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129 Cards in this Set
- Front
- Back
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What disease states are microcytes associated with?
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-iron deficiency anemia
-sideroblastic anemia -thalassemia minor -chronic disease (occasionally) -leasd poisoning -hemoglobinopathies (some) |
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What disease states are macrocytes associated with?
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-liver disease
-vitamin B12 deficiency -folate deficiency -neonates |
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A dimorphic population of erythrocytes would be associated with...
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-transfusion
-myelodysplastic syndromes -vitamin B12, folate or iorn deficiencies - early in treatment process |
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What disease states are associated with hypochromasia?
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-iron deficiency anemia
-thalassemias -sideroblastic anemia -lead poisoning -some cases of chronic disease |
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What disease states are associated with polychromasia?
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-acute and chronic hemorrhage
-hemolysis -effective treatment for anemia -neonates |
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What are the characteristics of polymorphonuclear neutrophils (segs)?
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-10-15 micrometers
-nucleus has 2-5 lobes connected by thin filaments without visible chromatin -coarsely clumped chromatin -pale blue to pink cytoplasm -rare primary granules -abundant secondary granules -50-70% in PB |
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What are the characteristics of band neutrophils?
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-10-15 micrometers
-C or S shaped nucleus, constricted but no threadlike filament, chromatin must be visible in filament -coarsely clumped chromatin -pale blue to pink cytoplasm -few primary granules -abundant secondary granules -0-5% in PB |
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What are the characteristics of lymphocytes?
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-7-18 micrometers
-round to oval nucleus, may be slightly indented, occasionaly nucleoli -condensed to deeply condensed chromatin -scant to moderate cytoplasm, sky blue, vacuoles may be present -few azurophilic granules -20-40% in PB |
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What are the characteristics of monocytes?
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-12-20 micrometers
-variable nucleus, may be round, horse-shoe or kidney shaped; often has folds producing "brainlike" convolutions -lacy chromatin -blue-gray cytoplasm; may have pseudopods; vacuoles may be absent or numerous -many fine granules frequently giving appearance of ground glass -3-11% in PB |
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What are the characteristics of eosinophils?
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-12-17 micrometers
-nucleus has 2-3 lobes connected by filaments without visible chromatin -coarsely clumped chromatin -pink cytoplasm, may have irregular borders -rare primary granules -abundant red to orange, round, secondary granules -0-5% in PB |
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What are the characteristics of basophils?
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-10-14 micrometers
-nucleus usually has 2 lobes connected by thin filaments without visible chromatin -coarsely clumped chromatin -lavender to colorless cytoplasm -rare primary granules -secondary granules are variable in number with uneven distribution; may obscure nucleus or washout during staining, giving appearance of empty areas -0-1% in PB |
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How large must the central zone of pallor be before a RBC is classified as hypochromic?
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The central zone of pallor must be greater than one third of the diameter of the cell.
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Describe an acanthocyte.
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Erythrocyte with irregularly spaced projections that vary in width, length, and number. Aka spur cell.
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What disease states are associated with acanthocytes?
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-abetalipoporteinemia
-severe liver disease -splenectomy -malabsorption -hypothyroidism -vitamin E deficiency |
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Describe echinocytes.
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Burrlike erythrocyte with short, evenly spaced projections. Aka burr cell or crenated cell.
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What disease states are associated with echinocytes?
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-uremia
-pyruvate kinase deficiency -microangiopathic hemolytic anemia -artifact |
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Describe spherocytes.
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Erythrocytes that are dark red in color, round and have no central zone of pallor.
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What disease states are associated with spherocytes?
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-hereditary spherocytosis
-some hemolytic anemias -transfused cells -severe burns |
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Describe codocytes.
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Red to salmon in color. Bull's eye shape; central concentration of hgb surrounded by colorless area with peripheral ring of hgb resembling bull's eye; may be bell or cup shaped. Aka target cell.
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What disease states are associated with codocytes?
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-hemoglobinopathies
-thalassemias -iron deficiency anemia -splenectomy -obstructive liver disease |
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Describe drepanocytes.
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Dark red to salmon color. Elongated cell with point on each end; may be curved or S-shaped. Aka sickle cell.
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What disease states are associated with drepanocytes?
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-homozygous hemoglobin S disease
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Describe Hgb C crystals.
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Dark red color. Hexagonal shape. One per cell if not induced.
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What disease states are associated with Hgb C crystals?
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-homozygous hemoglobin C disease
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Describe Hgb SC crystals.
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Dark red color. One to two fingerlike projections; may look like a mitten. One to two per cell.
