Module 6 Path Lab
Terms
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- Anisocytosis
- variation of RBC SIZE
- Poikilocytosis
- variation of RBC SHAPE
- What are the abnormal RBC shapes?
-
ovalocyte/elliptocyte
spherocyte
stomatocyte
target cell (codocyte)
tear drop (dacrocyte)
schizocyte (schistocyte)
acanthocyte (spur cell)
burr cell (echinocyte)
crenated cell
sickle cell (depranocyte) - Ovalocyte/elliptocyte
-
elongation of RBC w/ oval or elliptical shape
NON-specific finding
Increased w/ chemo - A finding of MANY elliptocytes is indicative of...?
- hereditary elliptocytosis (autosomal dominant)
- Spherocyte
-
loss of mbrn surface area causing a spherical shape
-- cells appear round w/ dense staining
-- NO central pallor - Microspherocytes are indicative of...?
- extravascular hemolysis
- Normal sized spherocytes are indicative of...?
- hereditary spherocytosis (autosomal dominant)
- Stomatocyte
-
central pallor is slit-like, instead of round
NON-specific finding
May be increased in myelodysplastic states - Stomatocytes are associated with...?
-
Rh null disease
Hereditary stomatocytosis (autosomal dominant) - Target cell (codocyte)
- central Hb, rim of pallor, and peripheral Hb staining, caused by increased cell mbrn for amount of Hb
- Target cells are associated with...?
-
liver disease
asplenia
hypochromic anemias
hemoglobinopathies - Tear drop (dacrocyte)
-
cell has "tear drop" shape
NON-specific finding - Tear drop cells are associated with...?
- myelofibrosis
- Schizocyte (schistocyte)
-
fragmented RBC
indicative of intravascular hemolysis
If cell takes on particular shape, can be "helmet" cell or "bite" cell - Acanthocyte (spur cell)
- cell mbrn has long projections, nonsymmetrical distributioin, w/ bulbous ends
- Acanthocytes are associated with...?
-
some types of liver disease
a-beta-lipoproteinemia - Burr cell (echinocyte)
- cell mbrn has short spikes, asymmetrical distribution, sharp pointed ends
- Burr cells are associated with...?
- renal failure
- Crenated cell
-
peripheral mbrn is scalloped
usually seen as drying artifact - Crenated cells can be associated with...?
- hyperosmolality
- Sickle cells (depranocyte)
- cell is elongated and curved w/ pointed ends
- Sickle cells are associated with...?
-
S-S disease
Can be assoc w/ few other hemoglobinopathies - List different RBC inclusions
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-- basophilic stippling
-- Howell-Jolly body
-- nucleated RBC
-- Pappenheimer body
-- Cabot ring
-- Heinz body
-- parasites - Basophilic stippling
- small blue dots disributed throughout the cell, remnants of RNA
- Basophilic stippling is associated with...?
-
Fine stippling:
-- young RBC
Course stippling:
-- thalassemia
-- lead intoxication
-- myelodysplastic states - Howell-Jolly body
-
usually single, dense, round inclusion of magenta color
remnant of nucleus - Howell-Jolly bodies are associated with...?
-
Most often:
-- asplenia
Also in:
-- megaloblastic anemia
-- myelodysplastic states - Nucleated RBC
- nucleated RBC precursors should not be seen in the peripheral circulation
- Nucleated RBCs are associated with...?
-
Stress
-- acute hemorrhage
-- severe anemia
-- hemolysis
True marrow neoplasm - Pappenheimer body
-
small blue inclusions usually eccentrically located
one or seversl
consists of stainable iron - Pappenheimer bodies are associated with...?
-
iron overload in marrow
asplenia - Siderocyte
- cell with Pappenheimer bodies
- Sideroblast
- nucleated RBC w/ iron
- Ringed sideroblast
- nucleated RBC w/ iron around nucleus
- Cabot ring
- ring-shaped structure that stains red-blue and thought to be remnant of microtubuules from mitotic spindle
- Cabot rings are associated with...?
- disordered erythropoiesis
- Heinz body
-
Only seen w/ supra vital staining
Consists of precipitated Hb and is indicative of unstable Hb - Heinz bodies are associated with...?
