ASCP Hema

Dohle bodies

Light blue patches in cytoplasm of neutrophils. Infection, burns

Erythrocytes

O2 transport. Produced in BM

Mean Corpuscular Hemoglobin (MCH) formula

(HGBx10)/RBC

Mean Corpuscular Hemoglobin Concentration (MCHC) formulao

(HGBx100)/HCT

Granulocytes

Defense against bacterial infection. Produced in BM

Lymphocytes

Cellular and humoral immunity. Produced in lymphoid tissue

Platelets

Coagulation. Produced in BM

WBC RR

4.5-11.5 x10^3 / microL

RBC RR

M: 4.6-6x10^6 / microL

F: 4-5.4x10^ / microL

HGB RR

M: 14-18 g/dL

F: 12-15 g/dL

HCT RR

M: 40-54%

F: 35-49%

MCV RR

80-100 fL

MCH RR

27-31 pg

MCHC RR

32-36%

PLT RR

150-450x10^3 microL

MCV first 5 days

Macrocytes. Higher in preterm infants

Retic %

newborns increased polychromasia

Seg %

50-70

Band %

0-5

Lymph newborn

few benign immature B cells may be seen

common myeloid progenitor

differentiate into erythrocytes, platelets (megaK), granulocytes (basophils, eosinophil, neutrophil), and monocytes

common lymphoid progenitor (CLP)

T-lymph, NK cell, B-lymph

Multipotential progenitor cell

Common myeloid progenitor or common lymphoid progenitor

Erytheopoiesis 1-2 month gestation

yolk sac and aorta-gonads mesonephros region (gower I/II and portland)

Erythropoiesis 3-6 month gestation

liver (primary), spleen

Erythropoiesis 7 month of gestation-4 years

Bone marrow (all marrow active)

Erythropoiesis adult

bone marrow (pelvis, vertebrae, ribs, sternum, skull. Shafts of long bones filled with fat-may reactivate to compensate for anemia- liver and spleen may reactivate if that fails to keep up with demand)

Rubriblast/pronormoblast

14-24 um

N:C ratio 8:1

Royal blue cytoplasm. Fine chromatin

1-2 nucleoli

Normally confined to bone marrow.

Prorubricyte/basophilic normoblast

12-17 um

N:C ratio 6:1

Chromatin is coarser with slightly visible parachromatin

Nucleoli not visible

Normally confined to bone marrow.

Rubricyte/polychromatophilic normoblast

10-15 um. N:C ratio 4:1. Cytoplasm is polychromatophilic due to hemoglobin production. Chromatin is clumped with distinct areas of parachromatin. Last stage to divide. Normally confined to bone marrow.

Metarubricyte/orthochromic normoblast

8-12 um

N:C ratio 1:2

Nucleus is pyknotic

Last nucleated stage

Normally confined to bone marrow.

Reticulocyte/Polychromatophilic erythrocyte

7-10 um

No nucleus. Cytoplasm is diffusely basophilic (bluish tinge)

Reticulum seen with supravital stain. 0.5%-1.5% of RBCs in adult peripheral blood.

Mature erythrocyte

7-8 um

Biconcave disk. Reddish-pink cytoplasm with area of central pallor 1/3 diameter of cell.

Megaloblastic anemia cause

vitamin b12 or folic acid deficiency (ex pernicious anemia)

Megaloblastic characteristics

Nucleus lags behind cytoplasm in maturation. cells grow larger without dividing. Oval macrocytes

Iron deficiency characteristics

cytoplasm lags behind nucleus in maturation due to inadequate iron for hgb synthesis. Microcytic, hypochromic RBCs

Hemoglobin A

2 alpha + 2 beta, >95% adults, 20% newborn

Hemoglobin A2

2 alpha + 2 delta, 1.5-3.7% adults,

Hemoglobin F

2 alpha + 2 gamma,

Hemoglobin S

Valine substituted for glutamic acid in 6th position of beta chain

Hemoglobin C

Lysine substituted for glutamic acid in 6th position of beta chain

Cellulose Acetate pH 8.6 crawl (closet to cathode - and origin)

hbg A2, C, E, OArab, CHarlem (A2,CE, Of, Clubs(harlem))

Cellulose Acetate pH 8.6 slow

hgb S, D, G, Lepore (Sad, Dog, Gets, Loved)

Cellulose Acetate pH 8.6 fast

hgb F

Cellulose Acetate pH 8.6 accelerated (closest to anode +)

hgb A

Citrate agar pH 6.2

cathode, F, A/A2, origin, S, C, anode

Methemoglobin

iron oxidized to ferric (3+), usually acquired from exposure to oxidants, cant bind O2, cyanosis, possibly death.

Methemoglobin findings

Heinz bodies. treat with methylene blue

Sulfhemoglobin

Sulfur bound to heme. Acquired from exposure to drugs & chemicals. O2 affinity 1/100th normal. Cyanosis. Cant be converted back to normal hemoglobin

Carboxyhemoglobin

carbon monoxide bound to heme. Decreased O2 to tissues. Can be fatal. Affinity of Hgb for Co is 200× greater than for O2. Skin turns cherry red

anisocytosis

variation in size, seen in many anemias

macrocytes

megaloblastic anemias, liver disease, reticulocytosis

normal in newborns

Microcytes

Iron deficiency anemia thalessemia

anemia of chronic infections

Poikilocytosis

variation in shape

Elliptocytes/ovalocytes

membrane defect. hereditary ovalocytosis various anemias

iron deficiency thalassemia

Crenated RBCs

Osmotic imbalance. if seen in thin part of smear, dont report. probably artifact due to excess anticoagulant or slow drying

Burr cells (echinocytes)

Membrane defect. Uremia

pyruvate-kinase deficiency

May be drying artifact. A few can be present in healthy individuals.

