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AMT MLS Exam - Hematology > Hematology - RBC Morphology, Inclusions, & Stains > Flashcards

Hematology - RBC Morphology, Inclusions, & Stains Flashcards

1
Q

What diseases are macrocytes associated with?

A
  1. megaloblastic anemias (B12/folate deficiency)
  2. liver disease
  3. accelerated erythropoiesis (reticulocytosis)

-normal in newborns

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2
Q

What diseases are associated with microcytes?

A
  1. iron deficiency anemia
  2. thalassemias
  3. sideroblastic anemia
  4. anemia of chronic disease
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3
Q

What is anisocytosis?

A

variation in RBC size - indicating a dimorphic population

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4
Q

What RBC parameter does anisocytosis correlate with?

A

RDW - esp. when it exceeds 15%

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5
Q

What diseases are associated with anisocytosis?

A
  1. post-transfusion
  2. post-treatment (B12, iron, folate)
  3. presence of 2 concurrent deficiencies (e.g., iron and B12)
  4. idiopathic sideroblastic anemia
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6
Q

What is poikilocytosis?

A

variation in the shape of RBCs

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7
Q
A

Echinocyte (Burr cell)

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8
Q

What is the clinical significance of echinocytes (burr cells)?

A

-membrane defect

  1. liver disease
  2. uremia
  3. hemolytic anemias
  4. TTP
  5. DIC
  6. carcinoma of stomach
  7. pyruvate kinase deficiency
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9
Q

What is the clinical significance of crenated RBCs?

A

-osmotic imbalance

-if seen in most cells in thin part of smear, do not report = probably artifact due to excess anticoagulant or slow drying

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10
Q

How can crenated RBCs be differentiated from burr cells?

A

Burr cells have more pointed projections as compared to the knobby projections of crenated cells.

-if the abnormality is seen in nearly all cells in the thin part of the smear, it is most likely artifact (crenation) due to slow drying of the smear or over-anticoagulation
-burr cells are seen in variable number throughout the smear

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11
Q

What is hypochromia?

A

the are of central pallor is greater than 1/3 the diameter of the RBC

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12
Q
A

spur cells (acanthocytes)

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13
Q

What is the clinical significance of acanthocytes (spur cells)?

A

-membrane defect (excessive cholesterol)

  1. alcoholic liver disease
  2. post-splenectomy
  3. abetalipoproteinemia
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14
Q

How are echinocytes and acanthocytes differentiated on a smear?

A
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15
Q
A

target cells (codocytes)

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16
Q

What causes target cells (codocytes)?

A

-excessive cholesterol in membrane
-hemoglobin distribution imbalance

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17
Q

What is the clinical significance of target cells (codocytes)?

A
  1. liver disease
  2. hemoglobinopathies (sickle cell, hemoglobin C)
  3. thalassemia
  4. iron-deficiency anemia
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18
Q
A

teardrops (dacrocytes)

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19
Q

What is the clinical significance of dacrocytes (tear drop)?

A
  1. anemias (megaloblastic)
  2. thalassemia
  3. extramedullary hematopoiesis (myelofibrosis)
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20
Q
A

sickle cells (drepanocytes)

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21
Q
A

schistocyte (RBC fragments)

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22
Q

What is the clinical significance of schistocytes?

A

-RBCs split by fibrin strands

  1. microangiopathic hemolytic anemias (DIC, TTP, HUS)
  2. prosthetic heart valves
  3. burns
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23
Q

What are spherocytes?

A

small, dark-staining RBCs without central pallor

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24
Q
A

spherocyte

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25
Q

What is the clinical significance of spherocytes?

A

membrane defect

-hereditary spherocytosis
-autoantibodies
-burns
-hemoglobinopathies
-hemolysis
-ABO HDFN
-incompatible blood transfusion
-transfusion of stored blood
-a few are normal due to aging of RBCs

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26
Q

How are the MCV and MCHC affected in hereditary spherocytosis?

A

MCV: normal to low
MCHC: slightly increased

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27
Q

On a blood smear spherocytes appear small in comparison to normal RBCs. Explain how their MCV may be normal.

A

Although spherocytes are small in diameter, their volume is normal because they are spherical rather than biconcave.

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28
Q

What are stomatocytes?

A

RBCs with a slit-like central pallor

(mouth cells)

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29
Q

What is the clinical significance of stomatocytes?

A

-hereditary stomatocytosis
-hereditary spherocytosis
-thalassemia
-alcoholic cirrhosis
-Rh null disease
-may be artifact in parts of the smear that are too thin or too thick

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30
Q
A

stomatocyte

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31
Q

What is the clinical significance of marked polychromasia?

A

it is a sign of accelerated erythropoiesis

-acute blood loss
-hemolytic anemia
-following anemia treatment

-supravital stain = retics

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32
Q
A

polychromasia

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33
Q

Describe rouleaux.

