pappenheimer bodies
Sideroblastic anemias
Hemochromatosis
Hemoglobinopathies
Thalassemias
100
Rouleaux typically caused by
Plasma proteins or immunoglobulins
(Paraproteins!)
101
How to fix rouleaux for PBS
Replace plasma with saline
102
Conditions associated with rouleaux
Multiple Myeloma (IgG)
Waldenstrom's macroglobulinemia (IgM)
103
Agglutination when micro clots are ruled out are usually due to
RBC antibody
104
Conditions associated with agglutination under PBS
Cold agglutinin
Immune hemolytic anemias
Clotted specimen
105
Toxic granulation
Granules prominent and bluer
Associated with infection
106
Dohle bodies
Sky blue inclusion
Associated with infection
107
Pelger Huet Anomaly
Hyposegmentation of the nucleus
Benign genetic variant
108
HYpersegmented. neutrophils
More than 5 lobes
Associated with B12 or folic acid deficiency
109
Necrobiotic neutrophil
Dying neutrophil
Apoptotic or pyknotic nucleus
110
If many necrobiotic neutrophils are present, what might you suspect?
Old specimen
111
Morulae
Seen in tick-born infection Erlichiosis
Organism multiplying in phagosome
112
When are plasma cells seen in the peripheral blood
Multiple myeloma because they're not typically in the PBS
113
Formula corrected for nRBCs
(WBC count * 100) / (100 + #nRBCs) = WBC count
114
IF clumping or satelliting is present, what must you do?
Hold PLT count results until the issue is resolved
115
How to fix satelliting or PLT clumping
Thorough mixing
Recollecting in citrate and correcting for the different anticoagulant dilution
116
What is the correction for using citrate
1.1
117
Large number of smudge cells usually indicates
Poor slide making technique
Abnormal fragile cells (leukemia)
118
Water artifacts can be caused by
Blood not dry before stain applied
Re-make smear to fix
119
Stain precipitate caused by
Dried out stain
Filter the stain to fix