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What disease states are associated with Hgb SC crystals?
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-Hemoglobin SC disease
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Describe stomatocytes.
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Erythrocyte with slitlike area of central pallor.
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What disease states are associated with stomatocytes?
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-hereditary stomatocytosis
-alcoholoism -liver disease -Rh null phenotype -artifact |
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Describe elliptocytes.
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Cigar-shaped erythrocyte with little or no zone of central pallor.
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Describe ovalocytes.
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Egg-shaped erythrocyte with little or no zone of central pallor.
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What disease states are associated with elliptocytes/ovalocytes?
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-hereditary elliptocytosis/ovalocytosis
-thalassemia major -iron deficiency anemia -megaloblastic anemias (macro ovalocytes) -mylophthisic anemias |
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Describe dacrocytes.
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Erythrocyte shaped like a tear drop or pear; may have one blunt projection. Aka, tear drop cell.
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What disease states are associated with dacrocytes?
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-myelofirbosis with myeloid metaplasia
-thalassemias -myelophthisic anemias -other causes of extramedullary hematopoiesis |
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Describe schizocyte.
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Red to salmon color. Fragmented erythrocytes; many sizes and shapes are present on a smear; often display pointed extremeties. Aka, schistocyte.
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What disease states are associated with schizocytes?
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-microangiopathic hemolytic anemia (disseminated intravascular coagulation)
-severe burns -hemolytic uremic syndrome -thrombotic thrombocytopenic purpura -renal graft rejection |
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Describe rouleaux.
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Erythrocytes arranged in rows like stacks of coins; increased proteins in patients with rouleaux may make background of slide appear blue.
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What disease states are associated with rouleaux?
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-increased concentrations of globulins and/or paraproteins
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Describe autoagglutination among RBCs.
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Clumping of erythrocytes; outlines of individual cells may not be evident.
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What disease states are associated with autoagglutination among RBCs?
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-antigen/antibody reactions
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What RBC inclusions are visible in a Wright-Giemsa stain?
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-Howell-Jolly body
-basophilic stippling -pappenheimer body -cabot ring |
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What RBC inclusions are visible in a New Methylene Blue (or other supravital) stain?
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-Howell-Jolly body
-basophilic stippling -pappenheimer body -cabot ring -reticulocyte -heinz body |
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What RBC inclusions are visible in a Prussion Blue stain?
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-pappenheimer body
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Describe Howell-Jolly bodies.
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Dark blue to purple color. Round to oval. 1 micron. Usually 1, but may be multiple, per cell. Composed of DNA.
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What disease states are associated with Howell-Jolly bodies?
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-splenectomy
-hyposplenism -megaloblastic anemia -hemolytic anemia |
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Describe basophilic stippling.
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Dark blue to purple. Fine or coarse granules. Numerous per cell with fairly even distribution. Composed of RNA.
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What disease states are associated with basophilic stippling?
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-lead intoxication
-thalassemia -abnormal heme synthesis |
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Describe pappenheimer bodies.
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Light blue. Fine irregular granules in clusters. usually one cluster; may be multiples. Often at periphery of cell. Composed of iron. Aka siderotic granules.
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What disease states are associated with pappenheimer bodies?
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-splenectomy
-hemolytic anemia -sideroblastic anemia -megaloblastic anemia -hemoglobinopathies |
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Describe cabot rings.
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Dark blue to purple. Loop, ring or figure eight; may look like beads on a string. One to two per cell. Thought to be remnants of mitotic spindle.
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What disease states are associated with cabot rings?
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-myelodysplastic syndrome
-megaloblastic anemia |
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Describe reticulocytes in New Methylene Blue stain.
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Anuclear immature erythrocyte. Composed of precipitated RNA. Greater than or equal to 2 per cell. Dark blue.
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What disease states are associated with reticulocytes?
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-erythrocyte maturation
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Describe Heinz bodies in New Methylene Blue stain.
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Dark blue to purple in a mature erythrocyte. Composed of precipitated hgb. Single or multiple, generally membrane bound.
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What disease states are associated with Heinz bodies?
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-unstable hgb
-some hemoglobinopathies -some erythrocyte enzyme deficiencies (i.e., G6PD) |
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How would you stimulate the formation of Heinz bodies?
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To stimulate the formation of Heinz bodies in susceptible cells, blood may be incubated with acetylphenylhydrazine.
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Describe iron deficiency anemia in PB.
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Erythrocytes are hypochromic and microcytic; large variation in size; possible thrombocytosis.