A

RBCs resemble a stack of coins

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34
Q

What is the clinical significance of rouleaux?

A

serum protein abnormality - increased globulin or fibrinogen

-multiple myeloma
-macroglobulinemia

-may be artifact = delay in spreading drop of blood OR smear is too thick

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35
Q

What is the clinical significance of agglutination on a blood smear?

A

RBCs in irregular clumps - RBCs coated with IgM antibodies and complement

-autoantibodies
-cold autoagglutination

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36
Q

Rouleaux vs. agglutination

A
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37
Q

Why is it important to report oval macrocytes?

A

because of their association with megaloblastic anemia

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38
Q

What is the clinical significance of hypochromic microcytic RBCs?

A

-iron deficiency anemia
-sideroblastic anemia
-thalassemia
-anemia of chronic inflammation

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39
Q

In what ways will the RBC morphology of a newborn differ from that of an adult?

A

-macrocytic and polychromatophilic
-a few nucleated RBCs (3-10 per 100 WBCs)
-Reference ranges are higher for newborns: WBCs, RBCs, hematocrit, hemoglobin, retics

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40
Q

What effect does chronic alcoholism have on RBC morphology?

A

-MCV is elevated
-target cells
-stomatocytes

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41
Q

How would you correct agglutination?

A

-warm the blood to 37*C

42
Q

How does agglutination affect indices when using an automated cell counting instrument?

A

-RBC count and hematocrit = falsely LOW
-MCHC = falsely high (>37 g/dL)

43
Q

If a patient has an MCV of 110 fL and marked polychromasia, what other hematology test would be abnormal?

A

-the reticulocyte count would be increased
-the polychromatophlic RBCs would be retics if stained with new methylene blue - they are slightly larger than a mature RBC, which is why the MCV is elevated

44
Q

What changes occur in a blood specimen stored at room temperature?

A

-RBCs swell = increasing MCV and hematocrit
-MCHC and ESR decrease
-Platelets and WBCs decrease

45
Q

What stain is used for basophlic stippling?

A

Wright & new methylene blue

-stain dark blue with Wright’s stain

46
Q
A

basophilic stippling

47
Q

What RBC inclusion is described below?

-multiple, irregular purple inclusions evenly distributed in the cell

A

basophilic stippling

48
Q

What is basophilic stippling composed of?

A

aggregation of RNA (ribosomes)

49
Q

What is the significance of basophilic stippling?

A

coarse: exposure to lead
fine: young RBC

50
Q

What conditions are associated with basophilic stippling?

A

-exposure to lead
-accelerated or abnormal hemoglobin synthesis
-thalassemia

51
Q

Which RBC inclusion is associated with lead poisoning?

A

coarse basophilic stippling

52
Q

What stain is used for Howell-Jolly bodies?

A

Wright & new methylene blue

-stain dark purple to black with Wright’s stain

53
Q
A

Howell-Jolly bodies

54
Q

What RBC inclusion is described below?

round, purple, 1-2 um in diameter; usually only 1 per cell

A

Howell-Jolly bodies

55
Q

What are Howell-Jolly bodies composed of?

A

nuclear remnants (DNA)

56
Q

What is the clinical significance of Howell-Jolly bodies?

A

-usually pitted by the spleen
-seen with accelerated or abnormal erythropoeisis

57
Q

What conditions are associated with Howell-Jolly bodies?

A

-post-splenectomy
-thalassemia
-hemolytic & megaloblastic anemias
-sickle cell anemia

58
Q

What stain is used for Cabot rings?

A

Wright

-appear dark violet

59
Q

Do Cabot rings stain with Perl’s Prussian blue stain?

A

yes

60
Q
A

Cabot rings

61
Q

What RBC inclusion is described below?

reddish purple rings or figure-8s

A

Cabot rings

62
Q

What are Cabot rings composed of?

A

-part of mitotic spindle
-remnant of microtubules
-fragment of nuclear membrane

63
Q

What is the clinical significance of Cabot rings?

A

-rapid blood regeneration
-abnormal erythropoiesis

64
Q

What conditions are associated with Cabot rings?

A

-megaloblastic anemia
-thalassemia
-post-splenectomy
-myelodysplastic syndromes
-lead poisoning

65
Q

What stain is used for Pappenheimer bodies?

A

Wright

(siderotic granules with Prussian blue stain)

66
Q

What RBC inclusion is described below?

small purplish blue granules that vary in size, shape, and number; are usually in clusters at the periphery

A

Pappenheimer bodies

67
Q
A

Pappenheimer bodies

68
Q

What are Pappenheimer bodies composed of?

A

unused iron particles

69
Q

What is the clinical significance of Pappenheimer bodies?

A

faulty iron utilization during hemoglobin synthesis

70
Q

What conditions are associated with Pappenheimer bodies?

