Download - good review im
![Page 1: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/1.jpg)
CBC andPeripheral Blood Smears
Morey A. Blinder, M.D.Associate Professor of Medicine and Laboratory Medicine
Department of Internal MedicineDivisions of Hematology and Laboratory Medicine
![Page 2: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/2.jpg)
Objectives
Automated cell counting
Peripheral blood morphology
![Page 3: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/3.jpg)
Coulter Principle
![Page 4: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/4.jpg)
Red Cell Parameters
![Page 5: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/5.jpg)
![Page 6: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/6.jpg)
Red Cell Histogram and Count
![Page 7: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/7.jpg)
Calculation of the RDW
RDW = Coefficient of variation of
red cell volume distribution
Normal range = 11.5% - 14.5%
RDW = X 100 S.D. Mean
![Page 8: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/8.jpg)
Red Cell Distribution Width - RDW
![Page 9: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/9.jpg)
Comparison of RDW in Iron Deficiency and Anemia of Chronic Disease
![Page 10: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/10.jpg)
![Page 11: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/11.jpg)
![Page 12: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/12.jpg)
![Page 13: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/13.jpg)
![Page 14: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/14.jpg)
![Page 15: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/15.jpg)
![Page 16: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/16.jpg)
CBC Report
QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.
![Page 17: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/17.jpg)
![Page 18: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/18.jpg)
Automated Cell Counting: Deficiencies Abnormalities and inclusions in WBC
RBC shape abnormalities
RBC inclusions
Platelet abnormalities and clumping
![Page 19: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/19.jpg)
Peripheral Blood Morphology
![Page 20: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/20.jpg)
Normal Peripheral Smear
![Page 21: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/21.jpg)
Normal Peripheral Smear
“More information can be gained fromexamining the blood smear than
from any single hematologic procedure”
![Page 22: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/22.jpg)
Reticulocyte: Polychromasia
![Page 23: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/23.jpg)
Reticulocyte Manual Count by Supravital Stain: Normal Count
![Page 24: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/24.jpg)
Reticulocytes: Elevated Count
![Page 25: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/25.jpg)
Erythrocyte Inclusions with Wright’s Stain
Inclusion Composition Appearance Condition
Basophilic Precipitated Evenly dispersed Lead poisoningstippling ribosomes fine or coarse granules thalassemia
other anemias
Howell-Jolly Nuclear Dense, round Post-splenectomybodies fragment blue granule
Pappenheimer Iron-containing Small blue granules Anemiasbodies granules in clusters
Organism Small blue inclusion MalariaBabesiosis
![Page 26: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/26.jpg)
Basophilic Stippling
![Page 27: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/27.jpg)
Howell-Jolly Body
![Page 28: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/28.jpg)
Malaria
![Page 29: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/29.jpg)
RBC Inclusions: Composite
![Page 30: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/30.jpg)
Erythrocyte Distribution Abnormalities Rouleaux formation Stacking of RBCs due to
increased plasma proteins coating RBCs
Agglutination Antibody-mediated clumping; temperature dependent
![Page 31: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/31.jpg)
Rouleaux Formation
![Page 32: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/32.jpg)
Agglutination Reaction
![Page 33: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/33.jpg)
Variations in RBC Size and Shape Anisocytosis Variations in size (e.g.
microcytes)
Poikilocytosis Variations in shape (e.g. target cells)
Hypochromia Increased central pallor due to decrease in hemoglobin
![Page 34: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/34.jpg)
Hypochromic Microcytic RBC
![Page 35: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/35.jpg)
Normal Hypochromic microcytic
![Page 36: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/36.jpg)
Hypochromia without Anisocytosis: Thalassemia Trait
![Page 37: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/37.jpg)
Severe Hypochromia: Iron Deficiency Anemia
![Page 38: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/38.jpg)
Mixed Population: Treated Iron Deficiency Anemia
![Page 39: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/39.jpg)
Microcytic Hypochromia: Alpha Thalassemia (-/--)
![Page 40: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/40.jpg)
Microcytic Hypochromia: Beta Thalassemia Major
![Page 41: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/41.jpg)
Microcytic Hypochromia: Beta Thalassemia Major
![Page 42: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/42.jpg)
Macrocytic Anemia: Macro-Ovalocytes
![Page 43: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/43.jpg)
Shape Abnormalities of ErythrocytesTerminology Description Condition
Target cells Central hemoglobin; target-shaped Liver disease; thalassemia: Abnormal Hgb; iron deficiency
Echinocyte Short spicules, equally-spaced Uremia, hypokalemia, artifactAcanthocyte Spiculated, irregular Liver disease (alcohol),
Post-splenectomySpherocyte Spherical, no central pallor HS, Immune hemolytic anemia
Schistocyte Fragmented RBC, helmet cells MAHA, burnsOvalocyte Oval/elliptical shaped Hereditary elliptocytosis,
Megaloblastic anemiaSickle cell bipolar spiculated shape Hgb S-containing
“banana” shaped hemoglobinopathyTeardrop cell single elongated extremity Myelophthistic changesBite cells Irregular gap in membrane G6PD deficiency
![Page 44: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/44.jpg)
Target Cells Diagnostic possibilities
• Liver disease• Hemoglobinopathy• Thalassemia• Iron deficiency• Post-splenectomy• Lipid disorders
![Page 45: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/45.jpg)
Echinocytes (Burr Cells)
![Page 46: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/46.jpg)
Acanthocytes (Spur Cells)
![Page 47: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/47.jpg)
Target Cells Spur Cells
Morphologic Changes in Liver Disease