Helmet (keratocyte)

hemolytic process

Acanthocytes (Spur Cells)

Membrane defect. Severe liver disease, abetalipoproteinemia.

Schistocytes

RBCs split by fibrin strands. Microangeopathic hemolytic anemias (DIC, TP, HUS), prosthetic heart valves

Hemoglobin C cyrstals

Blunt, 6-sided, dark-staining projection. "Bar of gold." "Washington monument" Hemoglobin C disease

Hemoglobin SC crystals

Glove-like intracellular crystals, hemoglobin SC disease

Teardrops (dacrocytes)

myelofibrosis, thalassemia

other anemias extramedullary hematopoiesis, perncious anemia

hypochromia

iron deficiency anemia, thalassemia

Anisochromia

Mixture of normochromic &

hypochromic RBCs. dimdorphic anemia, post-transfusion

Polychromasia

Young RBCs. Retics with supravital stain. Sign of active erythropoiesis. 1%-2% in normal adult. ↑with acute blood loss, hemolytic anemia, following treatment for iron deficiency or pernicious anemia.

Target cells

Hemoglobinpathies, thalessemia, liver disease. May be artifact if observed in only 1 part of smear

Stomatocytes

Hereditary stomatocytosis, hereditary spherocytosis, thalassemia, alcoholic cirrhosis, Rh null disease. May be artifact in parts of smear that are too thin or too thick.

Lymph %

18-42

Newborn bands

occasional metas and myelos More immature grans in earlier

Spherocytes

Membrane defect. Hereditary spherocytosis, autoantibodies, burns, hemoglobinopathies, hemolysis, ABO HDN, incompatible blood tf, tf of stored blood. A few are normal due to aging of RBCs.

Rouleux

Serum protein abnormality; e.g., ↑globulins or fibrinogen. Seen in multiple myeloma & macroglobulinemia. May be artifact due to delay in spreading drop of blood or smear that's too thick.

Agglutination

Autoantibodies, cold autoagglutinin

Basophilic stippling stain

Wrights and methylene blue

Basophilic stippling

Aggregation of RNA, exposure to lead, accelerated or abnormal hemoglobin synthesis, thalassemia

Howell-Jolly bodies stain

Wrights and new methylene blue

Howell-Jolly bodies

nuclear remnants (DNA), Usually pitted by spleen. seen in accelerated erythropoiesis. Postsplenectomy, thalassemia, hemolytic and megaloblastic anemias, sickle cell anemia

Cabot rings stain

wrights

Cabot rings

May be part of mitotic spindle, remnant of microtubules, or fragment of nuclear membrane. megaloblastic anemia, thalassemia, postsplenectomy

Pappenheimer bodies stain

Wrights. siderotic granules with Prussian Blue

Pappenheimer bodies

iron particles, faulty iron utilization. Sideroblastic anemias, postsplenectomy, thalassemia, sickle cell anemia, hemochromatosis

Reticulocyte stain

new methylene blue. polychromasia on wrights

Reticulocyte

residual RNA. >2% increases erythropoiesis

Heinz bodies stain

supravital stain (crystal violet, brilliant cresyl blue, methylene blue)

Heinz bodies

Precipitated, oxidized, denatured hemoglobin. Normal during aging but pitted by spleen. G6PD deficiencies, unstable hemoglobins, chemical injury to RBCs, drug-induced hemolytic anemia

Mean Corpuscular Volume (MCV) formula

(HCTx10)/RBC

Mean Corpuscular Volume

average volume of an RBC. used to classify anemias

Mean Corpuscular hemoglobin

average weight of hgb in individual RBCs

Mean Corpuscular hemoglobin Concentration

average concentration of hgb/dL RBCs >37 may indicate a problem with the specimen (hyperlipidemia, cold agglutinins) or instrument.

Hemoglobinopathy

Qualitative abnormality. abnormality in amino acid sequence of globin chain, not in amount of globin produced. (ex sickle cell anemia & trait, hemoglobin C disease & trait)

Thalassemia

Quantitative abnormality. Amino acid sequence of globin chains is normal, but underproduction of 1 or more globin chains (ex Beta-thalassemia major and minor)

Normocytic Anemia

Sickle cell anemia, sickle cell trait, hemoglobin C disease, hemoglobin C trait, SC disease, hereditary spherocytosis, autoimmune hemolytic anemia

Sickle cell anemia (SS)

Inheritance of sickle cell gene from both parents. Valine substituted for glutamic acid in 6th position of beta chain. >80% S, 1-20% F. Normal A2, no A. Moderate to severe anemia

Sick cell anemia smear

aniso, poik, sickle cells, target cells, nRBCs, HJ bodies, basophilic stippling, siderotic granules, polychromasia, retics 10-20%, increased WBC w/ shift to left and increased platelets

Sickle cell trait

inheritance of sickle cell gene from one parent. 50-65% A, 35-45 S, normal F, normal to slightly increased A2. No anemia.

Sickle cell trait smear

occasional target cells

Hemoglobin C disease

inheritance of gene for Hgb C from both parents. Lysine substituted for glutamic acid in 6th position of beta chains. >90 C, 7% F, no A. Mild to moderate anemia

Hemoglobin C disease smear

many target cells, folded cells, occasional Hgb C crystals

Hemoglobin C trait

Inheritance of gene for Hgb C from 1 parent. 60-70% A, 30-40% C

Hemoglobin C trait blood smear

many target cells