Blood films

Question 1

acanthocytes

Answer 1

aka spur or spike cells
many irregular spicules on RBCs

liver disease, hyposplenism, abetalipoproteinaemia

Question 2

basophilic RBC stippling

Answer 2

accelerated erythropoeisis or defective Hb synthesis, rRNA small dots at periphery

lead poisoning, megaloblastic anaemia, myelodysplasia, liver disease, haemaglobinopathy i.e. thalassaemia

Question 3

burr cells (echinocytes)

Answer 3

regular spicules

artefact if blood sat in EDTA for too long
uraemia, renal failure, GI bleeding, stomach carcinoma

Question 4

Heinz bodies

Answer 4

inclusions on edge of RBC due to denatured Hb- due to oxidative damage, when removed by macrophages=bite cells

+G6PD deficiency+, CLD

Question 5

Howell-Jolly Bodies

Answer 5

Nuclear (basophilic) inclusions within RBCs, usually removed by spleen

Post-splenectomy or hyposplenism (e.g. sickle cell disease, coeliac disease, congenital, UC/Crohn’s, myeloproliferative disease, amyloid) megaloblastic anaemia, hereditary spherocytosis

Question 6

Leucoerythroblastic

Answer 6

presence of nucleated red blood cells and myeloid precursors in peripheral blood

Marrow infiltration i.e. myelofibrosis, malignancy

Question 7

Pelger Huet Cells

Answer 7

Hyposegmented neutrophil with 2 lobes like a dumbbell Pseudo-pelger huet cells are also hypogranular

Congenital (lamin B Receptor mutation)
Acquired (myelogenous leukaemia and myelodysplastic syndromes [pseudo-pelger in MDS])

Question 8

Polychromasia

Answer 8

Bluish red blood cells due to presence of DNA. Polychromatic cells are usually reticulocytes which are immature RBCs

Usually increased naturally in response to shortened RBC life ↑in haemolytic anaemias ↓aplastic anaemia, chemo

Question 9

Right shift

Answer 9

Hypermature white cells - hypersegmented polymorphs (>5 lobes to nucleus)

Megaloblastic anaemia, uraemia, liver disease

Question 10

Rouleaux formation

Answer 10

Red cells stacked on each other

Chronic inflammation, paraproteinaemia, myeloma

Question 11

Schistocytes

Answer 11

Fragmented parts of RBCs – typically irregularly shaped with sharp edges and no central pallor

Microangiopathic anaemia, e.g. DIC, haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura, pre-eclampsia

Question 12

Spherocytes

Answer 12

Sphere shaped RBC Often a little smaller

Hereditary spherocytosis, Autoimmune Haemolytic Anaemia

Question 13

Stomatocytes

Answer 13

Central pallor is straight or curved rod-like shape. RBCs appear as ‘smiling faces’ or ‘fish mouth’

Can be artefact during slide preparation.
If not: Hereditary stomatocytosis, high alcohol intake, liver disease

Question 14

Target cells (codocyte)

Answer 14

Bull’s-eye appearance in central pallor

Liver disease, hyposplenism, thalassaemia, IDA