Clin Med L2 CBC - RBC portion

how do we examine blood?

through peripheral smears

how do you do peripheral smears?

you collect EDTA anticoagulated blood

place it on a glass slide

then the the blood is stained with Wright-Giemsa stain

what do peripheral smears allow you to identify and estimate?

identification and qualification % of WBC

identification and estimation of abnormal RBC morphology

estimation of platelet count

estimation for platelet clumping

what is CBC used for?

to evaluate

• hematology parameters

• white blood cell measures

• platelets, and white blood cell parameters

what is in a CBC?

• RBC count

• Hemoglobin

• Hematocrit

• MCV

• MCH

• MCHC

• RDW

• Platelet Count

• WBC count

• Neutrophils % and absolute

• Lymphocytes % and absolute

• Monocytes % and absolute

• Eosinophils % and absolute

• Basophils % and absolute

what is fishbones?

its a shorthand way of displaying labs and memorizing normalized ranges for your facility

what does RBC provide?

a count of the number of RBCs present in the specimen

• serves as an indirect estimate of the hemoglobin content of the blood

what does the Hemoglobin (Hgb) provide?

index of the oxygen carrying capacity of blood

what does the Hgb depend on?

on the number of RBCs as well as the amount of hemoglobin in each RBC

what does the Hemocrit (Hct) provide?

an indirect estimate of the number of RBCs and thus an indirect estimate of the amount of hemoglobin

what are the common abbreviations for hemoglobin and hemocrit?

H & H

Hgb & Hct

what does the Mean Corpuscular Volume (MCV) provide?

the size of RBC

represents average RBC volume

what CBC value is helpful in diagnosing anemias as normocytic etc?

MCV

what does the Mean Corpuscular Hgb (MCH) provide?

the weight of Hgb per RBC

and color bc the cell will appear different after being stained due to hgb

what does the Mean Corpuscular Hgb Content (MCHC) provide?

concentration of Hgb per cell

if you have a smaller or large volume of blood this cocentration will change

what does the RBC Distribution Width (RDW) provide?

range of sizes of RBCs

ratio of immature and mature RBC cells

when do you order a CBC?

assessment for anemia

platelet dysfunction

monitoring blood loss

dehydration

-penia means

deficiency

-cytosis or –philia means

an increase in number of cells

what is anemia?

condition in which the oxygen carrying capacity of the blood is reduced

what values do we usually see for anemia?

decreased hemoglobin level

decreased hematocrit

decreased red blood cell count

AT LEAST TWO VALUES ARE DECREASED

what specific value determines the type of anemia the person has?

based on size of RBC

• MCV

based on color of RBC

• MCH

what does a normal MCV value mean?

MCV 80-100

normocytic

what does a high MCV value mean?

MCV >100

macrocytic (increased MCV)

what does a low MCV value mean?

MCV <80

microcytic (decreased MCV)

what are the differential diagnosis’s for Microcytic values?

"TALIS"

• T – Thalassemias

• A – Anemia of Chronic Disease (also called Anemia of Inflammation)

• L – Lead poisoning

• I – Iron Deficiency Anemia

• S – Sideroblastic Anemia

what are the differential diagnosis’s for Normocytic values?

Hemolytic Intrinsic

"I Help People Get Proper Safe Hematology Care"

• I – Intrinsic (category)

• Help – Hereditary Spherocytosis

• People – Paroxysmal Nocturnal Hemoglobinuria (PNH)

• Get – G6PD Deficiency

• Proper – Pyruvate Kinase Deficiency

• Safe – Sickle Cell Anemia

• Hematology – HbC Disease

• Care – reinforces the clinical setting/context

what are the differential diagnosis’s for Normocytic values?

Hemolytic Extrinsic

Microangiopathic hemolytic anemia

Macroangiopathic hemolytic anemia

Autoimmune hemolytic anemia

what are the differential diagnosis’s for Macrocytic values?

Megalobastic

Folate deficiency (B9)

Cobalamin deficiency (B12)

Copper deficiency

Orotic acidura

Drug Induced (allopurinol)

what are the differential diagnosis’s for Macrocytic values?

Non-Megalobastic

Alcohol-use disorder

Liver Disease

Diamond-Blackfan anemia

what does this MCH value mean?

MCH ≥ 27

normochromic

what does a low MCH value mean?

MCH <27

hypochromic

cells barely are seen after being stained and viewed in peripheral smear

what is aplastic anemia?

what is it caused by?

failure of an organ tissue to develop normally

caused by aplasia of bone marrow or its destruction by chemical agents (such as medications) or other physical factors

is anemia a isolated diagnosis?

