2 - Abnormal CBC and Applications

How to determine normochromic and normocytic RBC?

• Normochromic: Central pallor not more or less than 1/3 of RBC(Literally the whitest white part, since the gradient can cover up to like, ½ or 2/3 ngl)

• Normocytic: RBC the same size as the nucleus of a small lymphocyte

Define hyper and hypochromic

• Hyperchromic: Central pallor <1/3 of RBC

• Hypochromic: Central pallor >1/3 of RBC

Name this type of RBC

Macro-ovalocyte(Hyperchromic macrocytic)

What is the correct name for a hyperchromic macrocytic RBC, and why?

• Macro-ovalocyte, since normally they’ll be oval shape

Name this RBC

Hypochromic microcytic

Name this type of RBC

Schistocyte/Fragmented RBC

Name this RBC

Spherocyte

Name this RBC

Codocyte/Target Cell

Name this RBC

Dacrocyte/Teardrop cell

What is an acanthocyte, what’s the other name, and what are the characteristics?

Spur cell, a RBC with sharp, irregular spikes

What is an echinocyte, what are the other 2 names, and what are the characteristics?

Burr cell or cremated cell, an RBC with blunt, regular spikes

Compare an ovalocyte and elliptocyte

Elliptocytes are longer

Name these 3 RBCs

A - Ghost cell(No Hb content)

B - Eccentrocyte(Hb contracted/pushed)

C - RBC with Hb leakage

What is this RBC, and what are the 2 main characteristics

Polychromasia → ใหญ่ + ม่วง

Name these 2 inclusion types

1. Basophilic stippling

2. Howell Jolly body

Name these 2 types of abnormal RBC distribution

1. Auto-agglutination

2. Roleux formation

Define anisocytosis and poikilocytosis

• RBCs of varying size and shape

What system does Siriraj use to grade severity of abnormalities?

• 4 lvl system + inclusion found

  • So for example, if 10-25% cells are polychromatic, it’s +, if 26-50%, then ++, 51-75% +++, and 76%-100 ++++

• Exception: NRCs, reported using NRC per 100 WBC

In signficant pathological RBCs and polychromasia, degree of severity is…

• Upped by one, so if we calculate 1+, we up it to 2+

What comes first in naming a blood smear for RBCs?

1. -chromatic + -cytic

2. anisocytosis, poikilocytosis

3. everything else

Name this cell and the main points for identification

• Myeloblast: Nucleolus, large size and N:C ratio

Name this cell and the main points for identification

• Promyelocyte: Similar to myeloblasts but smaller and slightly less N:C ratio, appearance of non-specific granules

Name this cell and the main points for identification

• Myelocyte: Smaller than promyelocytes now, less N:C ratio, appearance of specific granules(neu, baso, eosino)

Name this cell and the main points for identification

• Metamyelocyte: Kidney bean nucleus

Name this cell and the main points for identification

• Band/stab form: Horseshoe

Name this cell and the main points for identification

• Atypical/Transformed/Reactive lymphocyte: Large size, deep blue cytoplasm, clumped chromatin

Name this abnormality, and how can we tell?

Giant platelet, it’s bigger or equal to in size than an RBC

Name this abnormality, and how can we tell?

Pale staining or agranular platelet, just look at it

Name this abnormality, and how can we tell?

Platelet clumping, they’re all tgt

Low vs high Hb and Hct indicates…

• Low: Anemia

• High: Polycythemia/erythrocytosis

What is red cell distribution width?

• Determines how variable the size of the RBCs are, high = anisocytosis

Why can MCV value on paper not tell us RBC size in smear?

• Because a smear with RBCs all medium size will give a normal MCV BUT a smear with high and low RBC sizes would also give a normal MCV because it averages out

How can NRCs affect WBC count if we use an outdated machine?

• When we count for WBCs, we remove the RBCs(No nucleus), but an outdated system won’t remove the NRCs due to them having nuclei, and they’ll think they are WBCs, so the final WBC count will be higher than truth

2 Blood Smear Review types, and what is recommended?

1. Extensive BS review

2. BS overview

• Overview is recommended but combine it with a CBC