[04.11b] CBC and PBS Drills V2.pdf

Normocytic, normochromic anemia

How are the red blood cells (RBCs) described in Case 1?

Normal

What is the interpretation of the Mean Corpuscular Volume (MCV) in Case 1, which is 94 fL?

Decreased

What is the interpretation of the Red Cell Distribution Width (RDW) in Case 1, which is 10 percent?

Eosinophilia and slight monocytosis

What are the white blood cell (WBC) findings in Case 1, despite a normal total WBC count?

Normal platelet count

What is the platelet finding in Case 1?

Blood loss

What is the possible differential diagnosis for Case 1, suggested by normocytic and normochromic anemia?

RBC generation

Normocytic and normochromic characteristics suggest that the anemia is not a problem of what process?

3.8 grams/dL

What is the Hemoglobin result in Case 1?

4.2-5.4 x 10 power 6/microL

What is the normal range for RBC in Case 1's table?

Normal WBC count with eosinophilia and slight monocytosis

What is the overall interpretation of the WBCs in Case 1?

Use the nucleus of the lymphocyte

What is the tip provided for assessing RBC size on a blood smear?

Approximately the same size

How should the RBC size compare to the nucleus of the lymphocyte?

Microcytic

If an RBC is hypochromic, it is usually also what?

Approximately 4 WBCs in a slide

What is considered an adequate number of WBCs in a slide observation?

15-35

What is the normal amount of platelets expected in a slide observation?

Normocytic, normochromic

How are the RBCs described on the blood smear for Case 2?

Patient is normal

What is the possible differential for Case 2?

56/F

What is the age and sex of the patient in Case 3?

Decreased

What is the interpretation of the hemoglobin result of 114.0 grams/dL in Case 3?

Increased

What is the interpretation of the RBC count of 5.6 x 10 power 12/L in Case 3?

Decreased

What is the interpretation of the MCV of 66.60 fL in Case 3?

Decreased

What is the interpretation of the MCH of 20.60 pg in Case 3?

Increased

What is the interpretation of the RDW of 14.69 percent in Case 3?

Leukopenia

What is the overall WBC finding for Case 3 (WBC count 3.9 x 10 power 9/L)?

Neutropenia

If there is leukopenia, it may suggest that the patient also has what?

Absolute neutrophil count (ANC)

What measure should be computed to determine if neutropenia is present in Case 3?

ANC equals WBC Count multiplied by (percent Neutrophils plus percent Stab) multiplied by 1000

What is the formula for calculating the ANC (Equation 1)?

1,365 cells/microL

What is the computed ANC of the patient in Case 3?

Greater than 1000 cells/microL

What is the recall threshold for a normal ANC?

The patient does not have neutropenia

What does the ANC of 1,365 cells/microL suggest for Case 3?

Able to fight off infections

The patient's normal ANC suggests they will be able to do what?

Microcytic, hypochromic anemia

How are the RBCs described in Case 3?

Iron deficiency or thalassemia

What two conditions should be considered when microcytic, hypochromic anemia is present?

Mentzer index

What index should be computed to differentiate between iron deficiency and thalassemia?

Mentzer index equals Mean cell volume (MCV) divided by RBC Count

What is the formula for the Mentzer index (Equation 2)?

11.9

What is the calculated Mentzer index for Case 3 (MCV 66.60, RBC 5.6)?

Thalassemia more likely

What is the interpretation of a Mentzer index less than 13?

Iron deficiency anemia more likely

What is the interpretation of a Mentzer index greater than 13?

Thalassemia

Based on the Mentzer Index of 11.9, what is more likely for the patient in Case 3?

64/F

What is the age and sex of the patient in Case 4?

Decreased

What is the interpretation of Hemoglobin (89.0 g/dL), Hematocrit (0.25), and RBC (2.88 x 10 power 12/L) in Case 4?

Normochromic, normocytic anemia

How are the RBCs described in Case 4?

Leukopenia, but more specifically neutropenia

What are the WBC findings in Case 4?

Thrombocytopenia

What is the platelet finding in Case 4 (Platelet count 11 x 10 power 9/L)?

Aplastic anemia

What is a possible differential for Case 4 that may yield pancytopenia?

Pancytopenia

Aplastic anemia may yield what condition?

264 cells/microL

What is the calculated ANC for Case 4 (WBC 1.2 x 10 power 9/L, Neutrophils 22 percent)?

WBC x (Neutrophil / 100) x 1000

What is the formula used to calculate ANC in Case 4 (Eq. 1)?

