Peripheral Blood Cell Morphology And The Cbc

Front 1

What type of blood is used to do CBC and peripheral blood smears?

Back 1

a. EDTA anticoagulated blood
b. Purple top

Front 2

What types of cells are counted in the CBC?

Back 2

a. WBC
b. RBC
c. Platelets

Front 3

What are the most clinically relevant measurements in a CBC?

Back 3

a. RBC
b. wBC
c. Plt
d. Hb
e. Hct
f. MCV
g. RDW
h. Absolute leukocyte counts

Front 4

How are RBCs and WBCs sorted in the cell counter?

Back 4

a. By size

Front 5

How do sorters separate RBCs and WBCs?

Back 5

a. Electrical impedance
b. Light scattering

Front 6

What units are used to express Hb measurement?

Back 6

a. g/dL

Front 7

Hemoglobin measurement

Back 7

a. Common method in analyzers uses absorption peaks via the cyanmethemoglobin method
b. Improper venipuncture can affect results, particularly fingerstick samples or capillary samples

Front 8

Hematocrit measurement is expressed as...

Back 8

%

Front 9

Hematocrit modern analyzers

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a. Indirectly measure hemoglobin by taking MCV*RBC count
b. In normal individuals, the hematocrit is roughly 3x the hemoglobin

Front 10

Mean cell volume is measured...

Back 10

In femtoliters

Front 11

Mean cell volume

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a. Average weight of average RBC
b. Calculated from the Hb concentration and the RBC count

Front 12

Mean cellular hemoglobin concentration

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a. Average concentration of Hb given volume of RBCs
b. Calculated form Hb concentration and hematocrit

Front 13

MCHC measurement is expressed as...

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a. g/dL

Front 14

Red blood cell distribution width

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a. Measure of variation in size of the RBCs

Front 15

RDW measured in...

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a. Femtoliters

Front 16

Utility of RDW

Back 16

a. Can be used to detect some early anemias
b. Usually elevated in iron deficiency and megaloblastic anemias

Front 17

Machine diff

Back 17

a. Performed by the instrument analyzing cell size, cytoplasmic granularity, nuclear complexity of leukocytes
b. Does not differentiate bands from mature neutrophils
c. Much more accurate than manual differential when WBC morphology is normal
d. Can be “off” when abnormal WBC populations are present

Front 18

Absolute counts of WBCs

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a. Can help distinguish between reactive and neoplastic processes

Front 19

Relative vs. absolute WBC counts

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i. Differential % just gives you relative numbers
ii. Absolute counts matter
iii. How to calculate absolute from relative
1. Take % of cell on manual diff*total WBC count

Front 20

Mean platelet volume

Back 20

a. Analogous to MCV for RBCs
b. Indirect measure of age of platelets
c. Younger are larger

Front 21

Microcytosis

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a. <7um diameter of RBC

Front 22

Macrocytosis

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a. >8.6 um diameter of RBC

Front 23

Anisocytosis

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a. Variation in size of RBCs

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Poikilocytosis

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a. Variation in shape of RBCs

Front 25

Normochromic

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a. Normal amount of hemoglobin

Front 26

Hypochromic

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a. Decreased hemoglobin
b. Pail staining on Wright stain

Front 27

Polychromasia

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a. Increased immature RBC
b. Normal amount of Hb

Front 28

Causes of microcytic hypo chromic cells

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a. Iron deficiency anemia
b. Sideroblastic anemia→ hereditary/acquired
c. Lead or other heavy metal poisoning
d. Thalassemia

Front 29

Causes of macrocytic cells

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a. Vitamin B12/folate deficiency
b. Medication effect
c. Myelodysplasia
d. Alcohol abuse
e. Reticulocytosis

Front 30

Spherocytes

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a. Loss of membrane without loss of cytosol
b. Cells are much less deformable
c. Look more dense than surrounding cells

Front 31

Causes of spherocytosis

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i. Hereditary spherocytosis
ii. Immune-mediated hemolytic anemia
iii. Post-transfusion
iv. Artifact

Front 32

Elliptocytosis/ovalocytosis hereditary forms

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i. Cytoskeleton abnormality

Front 33

Elliptocytosis/ovalocytosis acquired forms

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i. Iron deficiency
ii. Thalassemias
iii. Megaloblastic anemia
iv. Myelofibrosis
v. Myelodysplastic syndromes