-
G-6-PD deficiency
some drugs
some hemoblobinopathies - Parasites
- intracellular parasites include malaria and babesia
- List the different types of chromicity
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anisochromia
hypochromic
hyperchromic
polychromasia - Anisochromia
- variation of chromicity
- Hypochromic
- central pallor is widened
- Hyperchromic
-
small or absent central pallor
ONLY seen in hereditary spherocytosis - Polychromasia
-
diffuse blue color of RBC
remnant of RNA
indicative of young RBC (reticulocyte) - Rouleau
- "sticking" together of RBC dut to loss of Zeta potential caused by increase fibrinogen or gamma globulins
- cold agglutinins
- agglutinated clumps of RBC due to autoAb of IgM type
- List RBC indices
-
1. Mean cell volume (MCV)
2. Mean cell Hb (MCH)
3. Mean cell Hb concentration (MCHC)
4. Reticulocyte index (RI)
5. RBC Distribution Width (RDW) - MCV
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Mean cell volume
MCV = Hct/RBC
Normal = 80-99 fl - MCH
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Mean cell Hb
MCH = Hbg/RBC
Normal = 26-32pg - MCHC
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Mean cell Hb conc
MCHC = Hgb/Hct
Normal = 33-37% - RI
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Reticulocyte index
RI = RC x (Pt Hct/45) x (1/F)
Hct 45 = F 1
Hct 35 = F 2.5
Hct 25 = F 2
Hct 15 = F 2.5 - RDW
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RBC distribution width
Numerical index for anisocytosis, coefficient variation of MCV
Normal is 11.6 - 14.6% - What are the two categories of abnormal WBC morphology?
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Acquired morphologic variations
Hereditary morphologic variants - Acquired morphologic variations?
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toxic granulation
Dohle bodies
hypersegmentation
hyposegmentation
degenerating PMNs
platelet satellitosis, platelet clumps
intracellular microorganisms - Toxic granulation
- prominence and increase in number of primary granules in PMNs
- Toxic granulations are associated with...?
- bacterial infections
- Dohle bodies
-
irregularly shaped blue staining bodies in the cytoplasm of PMNs
- consists of ribosomes and RER - Dohle bodies are associated with...?
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activated/reactive PMNs
frequently seen w/ toxic granulation - Hypersegmentation
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more than 5 lobes to a PMN nucleus
OR
>5% of PMNs w/ 5 lobes - Hypersegmentation is associated with...?
-
B12/folate deficiency
Rarely:
chemo
MDS
MPD - Hyposegmentation
- two lobes or non-lobated nucleus of a segmented PMN
- Hyposegmentation is associated with...?
- When acquired, "pseudo-Pelger Huet" assoc w/ MDS
- Degenerating Neutrophils
-
occasionally, may be seen in periph circ
-- nucleus will fragment and stain dark, as to stimulate either an NRBC or budding yeasts - Platelet satellitosis, platelet clumps
- EDTA induced platelet aggregation IN VITRO, causes interference w/ WBC count and platelet count
- Intracellular microorganisms in WBCs
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usualy bacteria or fungal orgs when present in high numbers
may be seen intracellularly on peripheral smear - List hereditary morphologic WBC variants
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May-Haegglin anomaly
Alder-Reilly anomaly
Chediak-Higashi Syndrome
Pelger-Huet Anomaly - May-Haegglin anomaly
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giant platelets and Dohle-like bodies in all granulocytes
normal WBC fxn, but may have thrombocytopenia
autosomal dominant - Alder-Reilly anomaly
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denze azurophilic granules in all WBCs including lymphocytes
-- granules consist of lysosomes containing abnormal storage compound
seen in pts w/ mucopolysaccharidoses
PMNs appear as basophils - Chediak-Higashi Syndrome
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abnormal large dense granules in lymphocytes
AND
abnormal gray-green granules in PMNs
primary d/o of lysosomes also affecting melanosomes
WBC have low counts and abnormal fxn
autosomal recessive - Pelger-Huet anomaly
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PMNs have only two lobes but normal fxn
autosomal dominant