1304- cell morphology

What conditions get rouleaux?

Hyperproteinemias

Multiple myeloma

Waldenstrom's Macroglobulinemia

Chronic inflammatory disorders

SOME lymphomas

In basic terms, describe a RBC:

Discocyte: lacks nucleus and organelles

Biconcave disc

120 day survival

7-8um diameter

Avg volume 90 fL

Transports O2/CO2

Pliable membrane made of lipids and proteins allows it to sustain constant surface to volume ratio

name a few conditions that can cause macrocytosis

Non-megaloblastic anemias

Hypothyroidism

BM disorders

Neonatal blood

Postsplenectomy

What is the most common cause of anemia?

iron deficiency

How much of the world is anemic

30%

In what age group is iron deficiency especially common?

Especially common in women of childbearing age

In what conditions are target cells (codocytes) seen?

Liver disease

Hemoglobinopathies

Thalassemia

Anemia

target cells are aka?

codocytes

In what conditions are stomacytes found in

Hereditary spherocytosis

Stomatocytosis

Hemolytic anemia

Alcoholic cirrhosis

Acute alcoholism

Rh null disease

In what conditions are red cell inclusions seen?

After splenectomy

Thalassemia syndromes

Sickle cell anemia

Megaloblastic and some other hemolytic anemias

Absence of spleen, splenic atrophy after multiple infarctions

Basophilic stippling is seen in what conditions

Alcoholism

Thalassemia syndromes

Megaloblastic anemias

Arsenic intoxication

Lead poisoning

Siderocytes are seen in conditions of iron overloading, such as?

Hemochromatosis

Hemoglobinopathies

Sickle cell anemia

Thalassemia

Teardrop cells are aka?

dacrocytes

What conditions are teardrop cells seen in?

Myelofibrosis

Thalassemia

Iron deficiency

Wherever inclusions are formed

Megaloblastic processes

Cabot rings are seen in what conditions?

Megaloblastic anemia

Dyserythropoiesis

Homozygous thalassemia

Post splenectomy

Leukocytosis without a shift to the left could be caused by what?

Exercise

Intense emotional stress

Anesthesia

Administration of epinephrine or glucocorticosteroids

Toxic changes + leukocytes + shift to the left means?

common changes in severe bacterial infections

What conditions is toxic granualtion seen in?

Severe bacterial infections

Toxemia of pregnancy

Vasculitis

Chemo

Dohle bodies are seen in what conditions?

Severe infections

Severe burns

Pregnant women

Chemo

May-hegglin anomaly

Chediak-higashi disorder

Heinz bodies are seen in what conditions?

Alpha thalassemia syndromes

Unstable HgB syndromes

RBC injury from chemicals

Glucose-6-phosphate dehydrogenase deficiency under oxidant stress

What could cause burr cells?

Uremia

Heart disease

Cancer of stomach

Bleeding peptic ulcer

Following injection of heparin

Untreated hypothyroidism

dehydration/azotemia

Echinocytes are aka?

Burr cells

In what conditions are schistocytes seen?

Microangiopathic hemolytic anemia

DIC

Heart valve surgery

Hemolytic uremic syndrome (HUS)

Thrombotic thrombocytopenic purpura

Severe burns

March hemoblobinuria

In what conditions do we often see anocytosis?

in leukemias/anemias

Result of abnormal development (iron, vit b12, folic acid)

What is anisocytosis

any significant variation in size (in RBCs)

Macrocyte is what size

> 9um

Microcyte is what size

< 6um

Name a few possible pathologies for macrocytes

megaloblastic process

high reticulocyte count

Liver disease

post-splenectomy

chemo

hypothyroidism

Name a few possible pathologies for microcytes

Iron deficiency

Thalassemic conditions

Sideroblastic anemias

Anemia of chronic diseases

Lead poisoning

Name a few possible pathologies for helmet cells

Pulmonary emboli

G6PD deficiency

Name a few possible pathologies for schistocytes

Prosthetic heart valve

Microangipathic HA

Clostridial infection

Name a few possible pathologies for burr cells

Renal disease

liver disease

burns

What does toxic granulation look like?

Medium to large granules evenly scattered in neuts

What does toxic vacuolization look like?

Round clear unstained areas dispersed in PTs w/ overwhelming infections

What condition could neut hypersegmentation be caused by?

Megloblastic processes

What conditions could neut hyposegmentation be caused by?

Pelger-huet anomaly

Result of leukemic process

Neut hyposegmentation = how many lobes

2 lobes or less

Neut hypersegmentation = how many lobes

6+ lobes

What do dohle bodies look like?

Oval, blue

Inclusions originating in RNA

Name a few cellular variations in shape

Dogle bodies

protozoan inclusions

HgB SC crystals

Hemolytic QC crystals

Cabot rings

Heinz bodies

Pappenheimer bodies

Basophilic stippling

RBC inclusion

Teardrop cells

Acanthocytes

Echinocytes

Fragmented cells

Sickle cell

Elliptocytes

Ovalocytes

Stomacytes

Spherocytes

Target cells

Poikilocytosis

Target cells are aka

codocytes

Sickle cells are aka

drepanocytes

Name 2 kinds of fragmented cells

Helmet/bite cells

Schistocytes

Echinocytes are aka

burr cells

Acanthocytes are aka

thorn cells, spur cells

Teardrop cells are aka

dacrocytes

Name a few kinds of protozoan inclusions

Plasmodium vivax

Plasmodium malaria

Plasmodium falciparum

Plasmodium ovale

Plasmodium knowlesi

Babesia microti

What is Plasmodium knowlesi transmitted by?