![Page 48: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/48.jpg)
Hepatorenal Syndrome: Burr + Spur Cells
![Page 49: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/49.jpg)
Spherocytes
![Page 50: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/50.jpg)
Spherocytes: Autoimmune Hemolytic Anemia
![Page 51: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/51.jpg)
Spherocytes: Hereditary Spherocytosis
![Page 52: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/52.jpg)
Schistocytes: Microangiopathic Hemolytic Anemia
![Page 53: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/53.jpg)
Elliptocytes: Hereditary Elliptocytosis
![Page 54: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/54.jpg)
Sickle Cell Anemia: Hgb SS
![Page 55: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/55.jpg)
Hemoglobin SC Disease
![Page 56: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/56.jpg)
Hemoglobin S-Beta Thalassemia
![Page 57: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/57.jpg)
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Homozygous Hemoglobin C Disease (Hgb CC)
![Page 58: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/58.jpg)
Teardrop Cells
![Page 59: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/59.jpg)
Bite Cells
![Page 60: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/60.jpg)
Heinz Bodies
![Page 61: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/61.jpg)
Morphology of Leukocytes Normal WBC populations
• Neutrophils (Granulocytes)• Lymphocytes• Monocytes• Eosinophils• Basophils
![Page 62: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/62.jpg)
Neutrophil
![Page 63: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/63.jpg)
Eosinophil
![Page 64: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/64.jpg)
Neutrophil Eosinophil
![Page 65: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/65.jpg)
Monocytes
![Page 66: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/66.jpg)
Monocytes
![Page 67: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/67.jpg)
Small Lymphocyte
![Page 68: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/68.jpg)
Small
Intermediate
Large
Lymphocytes
![Page 69: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/69.jpg)
Basophils
![Page 70: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/70.jpg)
Granulocyte Inclusions or VariantsTerminology Description Condition
Dohle bodies Pale blue areas in Infections, pregnancy, cancer neutrophil cytoplasm
Toxic Large purple granules InfectionGranulation in neutrophil cytoplasm
Vacuoles Transparent areas Infection, Toxin in neutrophil cytoplasm
Hypersegmented ≥ 6 nuclear lobes Megaloblastic anemia
Auer rods Reddish long needle-like Acute myeloid leukemia inclusions
Ehrlichia Blue inclusions in Ehrlichia sp. monocytes/neutrophils
![Page 71: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/71.jpg)
Dohle Bodies
![Page 72: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/72.jpg)
Toxic Granulation
![Page 73: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/73.jpg)
Toxic Granulation and Vacuole Formation
![Page 74: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/74.jpg)
Hypersegmented Neutrophils
![Page 75: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/75.jpg)
Auer Rod: Acute Myeloid Leukemia
![Page 76: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/76.jpg)
Ehrlichia
![Page 77: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/77.jpg)
Myeloid Leukemias and Leukemoid Reaction Bone marrow exam is almost always indicated
• Cytogenetic analysis• Flow cytometry analysis
![Page 78: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/78.jpg)
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Neutrophilia: Leukemoid Reaction
![Page 79: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/79.jpg)
Neutrophilia: CML
![Page 80: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/80.jpg)
Pelger-Huet Abnormality
![Page 81: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/81.jpg)
Acute Myeloid Leukemia: M1Myeloblasts without Differentiation
![Page 82: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/82.jpg)
Acute Myeloid Leukemia: M2Myeloblasts with Some Differentiation
![Page 83: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/83.jpg)
Acute Myeloid Leukemia: M3 Promyelocytic Leukemia
![Page 84: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/84.jpg)
Acute Myeloid Leukemia: M4 Myelomonocytic Leukemia
![Page 85: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/85.jpg)
Acute Myeloid Leukemia: M5 Monocytic Leukemia
![Page 86: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/86.jpg)
Acute Myeloid Leukemia: M6Erythroleukemia
![Page 87: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/87.jpg)
Acute Myeloid Leukemia: M7Megakaryocytic Leukemia
![Page 88: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/88.jpg)
Abnormalities of LymphocytesVariant Morphologic categories
Atypical lymphs Abundant cytoplasm, RBC “skirting”
Abnormal lymphs Nuclear abnormalities i.e. clefts, folds, notches
Plasmacytoid lymphs Abundant cytoplasm
Hairy cells Cytoplasmic projections
Sezary cells Deeply folded nucleus
Prolymphocyte Large lymph with prominent nucleolus
![Page 89: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/89.jpg)
Atypical (Reactive) Lymphocytes
![Page 90: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/90.jpg)
Atypical (Reactive) Lymphocytes
![Page 91: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/91.jpg)
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Abnormal Lymphocytes
![Page 92: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/92.jpg)
Plasmacytoid Lymphocytes
![Page 93: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/93.jpg)
Plasma Cell: Plasma Cell Leukemia
![Page 94: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/94.jpg)
Hairy Cell: Hairy Cell Leukemia
![Page 95: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/95.jpg)
Sezary Cell
![Page 96: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/96.jpg)
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Prolymphocytes
![Page 97: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/97.jpg)
Chronic Lymphocytic Leukemia (CLL)
![Page 98: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/98.jpg)
CLL: Smudge Cells
![Page 99: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/99.jpg)
CLL: Balloon Cells
![Page 100: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/100.jpg)
Acute Lymphocytic Leukemia: L1
![Page 101: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/101.jpg)
Acute Lymphocytic Leukemia: L2
![Page 102: good review im](https://reader035.vdocuments.mx/reader035/viewer/2022070508/577c77e71a28abe0548df683/html5/thumbnails/102.jpg)
Acute Lymphocytic Leukemia: L3 (Burkitts)