Morphology Flashcards
(32 cards)
Name the 2 dyes used in a Wright stain
Eosin (Y or B) and Methylene Blue
How do you identify immature white cells or red cells?
Red cells: Look for the presence of a nucleus
White cells: Chromatin pattern and colour of cytoplasm as well as the presence/absence of granules
What is the difference between a left shift, leukemoid reaction, and CML?
A left shift has toxic changes to the neutrophils. Leukemoid reaction doesn’t have an increase in eosinophils or basophils (both types of cells are increased in CML).
What is the main difference in acute and chronic leukemias?
Acute leukemia: Leukemic cells are immature
Chronic leukemia: Leukemic cells are mature
If you suspect Thalassemia from a PBS review, what is your next step? How can you report it from just the PBS?
Hb electrophoresis or HPLC. You could only differentiate major and minor from the PBS alone (based on the severity of the abnormal RBCs), but not between alpha and beta
If Hb electrophoresis shows a significantly increased HbF proportion, which condition is likely?
Beta-Thalassemia major
If Hb electrophoresis shows an increased HbA2 proportion, which condition is likely?
Beta-Thalassemia minor
How do you know from the PBS if the condition is Beta Thal null?
The smear would show a microcytic anemia, nRBCs, and basophilic stippling
How do you differentiate between hemoglobinopathies, and what follow-up tests are used?
Key diagnostic features:
Sickle cells (HbS), HbSC cells, HbC crystals.
Common findings: Target cells, folded cells.
Follow-up tests:
Hemoglobin electrophoresis or HPLC.
Sickle solubility test (for HbS).
Genetic testing (for Thalassemia).
Iron studies (to rule out IDA).
How do you differentiate between M4, M5a, and M5b leukemias?
M4 (Myelomonocytic Leukemia):
Severe left shift (immature myeloid cells).
Monocytosis (increased mature monocytes).
M5a (Monoblastic Leukemia):
Predominating monoblasts in the smear.
M5b (Monocytic Leukemia):
Predominating monocytes and promonocytes in the smear.
How do you identify an M7?
An M7 PBS will have megakaryoblasts with cytoplasmic blebbing, a normal or elevated platelet count (differentiates M7 from an M6), and giant platelets
How do you identify an M6?
An M6 PBS will have a dimorphic RBC population with dysplastic RBC precursors, a thrombocytopenia, and Howell-Jolly bodies
If platelet clumps are present in a sample, which parameters are affected and what is the purpose of a repeat specimen?
The WBC, RBC, and PLT counts are all affected. Therefore the parameters associated with those counts will also be affected. You need a repeat specimen to issue out accurate results for the patient
How can you differentiate an ABCL from a CML?
CML will have all the stages of the myeloid line represented in the PBS as well as basophilia and eosinophilia. An ABCL PBS will be predominated by blasts.
What are the characteristics of Sickle-Thal?
The PBS would show sickle cells, targets, and microcytes. Using HPLC or Hb electrophoresis, you could identify it was Sickle-Thal by the presence of HbS, HbF, and HbA (if not B null).
Describe the RBC morphology in PKD vs HbH disease
In PKD, the key RBC morph is burr cells, whereas with HbH, the key RBC morph are Heinz bodies which look like golf balls
What would you expect in post-splenectomy changes?
Howell-Jolly bodies, bite/blister cells, and acanthocytes
What are the key findings and next steps for diagnosing DIC or MAHA?
Findings:
Schistocytes on peripheral blood smear (PBS).
Coagulation tests: Prolonged PT and aPTT, positive D-Dimer (indicative of DIC).
CBC: Low platelet count (thrombocytopenia), a hallmark of both MAHA and DIC.
Next Steps:
Run coagulation tests (PT, aPTT, D-Dimer) to assess for DIC.
Perform a CBC to evaluate platelet count and other cell lines.
Correlate findings with clinical context (e.g., underlying cause like sepsis, malignancy, or HUS/TTP).
Would you do a diff if the slide shows agglutination? What would you do next?
I would only do a diff if the agglutination was moderate. If the agglutination was marked, I would warm the sample to 37C and make a new smear to perform the morphology report.
Would you do a diff if the slide shows rouleaux? What would you do next?
I would only do a diff if the rouleaux was moderate. If the rouleaux was marked, I would perform saline replacement on the sample and make a new smear to perform the morphology report.
Which conditions are associated with low platelets (thrombocytopenia)? How would you differentiate them?
Conditions:
May-Hegglin Anomaly
Most Acute Leukemias
Microangiopathic Hemolytic Anemias (MAHAs)
Differentiation:
CBC Parameters & Flags:
Look for blasts (suggestive of acute leukemia) or schistocytes/fragments (suggestive of MAHA).
Smear Examination:
Giant platelets (May-Hegglin).
Blasts or dysplastic cells (leukemia).
Schistocytes (MAHA).
What conditions should you consider if you see target cells on a blood smear, and what additional findings should you look for?
Possible conditions: Hemoglobinopathies, Liver Disease, and Iron Deficiency Anemia (IDA).
If macrocytic cells are also present, suspect Liver Disease.
If microcytic cells are present without other significant poikilocytosis, consider IDA.
If other abnormal poikilocytes are seen in significant amounts, think Hemoglobinopathy.
What are the measurements of the Improved Neubauer chamber?
Total squares: 9 (1mm by 1mm each, depth of 0.1mm).
Subdivisions:
4 corner squares (each divided into 16 smaller squares, 0.25mm by 0.25mm).
Central square (divided into 25 smaller squares, 0.2mm by 0.2mm).
25 central squares within the central square (divided into 16 smallest squares, 0.05mm by 0.05mm).
Which areas of the Improved Neubauer chamber do you count for CSF?
All nine squares on both sides.
