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71 Cards in this Set

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Anisocytosis
variation of RBC SIZE
Poikilocytosis
variation of RBC SHAPE
What are the abnormal RBC shapes?
ovalocyte/elliptocyte

spherocyte

stomatocyte

target cell (codocyte)

tear drop (dacrocyte)

schizocyte (schistocyte)

acanthocyte (spur cell)

burr cell (echinocyte)

crenated cell

sickle cell (depranocyte)
Ovalocyte/elliptocyte
elongation of RBC w/ oval or elliptical shape

NON-specific finding

Increased w/ chemo
A finding of MANY elliptocytes is indicative of...?
hereditary elliptocytosis (autosomal dominant)
Spherocyte
loss of mbrn surface area causing a spherical shape
-- cells appear round w/ dense staining
-- NO central pallor
Microspherocytes are indicative of...?
extravascular hemolysis
Normal sized spherocytes are indicative of...?
hereditary spherocytosis (autosomal dominant)
Stomatocyte
central pallor is slit-like, instead of round

NON-specific finding

May be increased in myelodysplastic states
Stomatocytes are associated with...?
Rh null disease

Hereditary stomatocytosis (autosomal dominant)
Target cell (codocyte)
central Hb, rim of pallor, and peripheral Hb staining, caused by increased cell mbrn for amount of Hb
Target cells are associated with...?
liver disease

asplenia

hypochromic anemias

hemoglobinopathies
Tear drop (dacrocyte)
cell has "tear drop" shape

NON-specific finding
Tear drop cells are associated with...?
myelofibrosis
Schizocyte (schistocyte)
fragmented RBC

indicative of intravascular hemolysis

If cell takes on particular shape, can be "helmet" cell or "bite" cell
Acanthocyte (spur cell)
cell mbrn has long projections, nonsymmetrical distributioin, w/ bulbous ends
Acanthocytes are associated with...?
some types of liver disease

a-beta-lipoproteinemia
Burr cell (echinocyte)
cell mbrn has short spikes, asymmetrical distribution, sharp pointed ends
Burr cells are associated with...?
renal failure
Crenated cell
peripheral mbrn is scalloped

usually seen as drying artifact
Crenated cells can be associated with...?
hyperosmolality
Sickle cells (depranocyte)
cell is elongated and curved w/ pointed ends
Sickle cells are associated with...?
S-S disease

Can be assoc w/ few other hemoglobinopathies
List different RBC inclusions
-- basophilic stippling

-- Howell-Jolly body

-- nucleated RBC

-- Pappenheimer body

-- Cabot ring

-- Heinz body

-- parasites
Basophilic stippling
small blue dots disributed throughout the cell, remnants of RNA
Basophilic stippling is associated with...?
Fine stippling:
-- young RBC

Course stippling:
-- thalassemia
-- lead intoxication
-- myelodysplastic states
Howell-Jolly body
usually single, dense, round inclusion of magenta color

remnant of nucleus
Howell-Jolly bodies are associated with...?
Most often:
-- asplenia

Also in:
-- megaloblastic anemia
-- myelodysplastic states
Nucleated RBC
nucleated RBC precursors should not be seen in the peripheral circulation
Nucleated RBCs are associated with...?
Stress
-- acute hemorrhage
-- severe anemia
-- hemolysis

True marrow neoplasm
Pappenheimer body
small blue inclusions usually eccentrically located

one or seversl

consists of stainable iron
Pappenheimer bodies are associated with...?
iron overload in marrow

asplenia
Siderocyte
cell with Pappenheimer bodies
Sideroblast
nucleated RBC w/ iron
Ringed sideroblast
nucleated RBC w/ iron around nucleus
Cabot ring
ring-shaped structure that stains red-blue and thought to be remnant of microtubuules from mitotic spindle
Cabot rings are associated with...?
disordered erythropoiesis
Heinz body
Only seen w/ supra vital staining