NO, you need to also find the underlying reason for the anemia

how do you know when you should be concerned for anemia and complete a further work up?

the presence of poikilocytosis on peripheral smear merits further investigation

what is poikilocytosis?

>10% of the cells having a different shape such as teardrop shaped, crescent shaped, sickled, etc

what is schistocytes?

fragmented blood cells which may encompass a wide variety of cell shapes

what is anisocytosis?

a peripheral smear with a variety of cell sizes

if ≤ 5% of cells vary from normal size, considered a ——

normal variation

what are spherocytes?

spherical cells with decreased surface membrane which appear microcytic and “hyperchromic” due to the loss of the central pale area

small and pigmented

is shape change for spherocytes reversible?

irreversible

what is the clinical significance of spherocytes?

hereditary spherocytosis

immune hemolytic anemia

what are burr cells?

cells with 10-30 rounded spicules evenly spaced over surface of cell

what is the clinical significance of burr cells?

renal disease, liver disease, or burns

what are helmet/bites cell?

cells with distinctive projections, usually two, surrounding an empty area of red cell membrane

what is the clinical significance of helmet/bites cells?

glucose-6-Phosphate-Dehydrogenase (G6PD) Deficiency

Disseminated Intravascular Coagulation (DIC)

mechanical heart valve or aortic stenosis

what are acanthocytes?

cell with normal or slightly reduced size possessing 3-8 finger-like projections distributed in an irregular manner along cell membrane

what is the clinical significance of acanthocytes cells?

severe liver disease

abetalipoproteinemia → spleen destroys RBCs

what are ovalocytes/elliptocytes?

oval, egg-shaped, or elongated shape cells

may be normocytic or macrocytic and normochromic or hypochromic

what is the clinical significance of ovalocytes/elliptocytes cells?

thalassemias

myelodysplastic syndrome

megaloblastic anemias

iron deficiency anemia

what are target cells?

cells with large portion of hemoglobin displayed at the rim of the cell and a portion of hemoglobin either central, eccentric, or banded

• Always hypochromic

what is the clinical significance of target cells?

liver disease (increased red cell membrane cholesterol) Hemoglobin C Disease

Iron def anemia

Thalassemias (decreased intracellular hemoglobin)

what are tear cell?

cell which look as if one end has been pulled out to a tail while the other is still rounded

what is the clinical significance of tear cells?

idiopathic myelofibrosis

Thalassemia

Iron Def Anemia

what are stomatocytes cells?

cells that have a rectangular or slit-like central pale area

what is the clinical significance of stomatocytes cells?

hereditary spherocytosis

hereditary stomatocytosis

acute alcoholism

what are rouleaux cells?

cells partially adhering to each other, microscopically have the appearance of a stack of coins

what is the clinical significance of rouleaux cells?

occurs in disease states with abnormal protein levels such as multiple myeloma

what are Basophilic Stippling (Inclusions)?

Small dark blue dotlike structures scattered fairly uniformly throughout the RBC

Derived from ribonucleoprotein and mitochondrial remnants

what is the clinical significance of Basophilic Stippling (Inclusions)?

conditions with defective or accelerated heme synthesis such as lead poisoning or Thalassemias

what are Howell-Jolly Bodies (Inclusions)?

Small, round, blue-black inclusions that occur singly or doubly in an eccentric position

Derived form DNA remnants

what is the clinical significance of Howell-Jolly Bodies (Inclusions)?

seen s/p splenectomy or in Thalassemias

hemolytic anemias, or megaloblastic anemias

what are Pappenheimer Bodies (Inclusions)?

Small, irregular magenta-colored granules that usually occur in small groups

Derived from hemosiderin granules (non-heme iron deposits)

what is the clinical significance of Pappenheimer Bodies (Inclusions)?

sideroblastic anemias

hemochromatosis

iron overload disorders

hemoglobinopathies

s/p splenectomy

what are Heinz Bodies (Inlcusions)?

Small scattered blue dot-like structures of varying size in the RBC – stained with supravital stain

If 1-4 found, considered normal, 5 or more/cell is considered pathogenic

what is the clinical significance of Heinz Bodies (Inlcusions)?

G6PD deficiency

alpha-thalassemia

drug-induced hemolytic anemias

when there is an increase in the RBCs, H&H, and sometimes WBCs what does this mean?

there is a decrease amount of fluid in the blood, concentrating the RBCs, creating an increase in the H&H

-good indication of dehydration