good review im
DESCRIPTION
good and simple review in imTRANSCRIPT
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
Objectives
Automated cell counting
Peripheral blood morphology
Coulter Principle
Red Cell Parameters
Red Cell Histogram and Count
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
Red Cell Distribution Width - RDW
Comparison of RDW in Iron Deficiency and Anemia of Chronic Disease
CBC Report
QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.
Automated Cell Counting: Deficiencies Abnormalities and inclusions in WBC
RBC shape abnormalities
RBC inclusions
Platelet abnormalities and clumping
Peripheral Blood Morphology
Normal Peripheral Smear
Normal Peripheral Smear
“More information can be gained fromexamining the blood smear than
from any single hematologic procedure”
Reticulocyte: Polychromasia
Reticulocyte Manual Count by Supravital Stain: Normal Count
Reticulocytes: Elevated Count
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
Basophilic Stippling
Howell-Jolly Body
Malaria
RBC Inclusions: Composite
Erythrocyte Distribution Abnormalities Rouleaux formation Stacking of RBCs due to
increased plasma proteins coating RBCs
Agglutination Antibody-mediated clumping; temperature dependent
Rouleaux Formation
Agglutination Reaction
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
Hypochromic Microcytic RBC
Normal Hypochromic microcytic
Hypochromia without Anisocytosis: Thalassemia Trait
Severe Hypochromia: Iron Deficiency Anemia
Mixed Population: Treated Iron Deficiency Anemia
Microcytic Hypochromia: Alpha Thalassemia (-/--)
Microcytic Hypochromia: Beta Thalassemia Major
Microcytic Hypochromia: Beta Thalassemia Major
Macrocytic Anemia: Macro-Ovalocytes
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
Target Cells Diagnostic possibilities
• Liver disease• Hemoglobinopathy• Thalassemia• Iron deficiency• Post-splenectomy• Lipid disorders
Echinocytes (Burr Cells)
Acanthocytes (Spur Cells)
Target Cells Spur Cells
Morphologic Changes in Liver Disease
Hepatorenal Syndrome: Burr + Spur Cells
Spherocytes
Spherocytes: Autoimmune Hemolytic Anemia
Spherocytes: Hereditary Spherocytosis
Schistocytes: Microangiopathic Hemolytic Anemia
Elliptocytes: Hereditary Elliptocytosis
Sickle Cell Anemia: Hgb SS
Hemoglobin SC Disease
Hemoglobin S-Beta Thalassemia
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Homozygous Hemoglobin C Disease (Hgb CC)
Teardrop Cells
Bite Cells
Heinz Bodies
Morphology of Leukocytes Normal WBC populations
• Neutrophils (Granulocytes)• Lymphocytes• Monocytes• Eosinophils• Basophils
Neutrophil
Eosinophil
Neutrophil Eosinophil
Monocytes
Monocytes
Small Lymphocyte
Small
Intermediate
Large
Lymphocytes
Basophils
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
Dohle Bodies
Toxic Granulation
Toxic Granulation and Vacuole Formation
Hypersegmented Neutrophils
Auer Rod: Acute Myeloid Leukemia
Ehrlichia
Myeloid Leukemias and Leukemoid Reaction Bone marrow exam is almost always indicated
• Cytogenetic analysis• Flow cytometry analysis
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Neutrophilia: Leukemoid Reaction
Neutrophilia: CML
Pelger-Huet Abnormality
Acute Myeloid Leukemia: M1Myeloblasts without Differentiation
Acute Myeloid Leukemia: M2Myeloblasts with Some Differentiation
Acute Myeloid Leukemia: M3 Promyelocytic Leukemia
Acute Myeloid Leukemia: M4 Myelomonocytic Leukemia
Acute Myeloid Leukemia: M5 Monocytic Leukemia
Acute Myeloid Leukemia: M6Erythroleukemia
Acute Myeloid Leukemia: M7Megakaryocytic Leukemia
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
Atypical (Reactive) Lymphocytes
Atypical (Reactive) Lymphocytes
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Abnormal Lymphocytes
Plasmacytoid Lymphocytes
Plasma Cell: Plasma Cell Leukemia
Hairy Cell: Hairy Cell Leukemia
Sezary Cell
QuickTime™ and aPhoto - JPEG decompressor
are needed to see this picture.
Prolymphocytes
Chronic Lymphocytic Leukemia (CLL)
CLL: Smudge Cells
CLL: Balloon Cells
Acute Lymphocytic Leukemia: L1
Acute Lymphocytic Leukemia: L2
Acute Lymphocytic Leukemia: L3 (Burkitts)