Peripheral Blood Film Examination

Question 1

An important component in the evaluation of an anemia is examination of the__________________, with particular attention to RBC diameter, shape, color, and inclusions.

Answer 1

peripheral blood film

Question 2

It also serves to verify the results produced by automated analyzers

Answer 2

peripheral blood film

Question 3

Normal RBCs on a Wright-stained blood film are nearly uniform, ranging from ________ in diameter

Answer 3

7 to 8um

Question 4

Small or microcytic cells are less than _______ in diameter

Answer 4

6um

Question 5

Large or macrocytic RBCs are greater than _________ in diameter

Answer 5

8um

Question 6

Certain _____________ of diagnostic value (such as sickle cells, spherocytes, schistocytes, and oval macrocytes) and ___________ (such as malarial parasites, basophilic stippling, and Howell-Jolly bodies) can be detected only by studying the RBCs on a peripheral blood film

Answer 6

shape abnormalities, RBC inclusions

Question 7

Cell description: Abnormal variation in RBC volume or diameter

Commonly Associated disease states: Hemolytic, megaloblastic, iron deficiency anemias

Answer 7

RBC abnormality: Anisocytosis

Question 8

Cell description: Large RBC (>8um in diameter), MCV > 100 fL

Commonly Associated disease states:
- Megaloblastic anemia
- Myelodysplastic syndromes
- Chronic liver disease
- Bone marrow failure
- Reticulocytosis

Answer 8

RBC abnormality: Macrocyte

Question 9

Cell description: Large oval RBC

Commonly Associated disease states: Megaloblastic anemia

Answer 9

RBC abnormality: Oval macrocyte

Question 10

Cell description: Small RBC (<6um in diameter), MCV < 80 fL

Commonly Associated disease states:
- Iron deficiency anemia
- Anemia of chronic inflammation
- Sideroblastic anemia
- Thalassemia/Hb E disease and trait

Answer 10

RBC abnormality: Microcyte

Question 11

Cell description: Abnormal variation in RBC shape

Commonly Associated disease states: Severe anemia; certain shapes helpful diagnostically

Answer 11

RBC abnormality: Poikilocytosis

Question 12

Cell description: Small, round, dense RBC with no central pallor

Commonly Associated disease states:
- Hereditary spherocytosis
- Immune hemolytic anemia
- Extensive burns (along with schistocytes)

Answer 12

RBC abnormality: Spherocyte

Question 13

Cell description: Elliptical (cigar-shaped), oval (egg-shaped) RBC

Commonly Associated disease states:
- Hereditary elliptocytosis or ovalocytosis
- Iron deficiency anemia
- Thalassemia major
- Myelophthisic anemias

Answer 13

RBC abnormality: Elliptocyte, ovalocyte

Question 14

Cell description: RBC with slit-like area of central pallor

Commonly Associated disease states:
- Hereditary stomatocytosis
- Rh deficiency syndrome
- Acquired stomatocytosis (liver disease, alcoholism)

Answer 14

RBC abnormality: Stomatocyte

Question 15

Cell description: Thin, dense, elongated RBC pointed at each end; may be curved

Commonly Associated disease states:
- Sickle cell anemia
- Sickle cell-B-thalassemia

Answer 15

RBC abnormality: Sickle cell

Question 16

Cell description: Hexagonal crystal of dense hemoglobin formed within the RBC membrane

Commonly Associated disease states: Hb C disease

Answer 16

RBC abnormality: Hb C crysta

Question 17

Cell description: Finger-like or quartz-like crystal of dense hemoglobin protruding from the RBC membrane

Commonly Associated disease states: Hb SC disease

Answer 17

RBC abnormality: Hb SC crysta

Question 18

Cell description: RBC with hemoglobin concentrated in the center and around the periphery resembling a target

Commonly Associated disease states:
- Liver disease
- Hemoglobinopathies
- Thalassemia

Answer 18

RBC abnormality: Target cell (codocyte)

Question 19

Cell description: Fragmented RBC caused by rupture in the peripheral circulation

Commonly Associated disease states:
- Microangiopathic hemolytic anemia (along with microspherocytes)
- Macroangiopathic hemolytic anemia
- Extensive burns (along with microspherocytes)

Answer 19

RBC abnormality: Schistocyte (schizocyte)

Question 20

Cell description: RBC fragment in shape of a helmet

Commonly Associated disease states:
———–same as schistocyte————–
- Microangiopathic hemolytic anemia (along with microspherocytes)
- Macroangiopathic hemolytic anemia
- Extensive burns (along with microspherocytes)

Answer 20

RBC abnormality: Helmet cell (keratocyte)

Question 21

Cell description: RBC with membrane folded over

Commonly Associated disease states:
- Hb C disease
- Hb SC disease

Answer 21

RBC abnormality: Folded cell

Question 22

Cell description: Small, dense RBC with few irregularly spaced projections of varying length

Commonly Associated disease states:
- Severe liver disease (spur cell anemia)
- Neuroacanthocytosis (abetalipoproteinemia, McLeod syndrome)

Answer 22

RBC abnormality: Acanthocyte (spur cell)

