HEMA P3 PRACTICALS

A. Spherocytes

B.

• Hereditary Spherocytosis

• Immune Hemolytic Anemia

• Extensive Burns

A. Identify the cell
B. Identify the disease / condition

A. Burr Cell

B.

• Uremia

• Pyruvate Kinase Deficiency

A. Identify the cell
B. Identify the disease / condition

A. Elliptocytes / Ovalocytes

B.

• Hereditary Elliptocytosis / Ovalocytosis

• Iron deficiency anemia

• Thalassemia Major

• Myelophthisic anemias

A. Identify the cell
B. Identify the disease / condition

A. Stomatocytes

B.

• Hereditary Stomatocytosis

• Rh Deficiency Syndrome

• Acquired Stomatocytosis (liver disease, alcoholism)

• Artifacts

A. Identify the cell
B. Identify the disease / condition

A. Sickle Cells

B.

• Sickle Cell Anemia

• Sickle cell-b-thalassemia

A. Identify the cell
B. Identify the disease / condition

A. Hb C Crystals

B. Hb C disease

A. Identify the cell
B. Identify the disease / condition

A. Hb SC crystals

B. Hb SC disease

A. Identify the cell
B. Identify the disease / condition

A. Target Cells (Codocytes)

B.

• Liver disease

• Hemoglobinopathies

• Thalassemia

A. Identify the cell
B. Identify the disease / condition

A. Schistocytes (Schizocytes)

B.

• Microangiopathic hemolytic anemia

• Macroangiopathic hemolytic anemia

• Extensive burns

A. Identify the cell
B. Identify the disease / condition

A. Helmet cells (Keratocytes)

B. Same as schistocyte

• Microangiopathic hemolytic anemia

• Macroangiopathic hemolytic anemia

• Extensive burns

A. Identify the cell
B. Identify the disease / condition

A, Acanthocytes (Spur cells)

B.

• Severe liver disease (Spur cell anemia)

• Neuroacanthocytosis (Abetalipoproteinemia, McLeod syndrome)

A. Identify the cell
B. Identify the disease / condition

A. Teardrop Cells (Dacryocytes)

B.

• Primary Myelofibrosis

• Myelophthisic Anemia

• Thalassemia

• Megaloblastic Anemia

A. Identify the cell
B. Identify the disease / condition

A. Diffuse basophilia

B.

• Hemolytic Anemia

• After treatment for iron, vitamin B12, or folate deficiency

C. RNA

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Basophilic stipplings

B.

• Lead Poisoning

• Thalassemias

• Hemoglobinopathies

• Megaloblastic anemia

• Myelodysplastic syndromes

C. Precipitated RNA

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Howell-Jolly Bodies

B.

• Hyposplenism

• Postsplenectomy

• Megaloblastic anemia

• Hemolytic anemia

• Thalassemia

• Myelodysplastic syndromes

C. DNA (Nuclear fragments)

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Heinz Bodies

B.

• Glucose-6-phosphate dehydrogenase deficiency

• Unstable hemoglobins

• Oxidant drugs / chemicals

C. Denatured hemoglobin

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Pappenheimer bodies

B.

• Sideroblastic anemia

• Hemoglobinopathies

• Thalassemias

• Megaloblastic anemia

• Myelodysplastic syndromes

• Hyposplenism

• Postsplenectomy

C. Iron

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Cabot rings

B.

• Megaloblastic anemia

• Myelodysplastic syndromes

C. Remnant of mitotic spindle

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Hb H

B. Hb H disease

C. Precipitated β-globin chains of hemoglobin

A. Identify the cell
B. Identify the disease / condition
C. Composition of Inclusion

A. Ringed Sideroblasts

B. Sideroblastic anemia

A. Identify the cell
B. Identify the disease / condition

A. Hypersegmented neutrophils and oval macrocytes

B. Megaloblastic anemia

A. Identify the cell
B. Identify the disease / condition

A. Aplastic anemia

B.

• Idiopathic acquired aplastic anemia

• Secondary acquired aplastic anemia

A. Identify the disease / Condition

B. What are the two major categories of this condition?

A. Pure Red Cell Aplasia

A. Identify the disease / condition

A. Myelophthisic anemia (presence of tear drop cells)

A. Identify the disease / condition

A. Congenital Dyserythropoetic Anemia

A. Identify the disease / condition

A. Hereditary spherocytosis

B. Ankyrin and Spectrin

A. Identify the disease / Condition

B. The most common mutated proteins are those that code for ______ and ______

A. Hereditary Elliptocytosis

B.