Hypochromic, Microcytic

How are the RBCs described in Case 5?

Poikilocytosis

The RBCs in Case 5 exhibit what characteristic?

Elliptocytes (red arrow) and Dacryocytes (black arrow)

What specific abnormal RBC shapes are noted in Case 5?

Iron deficiency

What is the possible differential diagnosis for Case 5?

64/F

What is the age and sex of the patient in Case 6?

307.95 x 10 power 9/L

What is the WBC result for Case 6?

Increased

What is the interpretation of the WBC count, MCH, MCHC, and Platelet count in Case 6?

Normochromic, normocytic anemia

How are the RBCs described in Case 6?

Leukocytosis and Thrombocytosis

What are the main WBC and Platelet findings in Case 6?

Infection

What is an unlikely differential diagnosis for Case 6 because the WBC count is too high?

20-25 x 10 power 9/L

What is the approximate typical WBC range for an infection?

Leukemia, specifically Chronic Myeloid Leukemia (CML)

What is the possible differential diagnosis for Case 6, indicated by massive leukocytosis and thrombocytosis?

Myeloid lineage

The high platelet count in Case 6 suggests a disease of what cell lineage?

30/F

What is the age and sex of the patient in Case 7?

Decreased

What is the interpretation of Hemoglobin (9.8 g/dL) and MCV (58.1 fL) in Case 7?

Increased

What is the interpretation of the Platelet count (463 x 10 power 9/L) in Case 7?

Microcytic, hypochromic anemia

How are the RBCs described in Case 7?

Normal count with neutrophilic predominance (slight neutrophilia)

How are the WBCs described in Case 7?

Thrombocytosis

What is the platelet finding in Case 7?

15

What is the calculated Mentzer Index (MCV/RBC) for Case 7?

Possible iron deficiency

What does a Mentzer Index of 15 suggest?

Female and 30 years old

What patient characteristics strengthen the suspicion of iron deficiency anemia in Case 7?

Bone marrow compensates by making platelets to seal off recurrent bleeding

What is the mechanism relating iron deficiency anemia to thrombocytosis in Case 7?

Normochromic and Normocytic

How are the RBCs described in Case 8?

Hypochromic

RBCs are described as this if they appear more pale or with more pallor.

Leukocytosis

What is the apparent WBC finding in Case 8?

Lacy

What characteristic describes the chromatin in the lymphoblasts seen in Case 8?

Lymphoblasts

What are the immature lymphocytes identified as in Case 8?

Small to medium size, mononuclear cells with scanty cytoplasm

What describes the lymphoblasts seen in Case 8?

Monotonous

What term describes the WBC population in Case 8, meaning only one type of cell is present?

Thrombocytopenia

What is the platelet finding in Case 8 (around 3 visible platelets)?

Immature leukocytosis/Acute lymphoblastic leukemia (ALL)

What is the differential diagnosis for Case 8?

Flow cytometry

What specific test is needed to prove the lineage of leukemia?

Microcytic and Hypochromic

How are the RBCs described in Case 9?

Leukocytosis with cells of the myeloid lineage in different stages of maturation

What is the WBC finding in Case 9?

Multilobed nucleus

What characterizes the mature neutrophils seen in Case 9?

Stab cell or Band form

What is another name for the band form neutrophil seen in Case 9?

Beans

What common food shape describes the metamyelocyte?

Thrombocytosis

What is the platelet finding in Case 9?

Leukemia (chronic) or Infection

What are the possible differentials for Case 9?

Incomplete Blood Count (ICBC)

What type of blood count result is presented in Table 10?

Difficult to determine accurate results

What is noted about the utility of an ICBC result?

Flow cytometry

What specific test is needed to prove lineage of leukemia, according to the active recall section?

True

A Mentzer index result of 15 indicates that the patient may have iron deficiency (True/False)?

Microcytic

When a red blood cell is hypochromic, it is usually also what, according to the active recall section?

73/F

What is the age and sex of the patient in Case 11?

Increased

What is the interpretation of Hemoglobin (17.4 g/dL), Hematocrit (57.4 percent), and RBC (6.3 x 10 power 12/L) in Case 11?

Decreased

What is the interpretation of the MCHC (30.3 g/dL) in Case 11?

Erythrocytosis

What is the RBC finding in Case 11 (increase in RBC)?

Leukocytosis and Thrombocytosis

What are the WBC and Platelet findings in Case 11?

Polycythemia

What term is used for an increase in RBC?

Panmyelosis

What term describes an increase in RBC, WBC, and platelets?