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Describe thalassemia minor in PB.
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Microcytosis, slight hypchromasia, codocytes, basophilic stippling.
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Describe thalassemia major in PB.
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Numerous nucleated erythrocytes, microcytes, hypochromasia, codocytes, basophilic stippling, many dacrocytes, many schizocytes, polychromasia.
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Describe Bart's hgb in PB.
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Marked variation in size, hypochromasia, numerous nucleated erythrocytes, variable polychromasia, macrocytes.
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Describe nonmegaloblastic macrocytic anemia in PB.
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Round macrocytes (MCV=112 fL), leukocyte and platelet counts usually normal.
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Describe megaloblastic anemia in PB.
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Pancytopenia, oval macrocytes, Howell-Jolly bodies, nucleated erythrocytes, basophilic stippling, hypersegmentation of neutrophils, giant platelets, codocytes, schizocytes, spherocytes, dacryocytes.
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Describe aplastic anemia in PB.
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Pancytopenia, normocytic normochromic (occasional macrocytes).
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Describe immune hemolytic anemia in PB.
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Spherocytes, schizocytes, polychromasia, nucleated erythrocytes.
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Describe hemolytic disease of the newborn in PB.
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Increased number of nucleated erythrocytes, macrocytic/normochromic, polychromasia, spherocytes.
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Describe hereditary spherocytosis in PB.
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Spherocytes (variable in number), polychromasia, nucleated erythrocytes possible.
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Describe hereditary elliptocytosis in PB.
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>25% elliptocytes, usually >60% elliptocytes, indices are normochromic.
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Describe microangiopathic hemolytic anemia (MAHA) in PB.
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schizocytes, spherocytes, polychromasia, nucleated erythrocytes, decreased platelet count.
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Describe Hgb CC disease in PB.
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codocytes, spherocytes, microcytes, polychromasia, intracellular or rod-shaped crystals possible.
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Describe Hgb SS disease in PB.
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drepanocytes (sickle cells) (in crises), codocytes, nucleated erythrocytes, schizocytes, Howell-Jolly bodies, basophilic stippling, polychromasia, increased leukocyte count with neutrophilia, increased platelet count.
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Describe Hgb SC disease in PB.
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few sickle cells, codocytes, intraerythrocytic crystals. Crystalline aggregates of hgb SC may protrude from the erythrocyte membrane.
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Describe hyposegmentation of neutrophils.
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bilobed or peanut shaped neutrophil nucleus with coarse chromatin.
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What disease states are associated with hyposegmentation of neutrophils?
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-Pelger-Huet anomaly
-myeloproliferative or myelodysplastic disorders |
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Describe hypersegmentation of neutrophils.
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Six of more lobes in neutrophilic nucleus.
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What disease states are associated with hypersegmentation of neutrophils?
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-megaloblastic anemias
-chronic infections -rarely inherited |
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Describe vacuoles in leukocytes.
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Unstained circular area; usually within cytoplasm; few to many.
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What disease states are associated with vacuoles in leukocytes?
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-bvacterial or fungal infection
-poisoning -burns -chemotherapy -artifact |
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Describe Dohle body in leukocytes.
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gray-blue round or oval body; in cytoplasm often near periphery; composed of ribosomal RNA; single or multiple
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What disease states are associated with Dohle bodies in leukocytes?
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-bacterial infection
-poisoning -burns -chemotherapy -May-Hegglin anomaly -pregnancy |
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Describe toxic granulation in leukocytes.
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prominent blue-black granules; in cytoplasm of neutrophils, unevenly distributed; composed of primary granules; few to many
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What disease states are associated with toxic granulation in leukocytes?
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-bacterial infection
-poisoning -burns -chemotherapy -pregnancy |
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Describe degranulation/agranulation in leukocytes.
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decreased number or absence of specific granules.
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What disease states are associated with degranulation/agranulation in leukocytes?
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-infection
-myelodysplastic syndrome |
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Describe erythrophagocytosis.
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Monocyte or macrophage that has engulfed an erythrocyte.
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What disease states are associated with erythrophagocytosis?
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-familial hemophagocytic histiocytosis
-idiopathic |
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Describe Gaucher disease.
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The Gaucher cell is a macrophage 20-80 microns in diameter, with one or more small, round to oval eccentric nuclei; cytoplasm has crompled tissue paper appearance; found in bone marrow, spleen, liver and other affected tissue.
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Describe Niemann-Pick disease.