Question 23

Cell description: RBC with blunt or pointed, short projections that are usually evenly spaced over the surface of cell; present in all fields of blood film but in variable numbers per field

Commonly Associated disease states:
- Uremia
- Pyruvate kinase deficiency

Answer 23

RBC abnormality: Burr cell (echinocyte)

Question 24

Cell description: RBC with a single pointed extension resembling a teardrop or pear

Commonly Associated disease states:
- Primary myelofibrosis
- Myelophthisic anemia
- Thalassemia
- Megaloblastic anemia

Answer 24

RBC abnormality: Teardrop cell (dacryocyte)

Question 25

Appearance in Supravital Stain: Dark blue granules and filaments in cytoplasm (seen in reticulocytes) Appearance in Wright Stain: Bluish tinge throughout cytoplasm; also called polychromasia (seen in polychromatic erythrocytes) Composition of inclusion: RNA Associated Diseases/Conditions: - Hemolytic anemia - After treatment for iron, vitamin - B12, or folate deficiency

Answer 25

Inclusion: Diffuse basophilia

Question 26

Appearance in Supravital Stain: Dark blue-purple, fine or coarse punctate granules distributed throughout cytoplasm Appearance in Wright Stain: Dark blue-purple, fine or coarse punctate granules distributed throughout cytoplasm Composition of inclusion: Precipitated RNA Associated Diseases/Conditions: - Lead poisoning - Thalassemias - Hemoglobinopathies - Megaloblastic anemia - Myelodysplastic syndromes

Answer 26

Inclusion: Basophilic stippling

Question 27

Appearance in Supravital Stain: Dark blue-purple dense, round granule; usually one per cell; occasionally multiple Appearance in Wright Stain: Dark blue-purple dense, round granule; usually one per cell; occasionally multiple Composition of inclusion: DNA (nuclear fragment) Associated Diseases/Conditions: - Hyposplenism - Postsplenectomy - Megaloblastic anemia - Hemolytic anemia - Thalassemia - Myelodysplastic syndromes

Answer 27

Inclusion: Howell-Jolly body

Question 28

Appearance in Supravital Stain: Round, dark blue-purple granule attached to inner RBC membrane Appearance in Wright Stain: Not visible Composition of inclusion: Denatured hemoglobin Associated Diseases/Conditions: - Glucose-6-phosphate - dehydrogenase deficiency - Unstable hemoglobins - Oxidant drugs/chemicals

Answer 28

Inclusion: Heinz body

Question 29

Appearance in Supravital Stain: Irregular clusters of small, light to dark blue granules, often near periphery of cell Appearance in Wright Stain: Irregular clusters of small, light to dark blue granules, often near periphery of cell Composition of inclusion: Iron Associated Diseases/Conditions: - Sideroblastic anemia - Hemoglobinopathies - Thalassemias - Megaloblastic anemia - Myelodysplastic syndromes - Hyposplenism - Postsplenectomy

Answer 29

Inclusion: Pappenheimer bodies

Question 30

Appearance in Supravital Stain: Rings or figure-eights Appearance in Wright Stain: Blue rings or figure-eights Composition of inclusion: Mitotic spindle remnant Associated Diseases/Conditions: - Megaloblastic anemia - Myelodysplastic syndromes

Answer 30

Inclusion: Cabot ring

Question 31

Appearance in Supravital Stain: Fine, evenly dispersed, dark blue granules; imparts “golf ball” appearance to RBCs Appearance in Wright Stain: Not visible Composition of inclusion: Precipitated B-globin chains of hemoglobin Associated Diseases/Conditions: Hb H disease

Answer 31

Inclusion: Hb H

Question 32

a review of the _____________ and platelets may help show that a more generalized bone marrow problem is leading to the anemia

Answer 32

white blood cells

Question 33

______________ can be seen in vitamin B12 or folate deficiency, whereas ______________ may be an indication of acute leukemia

Answer 33

hypersegmented neutrophils, blast cells and decreased platelets

Question 34

It is indicated for a patient with an unexplained anemia associated with or without other cytopenias, fever of unknown origin, or suspected hematologic neoplasm

Answer 34

Bone marrow examination

Question 35

It evaluates hematopoiesis and can determine whether there is an infiltration of abnormal cells into the bone marrow

Answer 35

Bone marrow examination

Question 36

Important findings in bone marrow that can point to the underlying cause of the anemia include: 1. ______________ (e.g., hypocellularity in aplastic anemia); 2. _______________ (e.g., folate/vitamin B12 deficiency or myelodysplastic syndromes); 3. _______________ (the gold standard for diagnosis of iron deficiency); and 4. _______________________ that may be inhibiting normal erythropoiesis.

Answer 36

1. abnormal cellularity 2. evidence of ineffective erythropoiesis and megaloblastic changes 3. lack of iron on iron stains of bone marrow 4. the presence of granulomata, fibrosis, infectious agents, and tumor cells

Question 37

Other tests that can assist in the diagnosis of anemia can be performed on a bone marrow specimen as well, including _____________, ______________, and ___________ to detect specific genetic mutations and chromosome abnormalities in leukemia cells (Chapter 29).

Answer 37

immunophenotyping of membrane antigens by flow cytometry, cytogenetic studies, and molecular analysis