A

-sideroblastic anemias
-post-splenectomy
-thalassemia
-sickle cell anemia
-hemochromatosis

71
Q

What stain is used for siderotic granules?

A

Prussian blue

72
Q

What RBC inclusion is described below?

blue granules of varying size and shape that stain with Prussian blue

A

siderotic granules

73
Q

What are siderotic granules composed of?

A

aggregates of iron particles

74
Q

What is the clinical significance of siderotic granules?

A

faulty iron utilization in hemoglobin synthesis

75
Q
A

siderotic granules

76
Q

What conditions are associated with siderotic granules?

A

-sideroblastic anemias
-post-splenectomy
-thalassemia
-sickle cell anemia
-hemochromatosis

77
Q

What stains are used for reticulocytes?

A

new methylene blue or brilliant cresyl blue

(polychromasia on Wright stain)

78
Q
A

Reticulocytes

79
Q

What are reticulocytes composed of?

A

residual RNA (ribosomes)

80
Q

What is the clinical significance of reticulocytes?

A

> 2%: increased erythropoiesis
<0.1%: decreased erythropoiesis

81
Q

What conditions are associated with reticulocytes?

A

-hemolytic anemia
-blood loss
-following treatment for iron deficiency or megaloblastic anemia

82
Q

What stain is used for Heinz bodies?

A

supravital stain (e.g., crystal violet, brilliant cresyl blue, methylene blue)

83
Q

What RBC inclusion is described below?

round blue inclusions, varying sizes, close to cell membrane; may be >1

A

Heinz bodies

84
Q
A

Heinz bodies

85
Q

What are Heinz bodies composed of?

A

precipitated, oxidized, denatured hemoglobin

86
Q

What is the clinical significance of Heinz bodies?

A

normal during aging but pitted by spleen

87
Q

What conditions are associated with Heinz bodies?

A

-G6PD deficiency
-unstable hemoglobins
-chemical injury to RBCs
-drug-induced hemolytic anemia

88
Q

Do Heinz bodies stain with Wrights stain?

A

NO

89
Q

Which of the following conditions is associated with basophilic stippling?

A. sideroblastic anemia
B. lead poisoning
C. G6PD deficiency
D. none of the above

A

B. lead poisoning

90
Q

Which of the following conditions is associated with Howell-Jolly bodies?

A. DIC
B. G6PD deficiency
C. post-splenectomy
D. none of the above

A

C. post-splenectomy

91
Q

Which of the following conditions is associated with Heinz bodies?

A. G6PD deficiency
B. post-splenectomy
C. multiple myeloma
D. none of the above

A

A. G6PD deficiency

92
Q

Which of the following conditions is associated with Pappenheimer bodies?

A. lead poisoning
B. sideroblastic anemia
C. post-splenectomy
D. none of the above

A

B. sideroblastic anemia

93
Q

Which of the following conditions is associated with rouleaux?

A. sideroblastic anemia
B. multiple myeloma
C. DIC
D. none of the above

A

B. multiple myeloma

94
Q

Which of the following conditions is associated with schistocytes?

A. sideroblastic anemia
B. multiple myeloma
C. DIC
D. all of the above

A

C. DIC

95
Q

What is a supravital stain?

A

a stain that stains unfixed cells in the living state

-new methylene blue
-brilliant cresyl blue
-crystal violet

96
Q

Where are reticulocytes found after centrifugation of whole blood?

A

just below the buffy coat

-they are less dense than mature RBCs

97
Q

What other RBC inclusions are seen on a reticulocyte smear?

A

-Howell-Jolly bodies
-Heinz bodies
-Pappenheimer bodies

-they are all stained by supravital stains

98
Q

Staining of RBC inclusions - reticulum:

Wright stain?
New Methylene blue?
Prussian blue?

A

Wright stain: cell appears polychromatophilic

New methylene blue: yes

Prussian blue: NO

99
Q

Staining of RBC inclusions - Howell-Jolly bodies:

Wright stain?
New Methylene blue?
Prussian blue?

A

Wright stain: yes

New methylene blue: yes

Prussian blue: NO

100
Q

Staining of RBC inclusions - Pappenheimer bodies:

Wright stain?
New Methylene blue?
Prussian blue?

A

Wright stain: yes

New methylene blue: yes

Prussian blue: yes

101
Q

Staining of RBC inclusions - siderotic granules:

Wright stain?
New Methylene blue?
Prussian blue?

A

Wright stain: yes, but called Pappenheimer bodies

New methylene blue: yes

Prussian blue: yes

102
Q

Staining of RBC inclusions - Heinz bodies:

Wright stain?
New Methylene blue?
Prussian blue?

A

Wright stain: NO

New methylene blue: yes

Prussian blue: NO

AMT MLS Exam - Hematology (6 decks)

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