BLOOD FILM Flashcards
What are blasts, seen on blood film?
They are nucleated precursor blood cells. Seen in acute myeloid leukemia, myelofibrosis, and malignant infiltration of bone marrow by a carcinoma.
What does dimorphic picture mean, with regard to blood films?
When red blood cells have two distinct patterns. For example in coeliac disease, there might be an iron deficiency as well as a folate/B12 deficiency in which case some red cells would be microcytic and others macrocytic. Another example of this is when someone with a severe anaemia has been treated with blood transfusion. Sideroblastic anaemia is also an example.
What are Howell-Jolly bodies?
DNA nuclear remnants in red blood cells and they are indicative of hyposplenism and splenectomy.
What is the arrow pointing at?
Howell Jolly body
What are reticulocytes, seen on a blood film?
They are immature red blood cells. If there are more than 1% reticulocytes, this can be indicative of haemolysis, haemorrhage or recent treatment for anaemia (anything that rapidly increases the rate of red blood cell production).
What are these cells? What is the dark material contained within the cytoplasm of the cell?
Reticulocytes (immature red blood cells that will mature over the next day)
RNA that will disintegrate
What is a Rouleaux formation?
When red cell stack on top of each in the context of a raised ESR.
What are these?
Rouleaux formations - clumping of red blood cell during stasis.
What does “left shift” mean with regard to a blood film?
When the neutrophils are still immature, so the nucleus does not have the distinct segmented shape of more mature neutrophils. Left shift is indicative of infection.
What does “right shift” mean with regard to a blood film?
When you get hypermature white blood cells. The neutrophils will have overly segmented nuclei (more than 5 lobes). Seen in megaloblastic anaemia, ureamia and liver disease.
What are these cells? What are they indicative of?
Target cells - they are caused by an increased ratio of cell surface membrane to volume in red blood cells. Most often caused reduced amount of haemaglobin as seen in thalassaemia, hyposplenism and liver disease, as well as iron deficiency anaemia to a lesser extent.
What are these cells? What are they indicative of?
Schistocytes - fragmented red blood cells produced by intravascular haemolysis. Indicative of haemolytic anaemias and microangiopathic haemolytic anaemia (MAHA) such as hemolytic uremic syndrome, DIC (disseminated intravascular coagulation), thrombotic thrombocytopenic purpura and malignant hypertension. In these situations, fibrin strands are generated which sever red blood cells as they try to move past a microscopic thrombus.
What are these cells? What are they indicative of?
Spherocytes - Spherical red blood cells, no longer concave. Indicative of hereditary spherocytosis, where they are losses of certain membrane proteins which make the red cells concave. Also seen autoimmune haemolytic anaemia.
What are contained within these cells? What are they indicative of?
Pappenheimer bodies - abnormal granules of iron found inside red blood cells on routine blood stain. They are seen in diseases such as sideroblastic anemia, hemolytic anemia, and sickle cell disease.
What are the cells called? What are they indicative of?
Tear drop red blood cell (dakryocytes) - seen in extra medullary haemopoeisis, as in thalassaemia and myelofibrosis.