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The Niemann-Pick cell is a macrophage, 20-90 microns in diameter, with a small eccentric nucleus and foamy cytoplasm. It is found in bone marrow and lymphoid tissue. The peripheral blood of patients with Niemann-Pick disease may exhibit vacuolated lymphocytes.
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Describe Sea Blue Histocyte.
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The sea blue histocyte is a macrophage 20-60 microns in diameter with an eccentric nucleus. The cytoplasm contains varying numbers of prominent blue-green granules. These cells are found in spleen, liver, and bone marrow.
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What disease states are associated with Sea Blue Histocyte?
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-familial sea blue histocytosis
-myeloproliferative diseases |
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Describe May-Hegglin anomaly.
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This anomaly is characterized by thrombocytopenia with large and/or bizarre platelets and large inclusions resembling Dohle bodies in all leukocytes with the absence of toxic granulation.
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Describe Chediak-Higashi anomaly.
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Large gray-blue granules in the cytoplasm of many monocytes and granulocytes. Lymphocytes may contain large red-pruple granules.
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Describe auer rods.
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Fused primary granules; usually rodes; occasionally round. Red. Located in cytoplasm. Single or multiple.
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What disease states are associated with auer rods?
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-acute leukemia (FAB M1 through M6)
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Describe reactive lymphocytes.
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Pleomorphic; easily indented by surrounding cells. 10-30 microns. Irregular nucleus; occasional nucleoli present. When compared with resting lymphocyte, chromatin pattern is less dense and may be fine and dispersed. Cytoplasm is pale blue to deeply basophilic, may stain unevenly with peripheral or radial basophilia. May have increased number sof azurophilic granules and occasional granule.
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What disease states are associated with reactive lymphocytes?
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-viral infections
-other antigenic stimulation, including organ transplantation |
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Describe acute myeloid leukemia, minimally differentiated in PB.
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-Large agranular blasts
-thrombocytopenia |
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Describe acute myeloid leukemia without differentiation in PB.
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-blasts
-thrombocytopenia -with/without auer rods |
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Describe acute myeloid leukemia with differentiation in PB.
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-Blasts with some maturation
-with/without auer rods -thrombocytopenia |
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Describe acute promyelocytic leukemia in PB.
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-hypergranular promyelocytes
-nuclei often biolobed or kedney-shaped -multiple auer rods possible |
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Describe acute promyelocytic leukemia, microgranular variant in PB.
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-deeply notched nuclei
-granules not visible by light microscopy but may be seen on electron microscopy |
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Describe acute myelomonocytic leukemia in PB.
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-myeloblasts and other immature myeloid cells
-monocytoid cells -thrombocytopenia -with/without auer rods |
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Describe acute myelocmonocytic leukemia with eosiniphilia in PB.
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-myeloblasts and other immature myeloid cells
-monocytoid cells -thrombocytopenia |
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Describe acute monocytic leukemia, poorly differentiated in PB.
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-Blasts
-thrombocytopenia |
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Describe acute monocytic leukemia, well-differentiated in PB.
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-blasts
-monocytoid cells -thrombocytopenia |
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Describe acute erythroleukemia in PB.
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-thrombocytopenia
-dimorphic, dichromic erythroid population -basophilic stippling -nucleated erythrocytes -with/without blasts |
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Describe acute megakaryocytic leukemia in PB.
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-with/without micromegakaryocytes
-pleomorphic blasts -blasts with agranular cytoplasm -platelet count may be normal or elevated |
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Describe acute lymphoid leukemia in PB.
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-with/without blasts
-small blasts with scant blue cytoplasm and round nucleoli -thrombocytopenia |
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Describe acute lymphoid leukemia in PB.
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-blasts (2-3 times the size of a resting lymphocyte)
-moderate cytoplasm -irregular nuclear membrane -prominent nucleoli -thrombocytopenia -morphologicall difficult to distinguish from acute myeloid leukemia |
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Describe chronic myeloid leukemia (CML) in PB.
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-marked leukocytosis
-spectrum of myeloid cells with predominance of myelocytes and PMNs -myeloblasts and promyelocytes (1-5%) -with/without pseudo-Pelger-Huet cells -eosinophilia and/or basophilia -monocytosis -platelets are normal to increased -with/without circulating micromegakaryocytes -LAP markedly decreased |
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Describe polycythemia vera (PV) in PB.
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-absolute erythrocytosis
-moderate leukocytosis -neutrophilia with few metamyelocytes, rare myelocytes -promyelocytes and myeloblasts extremely rare -with/without eosinophilia and/or basophilia -thrombocytosis -LAP normal or increased |
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What is the diagnosis of polycythemia vera made on?
