RBC MORPH

Question 1

SUMMARY OF STEPS REQUIRED TO PERFORM THE COMPLETE PERIPHERAL SMEAR

Answer 1

CHECK SLIDE IDENTIFICATION

PERFORM PATIENT SPECIMEN
ORIENTATION

PERFORM LOW POWER (x10) SCAN OF THE BLOOD FILM

PERFORM OIL EXAMINATION (100x) OF THE BLOOD FILM

Question 2

PERFORM LOW POWER (x10) SCAN OF THE BLOOD FILM

Answer 2

Check feather edge for fibrin threads
Examine film edges for excessive leukocytes
Very acceptable number of leukocytes
Verify stain quality
Examine RBC distribution patterns and shapes

Question 3

PERFORM OIL EXAMINATION (100x) OF THE BLOOD FILM

Answer 3

Prepare blood film with oil

Estimate platelet count

Estimate leukocyte count

Perform leukocyte differential

Classify 100 leukocytes

Question 4

Classify 100 leukocytes

Answer 4

Report results as percentages of all leukocyte counted
Keep separate counts of nucleated red blood cells
Note and report abnormal leukocyte morphology
Grade abnormal erythrocyte morphology
Identify miscellaneous abnormal cells

Question 5

CHECK THE SLIDE IDENTIFICATION

Answer 5

Check blood smear identification to ensure that the film and the AUTOMATED COUNT REPORT match

Question 6

-
-
Compare the actual findings on the blood film
Any extreme discrepancy should be investigated and resolved before the report is generated.

Answer 6

Number of leukocytes
Number of platelets
The erythrocyte indices

Question 7

CHECK FEATHERY EDGE FOR ____

Answer 7

FIBRIN THREADS

Question 8

PERFORM LOW POWER (x10) SCAN OF THE BLOOD FILM

Fibrin threads to entrap ____ and are accompanied by ___

Neither a differential count or a platelet estimate should be attempted on these blood films

Answer 8

leukocytes

platelet clumps

Question 9

A PROPERLY MADE PUSH WEDGE PERIPHERAL BLOOD FILM SHOWING THE BATTLEMENT PATTERN FOR LEUKOCYTE DIFFERENTIAL PROCEDURE

Answer 9

FEATHERY EDGE
LATERAL EDGE
EXAMINATION AREA
ORIGIN

Question 10

The edges of even the best prepared films have accumulations of _ and _

Edges should contain __ more leukocytes than the number present in the body of the film

Answer 10

granulocytes and monocytes

<2-3x

Question 11

VERIFY ACCEPTABLE NUMBER OF LEUKOCYTES

In a total leukocyte count of not less than ____, the acceptable working area should contain at least __ leukocytes

Answer 11

4.0 x 109/L

300

Question 12

VERIFY STAIN QUALITY

The stain should clearly distinguish between ___ ___ ___ ___ and __-___ ___

Answer 12

dark purple nuclear material and red-orange erythrocytes

Question 13

EXAMINE RBC DISTRIBUTION, PATTERNS, AND SHAPES

Answer 13

RBCs normally repel one another
RBCs should be distributed evenly (or just slightly overlapping)
Cells should not be distorted

Question 14

Indicates presence of abnormal serum globulins MULTIPLE MYELOMA

Answer 14

ROULEAUX FORMATION

Question 15

Presence of certain antibodies to RBC surface antigens

Answer 15

AGGLUTINATION

Question 16

Normal red cells should be:

Answer 16

Circular with smooth edges
Uniform in shapes and size and hemoglobin concentration
Normal diameter = 7-8mm
Diameter of the central pale area should not be > 1/3 of the cell diameter
No inclusions

Question 17

HYPERCHROMIC

NORMOCHROMIC

HYPOCHROMIC

Answer 17

MCHC = >37 g/dL
Seen in Spherocytosis

MCHC = 31-37 g/dL

MCHC = <31 g/dL
Seen in IDA, thalassemias, etc

Question 18

Term used to describe the variation in Hb content when both hypochromic and normochromic cells are present

Answer 18

ANISOCHROMASIA

Question 19

RED CELL SIZE
MACROCYTIC
NORMOCYTIC
MICROCYTIC

Answer 19

100fL

Question 20

MEAN CORPUSCULAR VOLUME (MCV)

Expressed in SI units as __
1 fL = —
NV: —-

Answer 20

Indicates the average volume of a single erythrocyte in a given blood sample

FEMTOLITERS

10-15/L

80-100fL

Question 21

MCV =

Answer 21

RBC (1012/L)

Question 22

ERYTHROCYTE INDICES

Discussed in relation to __ AND ___
Increased in ____, ____, ____, and ______
A ___ population yields a normal MCV
Increased _____ may increase MCV

Answer 22

Discussed in relation to anemia and hematologic disorders
Increased in megaloblastic anemias, chronic hemolytic anemias, liver disease, and hypothyroidism
A DIMORPHIC population yields a normal MCV
Increased reticulocytes may increase MCV

Question 23

MEAN CORPUSCULAR HEMOGLOBIN (MCH)
Expressed in SI as ___ (1pg = ___)
NV: ___
Should correlate well with __ and ___

