haematology - peripheral blood smears

Question 1

acanthocytes

Answer 1

RBCs show spicules

Question 2

acanthocytes suggests

Answer 2

liver disease
hyposplenism
abetalipoproteinaemia

Question 3

basophilic RBC stippling

Answer 3

small dots at the periphery (rRNA)

accelerated erythropoiesis/defective Hb synthesis

Question 4

basophilic RBC stippling suggests

Answer 4

lead poisoning
megaloblastic anaemia
myelodysplasia
liver disease
haemoglobinopathy (eg. thalassaemia)

Question 5

Burr cells (echinocytes)

Answer 5

sea urchin with regular spicules

Question 6

Burr cells (echinocytes) suggests

Answer 6

artefacts if sample sat in EDTA prior to film

uraemia
GI bleeding
stomach carcinoma

Question 7

Heinz bodies

Answer 7

inclusions on very edge of RBCs

due to denatured Hb

Question 8

Heinz bodies suggests

Answer 8

G6PD deficiency

chronic liver disease

Question 9

Howell-Jolly bodies

Answer 9

Basophilic (purple) nuclear remnants in RBCs

Question 10

Howell-Jolly bodies suggests

Answer 10

post-splenectomy
hyposplenism
- SCD, coeliac, congenital, UC/Crohn’s, myeloproliferative disease, amyloid

megaloblastic anaemia
hereditary spherocytosis

Question 11

Leucoerythroblastic anaemia

Answer 11

presence of nucleated RBCCs and myeloid precursors

Question 12

Leucoerythroblastic anaemia suggests

Answer 12

marrow infiltration

• myelofibrosis
• malignancy

Question 13

Pieger Huet Cells

Answer 13

hypo segmented neutrophil with 2 lobes like a dumbell

Question 14

Pieger Huet Cells suggests

Answer 14

congenital
- lamin B receptor mutation

acquired

• myelogenous leukaemia
• myelodysplastic syndromes

Question 15

Polychromasia

Answer 15

bluish RBCs due to DNA presence

usually reticulocytes (immature RBCs)

Question 16

polychromasia suggests

Answer 16

natural response to shortened RBC life

↑ haemolytic anaemia

↓ aplastic anaemia, chemo

Question 17

right shift

Answer 17

hyper mature white cells

hyper-segmented polymorphs (>5 lobes to nucleus)

Question 18

right shift suggests

Answer 18

megaloblastic anaemia
uraemia
liver disease

Question 19

rouleaux formation

Answer 19

stacked RBCs

Question 20

rouleaux formation suggests

Answer 20

chronic inflammation
paraproteinaemia
myeloma

Question 21

schistocytes

Answer 21

fragmented parts of RBCs
sharp edges
no central pallor

Question 22

schistocytes suggests

Answer 22

microangiopathic anaemia

• DIC
• HUS
• thrombotic thrombocytopenia purpura
• pre eclampsia

Question 23

spherocytes

Answer 23

sphere shaped RBCs

often smaller

Question 24

spherocytes suggests

Answer 24

hereditary shperocytosis

autoimmune haemolytic anaemia

Question 25

stomatocytes

Answer 25

central pallor is straight/curved rod | 'smiley face'/'fish mouth' RBCs

Question 26

stomatocytes suggests

Answer 26

artefact hereditary stomatocytosis high alcohol intake liver disease

Question 27

target cells (codocytes)

Answer 27

bull's eye appearance in central pallor

Question 28

target cells (codocytes) suggests

Answer 28

liver disease hyposplenism thalassaemia IDA