Front 34

Causes of target cells

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a. Redundant membrane in relation to the volume of cell
b. May be thinner than normal
c. Bell-shaped in bloodstream
d. LIVER DISEASE

Front 35

Macrocytic target cell causes

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1. Liver disease
2. Megaloblastic anemia

Front 36

Microcytic target cell causes

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1. Thalassemia
2. Iron deficiency

Front 37

Normocytic target cell causes

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1. Sickling disorders
2. HgbE

Front 38

Acanthocyte spicules

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i. Unevenly distributed over RBC surface
ii. Unequal length

Front 39

Causes of acanthocytes

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i. Inherited (abetalipoproteinemia)
ii. Acquired (liver disease, myelodysplastic syndromes, malnutrition)

Front 40

Echinocyte spicules

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i. Evenly distributed over RBC surface
ii. Short, blunt

Front 41

Echinocyte causes

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i. Storage artifact
ii. Liver disease +/- renal failure
iii. Enzyme deficiencies

Front 42

Stomatocytosis

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a. Occasionally seen in healthy patients
b. Commonly associated with alcohol excess and alcoholic liver disease
e. Narrow, slit-like zone of central pallor
c. Hydroxyurea therapy
d. Myeldodysplastic syndrome
e. Inherited disorders→ Rh null syndrome

Front 43

Schistocyte cause

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a. Microangiopathic hemolytic anemias
b. Mechanic heart valves
c. Hereditary pyropoikilocytosis

Front 44

Microangiopathic hemolytic anemias

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i. TTP/HUS
ii. DIC
iii. Toxins→ snake venom
iv. Vasculitis

Front 45

Sickle cell disease caused by...

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i. Homozygosity for hemoglobin S variant of beta chain of hemoglobin
ii. Hemoglobin S in combination with other hemoglobin variants or thalassaemias
ii. Substitution at position 6 on Hb chain

Front 46

Sickle cell disease caused by (continued)...

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b. Hgb S polymerizes in low oxygen tension
c. Cells sickle and are less deformable→ vascular obstruction leading to infarction

Front 47

Hemoglobin C disease

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a. Irregularly contracted cells
b. Target cells (normocytic)
c. Hemoglobin C crystals
d. Spherocytes

Front 48

Bite cell

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a. Degmacyte from G6P DH deficiency

Front 49

Heinz bodies

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i. Aggregates of denatured Hb
ii. Adhere to cell membrane
iii. Plucked out in spleen, having the appearance of being bitten

Front 50

Teardrop cells

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a. Dacrocytes
b. Teardrops all point in different directions
c. Likely due to bone marrow fibrosis
d. Typically seen in cancer patients

Front 51

Primary dacrocyte

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i. Idiopathic myelofibrosis

Front 52

Secondary dacrocyte

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i. Reaction to myeloma
ii. Solid tumors
iii. Therapy

Front 53

Polychromasia

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a. Blue-gray color of immature RBCs due to residual ribosomal material within the cytoplasm
b. Seen in reticulocytosis, premature release of immature cells from marrow

Front 54

Howell-Jolly bodies

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a. Small nuclear remnant
b. Typically single-- USE TO DIFFERENTIATE

Front 55

Howell-Jolly bodies seen in

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i. Post-splenectomy states
ii. Hemolytic anemias
iii. Megaloblastic anemia
iv. Normal finding in neonates

Front 56

Pappenheimer granules

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a. Iron-containing mitochondrial remnants

Front 57

Basophilic stippling

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a. RNA
b. Aggregates of ribosomes

Front 58

Basophilic stippling seen in...

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i. Thalassemia
ii. Megaloblastic anemia o Liver disease
iii. Lead poisoning
iv. Hemolytic anemia
v. Dyserythropoietic states

Front 59

Hyposegmented neutrophils

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a. Inherited
i. Pelger-Huet Anomaly
b. Acquired
i. Myelodysplastic syndromes

Front 60

Hypersegmented neutrophils

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a. Seen with megaloblastic anemia, myelodysplastic syndromes, in some infections, and due to some medications

Front 61

Microcytic hyperchromic cells

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a. Cells are small (<7um, <80fL)
b. Central zone of pallor is >1/3 the diameter of the cell

Front 62

Pappenheimer granules seen in...

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b. Sideroblastic anemias, post-splenectomy states, lead poisoning
c. Reticulocytes often contain these
d. Occur in small clusters near periphery of cell