Answer 23

Indicates the average WEIGHT of Hb per erythrocyte
PICOGRAMS
(1pg = 10-12g)

26-34pg

MCV and MCHC

Question 24

MCH =

Answer 24

RBC (1012/L)

Question 25

MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC) Expressed in SI units as __ (formerly in %) NV : __ MCHC formula

Answer 25

Indicates the average concentration of Hb in the erythrocytes of any specimen g/L 31-37 g/L Hgb (g/dL) ----------------- HCT%

Question 26

MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC) “___” is NOT used as an actual description of RBC morphology RBC cannot accommodate Hgb --- therefore, a result of --- should be ----

Answer 26

Hyperchromia >37g/dL\ recalculated

Question 27

Variation in red cell population size or diameter Should be estimated semi-quantitatively: _, _, _. ___ vs ___ Correlated with the RED CELL DISTRIBUTION WIDTH (RDW)

Answer 27

ANISOCYTOSIS SLIGHT, MODERATE, MARKED MICROCYTES VS MACROCYTES

Question 28

Normal RBCs show little or no shape variation | Recognition of various shapes or poikilocytes on the film is very helpful in the differentiation of ___

Answer 28

POIKILOCYTOSIS | anemia

Question 29

``` Poikilocyte shape can be explained by: - - - - - - ```

Answer 29

Structural and biochemical changes in the membrane Metabolic state of the cell Hemoglobin molecule abnormalities Abnormal microenvironment Changes in the red cell’s ability to deform Red cell age

Question 30

OVAL MACROCYTES

Answer 30

Megaloblastic erythropoiesis

Question 31

SPHEROCYTES

Answer 31

Hereditary spherocytosis | SPECTRIN

Question 32

ELLIPTOCYTES

Answer 32

Hereditary elliptocytosis | ANKYRIN/BAND 4.1

Question 33

ECHINOCYTES (CRENATED CELLS) | BURR CELLS

Answer 33

Uremia and Renal Insufficiency

Question 34

ACANTHOCYTES (SPUR CELLS)

Answer 34

Abetalipoproteinemia, alcoholic cirrhosis, post- splenectomy cases, hepatitis, etc

Question 35

STOMATOCYTE

Answer 35

``` Alcoholism, cirrhosis, obstructive liver disease, Rh null disease, Hereditary stomatocytosis ```

Question 36

TARGET CELLS (LEPTOCYTES/MEXICAN HAT CELLS)

Answer 36

``` Thalassemias, Hemoglobinopathies SS, CC, DD, EE, Obstructive liver disease, postsplenectomy, and IDA ```

Question 37

SCHISTOCYTES/KERATOCYTES

Answer 37

``` Microangiopathic hemolytic anemia, severe burns, renal graft rejection, glomerulonephritis, vasculitis, TTP, and DIC ```

Question 38

DACROCYTES (TEARDROP CELLS)

Answer 38

Myelofibrosis, myelophthisic anemia, b-thalassemia and pernicious anemia

Question 39

PYROPOIKILOCYTES

Answer 39

Burns, Hereditary Pyropoikilocytosis

Question 40

DREPANOCYTES (SICKLE CELLS)

Answer 40

Sickle cell Disease and Sickle cell Trait

Question 41

HEMOGLOBIN CC CRYSTALS

Answer 41

crystal daw

Question 42

INCLUSIONS

Answer 42

``` POLYCHROMATOPHILIC RED CELLS HEINZ BODIES CABOT RINGS HEMOGLOBIN H INCLUSIONS MALARIA BABESIA ```

Question 43

37C X 30 minutes in BCB | Multiple small dots in ALL cells

Answer 43

HEMOGLOBIN H INCLUSIONS

Question 44

``` Blue ring with red dot Mitotic spindle (?) ```

Answer 44

CABOT RINGS

Question 45

37C X 4H in acetylphenylhydrazine + crystal violet | N: 70% of cells

Answer 45

HEINZ BODIES

Question 46

Diffuse basophilia

Answer 46

POLYCHROMATOPHILIC RED CELLS

Question 47

Few irregular dots in periphery | (+) Iron Stain

Answer 47

PAPPENHEIMER BODIES

Question 48

Dark, irregular dots

Answer 48

BASOPHILIC STIPPLING

Question 49

Round, singlular, reddish-blue bodies

Answer 49

HOWELL-JOLLY BODIES

Question 50

SEMIQUANTITATIVE REPORTS ON ABNORMALITIES IN ERYTHROCYTE MORPHOLOGY SHOULD BE FORMATTED TO PROMOTE BOTH _______ and _________

Answer 50

EFFECTIVE COMMUNICATION WITH THE PHYSICIAN AND LABORATORY REPRODUCIBILITY

Question 51

SEMIQUANTITATIVE WAY OF REPORTING (DEGREE OF POIKILOCYTOSIS, ANISOCYTOSIS AND COLOR CONTENT)

Answer 51

SLIGHT (15%)

Question 52

SEMIQUANTITATIVE WAY OF REPORTING (FOR PARTICULAR SIZE VARIATION OR VARIATION IN SHAPE)

Answer 52

OCCASIONAL (10%)