• SPTA1

• SPTB

• EPB41

A. Identify the disease / Condition

B. What are the defective genes? (3)

A. Hereditary Pyropoikilocytosis

B. TRUE

A. Identify the disease / Condition

B. TRUE OR FALSE.
This is now considered as a severe form of HE

A. Overhydrated Hereditary Stomatocytosis
and Dehydrated Hereditary Stomatocytosis

B. RHAG Gene (Overhydrated); 16q23-24 (dehydrated)

A. Identify the disease / Condition

B. This has been linked with mutations in the __________

A. Spur Cell Anemia

A. Identify the disease / condition

A. Glucose-6-Phosphate Dehydrogenase Deficiency

A. Identify the disease / condition

A. Pyruvate Kinase Deficiency

A. Identify the disease / condition

A. Thrombocytopenic Purpura (presence of schistocytes)

A. Identify the disease / condition

A.

• Idiopathic TTP

• Secondary TTP

• Inherited TTP (aka Upshaw-Schulman syndrome)

B. Von willebrand factor cleaving protease known as ADAMTS-13

A. What are three 3 classifications?

B. This is a deficiency in?

A. Traumatic Cardiac Hemolytic Anemia

A. Identify the disease / condition

A. Malaria

A. Identify the disease / condition

A. BABESIOSIS

A. Identify the disease / condition

A. Hyposegmented Neutrophils

B. Pelger-Huet Anomaly

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Hypersegmented Neutrophils

B. Megaloblastic Anemia

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Auer Rods

B. Acute Myelogenous Leukemia

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Dohle Bodies

B.

• Food poisoining

• Infections

• Following chemotherapy

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Atypical Lymphocytes

B.

• Cytomegalovirus

• Drugs

• Epstein-Barr virus (infectious mononucleosis)

• Syphilis

• Toxoplasmosis

• Viral hepatitis

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Chediak-Higashi granules

B. Chediak-Higashi syndrome

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Alder-Reilly granules

B.

• Alder-Reilly anomaly

• Mucopolysaccharidoses (Hurler’s)

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Toxic Granules / Vacuoles

B.

• Infections

• Burns

• Malignancy

• Chemical poisoning

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Smudge cells / Basket cells

B. Chronic Lymphocytic Leukemia

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. LE Cells

B. Lupus Erythematosus

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Hairy Cells

B. Hairy Cell Leukemia

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Sezary Cells

B.

• Sezary syndrome

• Mycosis Fungoides

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Grape cells / Mott cells

B.

• Multiple myeloma

• Reactive states of lymphocytes

A. Identify the abnormality / cell

B. This is seen in what condition / disease

A. Hodgkin’s Lymphoma

B. Reed-Sternberg cell

C. Owl’s Eye Appearance

A. Identify the abnormality / cell

B. This is seen in what condition / disease

C. What is the appearance?

A. Flame Cells

B. Multiple Myeloma

A. Identify the abnormality / cell

B. This is seen in what condition / disease

Essential Thrombocytopenia

A. Identify the disease / Condition

A. Gaucher Cells

B. Gaucher Disease

C. β-glucocerebrosidase

A. Identify the cell
B. Identify the disease / condition
C. Enzyme deficient

A. Niemann-Pick cells

B. Niemann-Pick disease

C. Sphingomyelinase

A. Identify the cell
B. Identify the disease / condition
C. Enzyme deficient

Anisocytosis

- Hemolytic Anemia
- Megaloblastic Anemia
- Iron deficiency Anemia

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Abnormal variation in RBC volume or diameter Parameter: RDW (Normal: 11.6-14.6); 20% increased

Macrocyte

- Megaloblastic anemia
- Myelodysplastic syndromes
- Chronic liver disease
- Bone marrow failure
- Reticulocytosis

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Large RBC (>8 mm in diameter) MCV: >100 fL

Oval Macrocyte

Megaloblastic Anemia

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Large oval RBC

Microcyte

- Anemia of chronic inflammation
- Sideroblastic anemia
- Thalassemia / Hb E disease and trait

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Small RBC (< 6 um in diameter)
MCV: < 80 fL

Poikilocytosis

- Severe anemia; certain shapes helpful diagnostically

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Abnormal variation in RBC shape

Spherocytes

- Hereditary spherocytosis
- Immune hemolytic anemia
- Extensive burns (along with schistocytes)

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Small, round, dense RBC with no central pallor

Elliptocyte / Ovalocyte

- Hereditary elliptocytosis or ovalocytosis
- Iron deficiency anemia
- Thalassemia major
- Myelophthisic anemias

