Peripheral Blood Morphology

Question 1

Mean Corpuscle Volume (MCV)

Answer 1

• Measurement of the average volume of each RBC

Question 2

Spherocytes

Answer 2

• Loss of central pallor and spherical in shape

Question 3

If a patient has Howell-Jolly bodies after a splenectomy and then later is tested and does not have them, what could have occurred?

Answer 3

• The spleen has the ability to regenerate in various parts of the body so perhaps this is the case –> accessory spleen

Question 4

Acanthocytes

Answer 4

• Spur cells
• Have larger, irregular projections

Question 5

Polychromasia refers to

Answer 5

Red cells that have a more bluish tinge

Question 6

If you see these cells, then it is an emergency and fatal in 80% of cases if left untreated after a few hours

Answer 6

• Schistocytes

** MAHA

Question 7

If due to autoimmune hemolysis, the spherocytes are

Answer 7

• Smaller and referred to as microspherocytes

Question 8

What would you use to measure hypochromasia?

Answer 8

• MCH

Question 9

In normal peripheral blood, what cell types should be present?

Answer 9

WBCs, RBCs, and platelets

Question 10

Differential diagnoses of macrocytosis

Answer 10

• B12/ folate deficiency
• Liver disease
• Thyroid disease
• Chemotherapy (hydrea in particular)
• Anti-retrovirals (AZT)
• Aplastic anemia
• MDS (myelodysplastic syndrome)
• Elevated reticulocyte count

Question 11

When looking at a blood smear, what part are we interested in looking at for diagnostic purposes?

Answer 11

The feathered edge

Question 12

Megaloblastic anemia

Answer 12

• Red cells are macrocytic
• Hypersegmented neutrophils
• Vit. B12 and folate deficiency will cause this

Question 13

Autoimmune Hemolytic Anemia (AIHA)

Answer 13

• Polychromasia
• Microspherocytes

Question 14

Poikolocytosis refers to

Answer 14

• Red cells that vary widely in shape

Question 15

Howell- Jolly Bodies

Answer 15

• Small, peripheral, round, purple inclusions that are found within the red cells that are nuclear remnants

Question 16

Echinocytes

Answer 16

• Burr cells
• Have small, regular projections

Question 17

The overarching term for red cells that vary widely in size

Answer 17

-Anisocytosis

Question 18

Most common cause of microcytosis

Answer 18

Iron deficiency anemia

Question 19

A normal RBC should be about the size of

Answer 19

A lymphocyte nucleus

Question 20

What lab value can you use to determine macrocytosis?

Answer 20

MCV

Question 21

Hypochromasia refers to

Answer 21

• Red cells that have too little hemoglobin that results in them being less red when stained

Question 22

Rouleaux

Answer 22

• Linear arrangements of red cells and are described as “piles of coins on a plate”

Question 23

Which type of process should you think of when see spherocytes?

Answer 23

• Hemolytic process

Question 24

Sickle cells are seen in which condition?

Answer 24

• Sickle cell anemia

Question 25

Most likely, in polychromasia the large blue cells are actually what type of cell?

Answer 25

- Reticulocytes

Question 26

Acathocytes are seen in what condition?

Answer 26

Liver disease

Question 27

What are some cells that are present after a splenectomy?

Answer 27

* Howell- jolly bodies * Target cells * Acanthocytes --\> spur cells * Schistocytes * Nucleated RBCs

Question 29

Agglutination

Answer 29

- Occurs when RBCs are coated with IgM - IgM is big enough to bridge 2 red cells and cause them to clump together

Question 30

Teardrop cells

Answer 30

- Seen in myelophthisic processes, which are diseases of **bone marrow infiltration**

Question 32

Different cell morphologies seen in liver disease

Answer 32

* Target cells * Acanthocytes * Macrocytosis

Question 33

Beta- Thalassemia major

Answer 33

A- Target cells B- Howell-jolly body C- Nucleated red cell D- Schistocyte E- Basophilic stippling \*\* Teardrops can also be seen

Question 34

RBC membranes have what charge overall and what causes them to form rouleaux?

Answer 34

- RBC membranes have a net positive charge and when there are negatively charged proteins present, that means that the RBCs will bind together

Question 35

When are Howell-Jolly bodies seen?

Answer 35

- After splenectomy or in cases of splenic hypofunction ## Footnote \*\* May be seen in sickle cell disease and B-thalassemia major

Question 36

Teardrop cells can be seen in which conditions?

Answer 36

* Myelofibrosis * Tumor metastasis to the bone marrow * Granulomatous diseases * Leukemias and lymphomas * Sometimes in massive splenomegaly

Question 37

What disorders are rouleaux seen in?

Answer 37

* Mutliple myeloma * Waldenstrom's macroglobulinemia * Severe hypo-albuminemia

Question 38

The area of central pallor is ___ than the total red cell diameter in hypochromasia.

Answer 38

- More than 1/3 total red cell diameter ## Footnote \* Measured with MCH

Question 39

What does the red cell distribution width (RDW) measure?

Answer 39

- Range of red blood cell sizes

Question 40

How can you determine microcytosis?

Answer 40

1. Looking at the lymphocyte nucleus as a reference in the blood smear 2. Using the MCV, which measures the average volume of each RBC

Question 41

Which type of cells will you see in a patient with sickle cell anemia along with sickle cells?

Answer 41

- Target cells

Question 42

Differential diagnoses of target cells

Answer 42

* **Liver disease** * Thalessemia * Hemoglobin C disease * After splenectomy \*\*LTHA "Target cells are LiT, HA!"

Question 43

Echinocytes are seen in what kind of disease?

Answer 43

- Renal disease

Question 44

Schistocytes

Answer 44

- Red cell fragments that have sharp edges

Question 45

Spherocytes may be seen in these 2 conditons

Answer 45

* Hereditary spherocytosis * Autoimmune hemolysis \*\* HA

Question 46

Microcytosis refers to

Answer 46

Red cells that are small

Question 47

Macrocytosis refers to

Answer 47

- Large red cells

Question 48

Most people with MDS are

Answer 48

Normocytic

Question 49

Vit. B12 and folate deficiency will cause which type of anemia?

Answer 49

- Megaloblastic anemia

Question 50

Shistocytes are a hallmark of what condition?

Answer 50

- Microangiopathic hemolytic anemia (MAHA)

Question 51

Target cells look like \_\_\_\_

Answer 51

-Bulls-eyes

Question 52

Differential diagnoses of microcytosis

Answer 52

* **Iron deficiency** * Thalessemia * Lead poisoning * Anemia of chronic disease (usually normocytic) * Sideroblastic anemia * Hemoglobin C disease and trait ## Footnote **\*\*ITLASH**

Question 53

The area of central pallor of a RBC should be about ____ of total RBC diameter

Answer 53

-1/3

Question 54

Iron Deficiency Anemia

Answer 54

- Hypochromic, microcytic cells - Increased number of platelets - Increased RDW (so there is a wide range of sizes of RBCs) - Decreased MCV (microcytic) - Decreased MCH (low hemoglobin) - Target cells