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The diagnosis of polycythemia vera is not made on morphology but on the basis of an elevated erythrocyte mass and normal oxygen saturation.
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Describe essential thrombocythemia (ET).
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-marked thrombocytosis
-abnormal platelet morphology -with/without leukocytosis -neutrophilia with bands/metamyelocytes -LAB normal or increased |
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Describe myelofibrosis with myeloid metaplasia (MMM).
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-mild erythrocytic hyperplasia
-dacryocytes common, NRBCs, polychromasia -normal, increased, decreased leukocytes -immature granulocytes -<5% blasts -with/without basophilia/eosinophilia -leukocyte morphological abnormalities -LAP normal, increased, decreased -platelets low, normal, increased -giant bizarre platelet shapes -abnormal granulation -with/without ciruculating megakaryocytes |
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Evidence of dyserythropoiesis may include any or all of the following:
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-oval macrocytes
-hypochromic microcytes -dimorphic erythrocyte population -erythrocyte precursors with >1 nucleus -abnormal nuclear shapes -nuclear bridging -uneven cytoplasmic staining -ringed sideroblasts |
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Evidence of dysmyelopoiesis may include any or all of the following:
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-abnormal granulation
-abnormal nuclear shapes -persistent basophilic cytoplasm -uneven cytoplasmic staining |
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Evidence of dysmegakaryopoiesis may include any or all of the following:
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-giant platelets
-platelets with abnormal granulation -circulating micromegakaryocytes -large mononuclear megakaryocytes -abnormal nuclear shapes |
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Describe prolymphocytic leukemia (PLL).
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-absolute lymphocytosis
-relatively large cells having one prominent nucleolus -chromatin structure intermediate between that of blast and mature lymphocyte -relatively uniform within a given patient -anemia -thrombocytopenia |
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Describe chronic lymphocytic leukemia (CLL).
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-absolute sustained lymphocytosis
-homogeneous appearance within given patient -mature-appearing lymphocytes w/ round nuclei & block-type chromatin -cytoplasm scant/moderate -lymphocytes more fragile than normal -normocytic/normochromic anemia -hemolytic anemia -thrombocytopenia w/ disease progression |
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Describe hairy cell leukemia (HCL).
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-pancytopenia
-reniform to oval nuclei w/ diffuse homogeneous chromatin -may have single nucleolus -cytoplasm irregular and gray-blue w/ delicate hair-like projections |
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Describe Waldenstrom macroglobulinemia.
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-leukocyte count usually normal
-rare plasmacytoid cell or plasma cell -normcytic/normochromic anemia w/ rouleaux -normal to decreased platelet numbers -excess protein may cause blue precipitate |
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How can Waldenstrom macroglobinemia be distinguished from multiple myeloma and heavy chain disease?
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immunoelectrophoresis
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Describe multiple myeloma.
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-possible neutropenia
-rare abnormal circulating plasma cell -normocytic/normochromic anemia -rouleaux -platelet count normal to decreased |
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Describe non-Hodgkin lymphomas.
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-occasional lymphoma cell found in PB
-diagnosis determined by lymph node biopsy, immunophenotyping and cytogenetics |
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Describe T-cell leukemia/lymphoma.
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-leukocytosis
-cell size & nucleus shape vary -multilobed nucleus may resemble cloverleaf -chromatin moderately condensed -nucleoli inconspicuous |
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What are Sezary cells and what do they represent?
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Sezary cells in the peripheral blood are morphologically altered T cells and represent the cutaneous T-cell lymphoma mycosis fungoides, which involves the skin.
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Describe Burkitt leukemia/lymphoma.
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-medium to large size cells with dark blue cytoplasm
-vacuoles in cytoplasm -3-5 nucleoli -thrombocytopenia |
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What is the purpose of myeloperoxidase stain?
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Stains granules containing peroxidase, i.e., primary granules in neutrophils and granules in eosinophils and monocytes.
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What is the purpose of Sudan Black B stain?
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Stains lipids, including neutroal fat, phospholipids, and sterols. Parallels myeloperoxidase reaction.
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What is the purpose of alpha-Naphthyl butyrate esterase (NBE)?
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Esterase hydrolyzes an ester. Diffusely positive in monocytes and negative or focally positive in the neutrophil series.
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What is the purpose of periodic acid-Schiff (PAS)?
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Stains carbohydrates, primarily glycogen. Block positivity is associated with acute lymphoblastic leukemia and early precursors of FAB M6 leukemia. Later precursors show diffuse positivity.
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