Blood Film

Question 1

What causes basophilic stippling?

Answer 1

Denatured RNA in RBC

Lead poisoning

Question 2

What are blasts?

Answer 2

Nucleated precursor cells

Seen in myelofibrosis, leukaemia and malignant marrow infiltration

Question 3

What are howell jolly bodies?

Answer 3

DNA nuclear remnants in RBC which are normally removed by the spleen
Seen in hyposplenism; sickle cell, coeliac disease

Question 4

What is hypochromia?

Answer 4

Reduced staining of RBC due to decreased Hb synthesis

Seen in IDA, thalassaemia and sideroblastic anaemia

Question 5

What is a leukoerythroblastic film?

Answer 5

Immature cells (myelocytes, promyelocytes, metamyelocytes, normoblasts) +/- tear drop RBC from haemolysis or marrow infiltration

Question 6

What is poikilocytosis?

Answer 6

Variation in RBC, e.g. in IDA, myelofibrosis and thalassaemia

Question 7

What is polychromasia?

Answer 7

RBC of different ages stain (reticulocytes stain blue)

Response to bleeding, haematinic replacement, haemolysis or marrow infiltration

Question 8

What is rouleaux formation?

Answer 8

Red cell stack on each other (raised ESR)

Seen in multiple myeloma

Question 9

What are schistocytes?

Answer 9

Fragmented RBC from slicing via fibrin bands in intravascular haemolysis
Look for microangiopathic haemolysis; DIC, HUS, PET, mechanical heart valves, TTP

Question 10

What are spherocytes?

Answer 10

Spherical cells found in hereditary spherocytosis and autoimmune haemolytic anaemia

Question 11

What are target cells?

Answer 11

RBC with central staining, a ring of pallor and an outer rim of staining seen in liver disease, hyposplenism and thalassaemia

Question 12

What are tear drop RBCs?

Answer 12

Seen in extramedullary hematopoiesis

Question 13

What can cause a neutrophilia?

Answer 13

Bacterial infections
Inflammation 
Myeloproliferative disorders
Drugs (Steroids) 
Disseminated malignancy 
Stress

Question 14

What can cause a neutropenia?

Answer 14

Viral infections
Drugs; post chemo, cytotoxic agents, carbimazole, sulfonamides
Severe sepsis
Neutrophil antibodies; SLE, haemolytic anaemia
Hypersplenism; felty’s syndrome
Bone marrow failure

Question 15

What is a barr body?

Answer 15

Inactivated X chromosome

Question 16

What can cause a lymphocytosis?

Answer 16

Acute viral infections
Chronic infections
Leukaemia and lymphoma; esp CLL
Large number of atypical lymphocytes = EBV

Question 17

What can cause a l yphopenia?

Answer 17

Steroid therapy 
SLE
Uraemia
Legionnaire's disease 
HIV 
Marrow infiltration 
Post chemo/radiotherapy

Question 18

What can cause an eosinophilia?

Answer 18

Drug reactions; erythema multiforme
Allergies; asthma; atopy 
Parasitic infections; esp helminths 
Skin disease 
eGPA

Question 19

What will megaloblastic anaemia show?

Answer 19

Oval macrocytes
Hypersegmented neutrophils
Hypercellular bone marrow

Question 20

What will a blood film in iron deficiency anaemia show?

Answer 20

Microcytic 
Hypochromic anaemia 
Anisocytosis 
Poikilocytosis 
Reduced ferritin

Question 21

By how much should an iron level rise with iron supplements?

Answer 21

10g/L a week

Question 22

What can cause a thrombocytopenia?

Answer 22

Aplastic anaemia
Megaloblastic anaemia
Marrow infiltration (leukaemia, myeloma)
Marrow suppression (cytotoxic drugs, radiotherapy)
Excess destruction; TIP, SLE, CLL, heparin, viruses
DIC, TTP, HUS
Myeloproliferative disease, NSAIDs, increased urea