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Elliptical (cigar-shaped), oval (egg-shaped) RBC

Stomatocytes

- Hereditary stomatocytosis
- Rh deficiency syndrome
- Acquired stomatocytosis (liver disease, alcoholism) - Artifact

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
RBC with slit-like area of central pallor

Sickle cells

- Sickle cell anemia
- Sickle cell-β-thalassemia

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Thin, dense, elongated RBC pointed at each end; may be curved

Hb C crystals

Hb C disease

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Hexagonal crystal of dense hemoglobin formed within the RBC membrane

Hb SC crystals

Hb C disease

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Finger-like or quartz-like crystal of dense hemoglobin protruding from the RBC membrane

Target cells (Codocytes)

- Liver disease
- Hemoglobinopathies
- Thalassemia

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
RBC with hemoglobin concentrated in the center and around the periphery resembling a target

Schistocytes (Schizocytes)

- Microangiopathic hemolytic anemia* (along with microspherocytes)
- Macroangiopathic hemolytic anemia
- Extensive burns (along with microspherocytes)

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Fragmented RBC caused by rupture in the peripheral circulation

Helmet cells (Keratocytes)

- Microangiopathic hemolytic anemia* (along with microspherocytes)
- Macroangiopathic hemolytic anemia
- Extensive burns (along with microspherocytes)

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
RBC fragment in shape of a helmet

Folded cell

- Hb C disease
- Hb SC disease

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
RBC with membrane folded over

Acanthocytes (Spur cells)

- Severe liver disease (spur cell anemia)
- Neuroacanthocytosis (abetalipoproteinemia, McLeod syndrome)

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
Small, dense RBC with few irregularly spaced projections of varying length

Burr cells (Echinocytes)

- Uremia
- Pyruvate kinase deficiency

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
RBC with blunt or pointed, short projections that are usually evenly spaced over the surface of cell; present in all fields of blood film but in variable numbers per field

Teardrop cells (Dacryocytes)

- Primary myelofibrosis
- Myelophthisic anemia
- Thalassemia
- Megaloblastic anemia

RBC Abnormality: ?
Commonly Associated Disease: ?

Cell Description:
RBC with a single pointed extension resembling a teardrop or pear

Diffuse Basophilia

RNA

Hemolytic anemia after treatment for iron, vitamin B12, or folate deficiency

Inclusion: ?
Composition: ?
Associated Diseases: ?

Appearance in Supravital Stain:
Dark blue granules and filaments in cytoplasm (seen in reticulocytes)

Appearance in Wright Stain:
Bluish tinge throughout cytoplasm; also called polychromasia (seen in polychromatic erythrocytes)

Basophilic Stippling

Precipitated RNA

- Lead poisoning
- Thalassemias
- Hemoglobinopathies
- Megaloblastic anemia
- Myelodysplastic syndromes

Inclusion: ?
Composition: ?
Associated Diseases: ?

Appearance in Supravital and Wright Stain:
Dark blue-purple, fine or coarse punctate granules distributed throughout cytoplasm

Howell-Jolly Bodies

DNA (Nuclear Fragments)

- Hyposplenism
- Postsplenectomy
- Megaloblastic anemia
- Hemolytic anemia
- Thalassemia
- Myelodysplastic syndromes

Inclusion: ?
Composition: ?
Associated Diseases: ?

Appearance in Supravital and Wright Stain:
Dark blue-purple dense, round granule; usually one per cell; occasionally multiple

Heinz Bodies

Denatured Hemoglobin

- G6PD Deficiency
- Unstable hemoglobins
- Oxidant drugs/chemicals

Inclusion: ?
Composition: ?
Associated Diseases: ?

Appearance in Supravital Stain:
Round, dark blue-purple granule attached to inner RBC membrane

Appearance in Wright Stain:
Not visible

Pappenheimer Bodies

Iron

- Sideroblastic anemia
- Hemoglobinopathies
- Thalassemias
- Megaloblastic anemia
- Myelodysplastic syndromes
- Hyposplenism
- Postsplenectomy

Inclusion: ?
Composition: ?
Associated Diseases: ?

Appearance in Supravital and Wright Stain:
Irregular clusters of small, light to dark blue granules, often near periphery of cell

Cabot Rings

Precipitated β-globin chains of hemoglobin

Hb H disease

Inclusion: ?
Composition: ?
Associated Diseases: ?

Appearance in Supravital Stain:
Rings or figure-eights

Appearance in Wright Stain:
Blue rings or figure-eights