Anopheles mosquito

What is Babesia microti transmitted by?

Tick bites

What can Plasmodium knowlesi be confused with?

a platelet sitting on the RBC

What can Babesia microti resemble?

malaria

Name a couple different forms Plasmodium knowlesi can appear in:

ring

toph

Can Babesia microti appear outside the RBC? Or can it only appear inside the RBC?

Can appear outside the erythrocyte

Can you use romanowsky stains to visualize heinz bodies?

NOOO

What are heinz bodies caused by?

denatured or precipitated HgB

What structures may cabot rings represent?

Mitotic spindle

Remnants of microtubules

Fragments of nuclear membrane

What do regular platelets look like on a slide?

2-4um

Discoid shape

Blue granules dispersed throughout light blue cytoplasm

Acanthocytes are often a result of what 4 conditions?

Liver disease

Autoimmune hemolytic anemia

Myeloproliferative disorders

Abetalipoproteinemia (rare)

What do elliptocytes look like?

Pencil, rod-shaped, cigar-shaped

What do we evaluate when looking at macrocytes?

shape (oval vs round)

Colour (red vs blue)

Pallor if present, and inclusions

Can teardrop cells revert to discocyte shape?

NO

What do teardrop cells look like?

Cells w/ inclusions causes pinch

What percentage of cells differing from normal RBC size is considered "normal"?

5%

What percentage of cells differing from normal RBC size is considered "slight"?

5-10%

What percentage of cells differing from normal RBC size is considered "1+, 2+, 3" and 4+"?

1+= 10-25%

2+= 35-50%

3+= 50-75%

4+= >75%

When viewing cells, how do you know what a good part of the slide looks like?

RBCs are barely touching, no overlap

(we dont take this into consideration when looking for platelet clumping though)

Why dotn we view cells in the thicker portion of the slide?

Thicker portion of the slide tends to have cells overlapping, distorted in size, shape, and colour

The thin area of a slide should represent HOW MUCH of the entire film?

1/3

Do we use heat or saline do disperse agglutination in a blood sample?

Warming sample to 37C should work

Saline doesnt work

What size and volume cells are considered normocytic?

7-8um

80-100fL for adults

In what conditions are spherocytes seen?

autoimmune hemolytic anemia

burns

How can you tell if a stomatocyte is genuine and not artifactual?

In a genuine stomatocyte, the slit is shaded vs indistinct

What do sickle cells look like?

crescent/sickle-shaped with pointed projections at one or both ends

Rigid, inflexible cells

What do reversible vs irreversible sickle cells look like?

The irreversible sickle cells are skinny while the reversible ones are fat

What is agglutination

Aggregation of RBCs into random clusters or masses

Occurs at RT during sample prep

Result of Ag/Ab rxn w/in the body, can even be autoagglutination

Name 2 conditions which could cause agglutination

Cold hemagglutinin disease

Paroxysmal cold hemoglobinuria (PCH)

What does rouleaux look like

RBCs appear as stacks of coins on smear (length doesnt matter)

What do the RBC indices look like when there are agglutination issues?

MCHC and MCV usually falsely elevated

Is ESR elevated or decreased with rouleaux?

Elevated

How to disperse rouleaux

Using saline dltn of serum disperses rouleaux

What part of a slide do you look at to confirm rouleaux?

Must verify in thin area

Too thick of an area might make it look like rouleaux, could also be artifactual

Severe rouleaux can make RBC size/shape interpretation impossible though

How does rouleaux work? What makes RBCs do that??

RBCs are "sticky" due to elevated globulins or fibrinogen

Zeta potential is lowered, and they stack

Anisocytosis severity should corespond with what RBC indice?

RDW

How is anisocytosis reported

Micro/Macrocytosis should correlate w/ RBC indices

Can report as dimorphic population

Anisocytosis 1+, 2+, 3+, 4+, etc

Normocytes are indicated by what RBC indice

MCV

In the case of normocytes, what would a normal MCV with high RDW mean?

Mixture of small and large cells

May be result of blood transfusion or recovery from anemia

Consult PT history

Macrocytes have an MCV of? Or a diameter of?

MCV > 100fL

9um+

Anemias with MCV > 100fL are called?

Macrocytic

Hereditary elliptocytosis are what % elliptical in appearance?

25-90%

Ovalocytes shape

egg-shaped

Poikilocytosis describes what?

Describes variations in RBC shape, such as: tear drops, pencils, sickles

When do we use the term "poikilocytosis?"

Used w/ more descriptive terminology

Refers to entire RBC morphology

Many labs don't use the term

If a megalobalstic anemia had oval macrocytes, what would they look like?

>9um in diameter and lack central pallor

What happens when sickle cells cant revert to discocyte shape upon oxygenation?

Sickling event (ouch)

Echinocytes may be artifact (crenated), but what do true burr cells look like?

occur in small numbers

Irregularly sized and unevenly spaced spicules

Name 3 infections which could cause a shift to the left

Acute (leukocytosis)

Fungal (leukocytosis)

Viral (leukocytosis)

What would a viral infection causing a shift to the left look like?

No neutrophilia

Lymphocytosis

What would a fungal infection causing a shift to the left look like?

Neutrophilia but more commonly monocytosis

Leukocytosis

What would an acute infection causing a shift to the left look like?

Neutrophilia

WBC <50, left shift but not usually myelocytes

What 2 conditions are leukemoid rxns seen in?

Acute infections

Chronic infections