Consists of precipitated Hb and is indicative of unstable Hb
Heinz bodies are associated with...?
G-6-PD deficiency

some drugs

some hemoblobinopathies
Parasites
intracellular parasites include malaria and babesia
List the different types of chromicity
anisochromia

hypochromic

hyperchromic

polychromasia
Anisochromia
variation of chromicity
Hypochromic
central pallor is widened
Hyperchromic
small or absent central pallor

ONLY seen in hereditary spherocytosis
Polychromasia
diffuse blue color of RBC

remnant of RNA

indicative of young RBC (reticulocyte)
Rouleau
"sticking" together of RBC dut to loss of Zeta potential caused by increase fibrinogen or gamma globulins
cold agglutinins
agglutinated clumps of RBC due to autoAb of IgM type
List RBC indices
1. Mean cell volume (MCV)

2. Mean cell Hb (MCH)

3. Mean cell Hb concentration (MCHC)

4. Reticulocyte index (RI)

5. RBC Distribution Width (RDW)
MCV
Mean cell volume

MCV = Hct/RBC

Normal = 80-99 fl
MCH
Mean cell Hb

MCH = Hbg/RBC

Normal = 26-32pg
MCHC
Mean cell Hb conc

MCHC = Hgb/Hct

Normal = 33-37%
RI
Reticulocyte index

RI = RC x (Pt Hct/45) x (1/F)

Hct 45 = F 1
Hct 35 = F 2.5
Hct 25 = F 2
Hct 15 = F 2.5
RDW
RBC distribution width

Numerical index for anisocytosis, coefficient variation of MCV

Normal is 11.6 - 14.6%
What are the two categories of abnormal WBC morphology?
Acquired morphologic variations

Hereditary morphologic variants
Acquired morphologic variations?
toxic granulation

Dohle bodies

hypersegmentation

hyposegmentation

degenerating PMNs

platelet satellitosis, platelet clumps

intracellular microorganisms
Toxic granulation
prominence and increase in number of primary granules in PMNs
Toxic granulations are associated with...?
bacterial infections
Dohle bodies
irregularly shaped blue staining bodies in the cytoplasm of PMNs
- consists of ribosomes and RER
Dohle bodies are associated with...?
activated/reactive PMNs

frequently seen w/ toxic granulation
Hypersegmentation
more than 5 lobes to a PMN nucleus

OR

>5% of PMNs w/ 5 lobes
Hypersegmentation is associated with...?
B12/folate deficiency

Rarely:
chemo
MDS
MPD
Hyposegmentation
two lobes or non-lobated nucleus of a segmented PMN
Hyposegmentation is associated with...?
When acquired, "pseudo-Pelger Huet" assoc w/ MDS
Degenerating Neutrophils
occasionally, may be seen in periph circ
-- nucleus will fragment and stain dark, as to stimulate either an NRBC or budding yeasts
Platelet satellitosis, platelet clumps
EDTA induced platelet aggregation IN VITRO, causes interference w/ WBC count and platelet count
Intracellular microorganisms in WBCs
usualy bacteria or fungal orgs when present in high numbers

may be seen intracellularly on peripheral smear
List hereditary morphologic WBC variants
May-Haegglin anomaly

Alder-Reilly anomaly

Chediak-Higashi Syndrome

Pelger-Huet Anomaly
May-Haegglin anomaly
giant platelets and Dohle-like bodies in all granulocytes

normal WBC fxn, but may have thrombocytopenia

autosomal dominant
Alder-Reilly anomaly
denze azurophilic granules in all WBCs including lymphocytes
-- granules consist of lysosomes containing abnormal storage compound

seen in pts w/ mucopolysaccharidoses

PMNs appear as basophils
Chediak-Higashi Syndrome
abnormal large dense granules in lymphocytes
AND
abnormal gray-green granules in PMNs

primary d/o of lysosomes also affecting melanosomes

WBC have low counts and abnormal fxn

autosomal recessive
Pelger-Huet anomaly
PMNs have only two lobes but normal fxn

autosomal dominant