Hematology

Chapter 17

Hematology

6 What test should be ordered next?

Peripheral blood smear. There are many “classic” findings that can help make the diagnoses:

image Sickled cells (sickle cell disease; Fig. 17-2; Plate 30).

image
Figure 17-2 Sickle cells show a sickle or crescent shape resulting from the polymerization of hemoglobin S. This smear also shows target cells and boat-shaped cells with a lesser degree of polymerization of hemoglobin S than in a classic sickle cell. See Plate 30. (From Goldman L, Schafer AI. Goldman’s Cecil medicine. 24th ed. Philadelphia: Saunders, 2011, Fig. 160-7.)

image Hypersegmented neutrophils (folate/B12 deficiency; Fig. 17-3; Plate 31).

image
Figure 17-3 Megaloblastic changes of macrocytosis and a hypersegmented neutrophil. See Plate 31. (From Rakel RE, Rakel DP. Textbook of family medicine. 8th ed. Philadelphia: Saunders, 2011, Fig. 39-4; The American Society of Hematology Image Bank image #2611. Copyright 1996 American Society of Hematology, used with permission.)

image Hypochromic and microcytic RBCs (iron deficiency; Fig. 17-4; Plate 32).

image
Figure 17-4 Iron-deficiency anemia. Pale red blood cells (RBCs) with enlarged central pallor. See Plate 32. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders, 2006, Fig. 31-2.)

image Basophilic stippling (lead poisoning; Fig. 17-5; Plate 33).

image
Figure 17-5 Basophilic stippling. Irregular basophilic granules in red blood cells (RBCs); often associated with lead poisoning and thalassemia. See Plate 33. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders, 2006, Fig. 29-23.)

image Heinz bodies (glucose-6-phosphatase deficiency; Fig. 17-6; Plate 34).

image
Figure 17-6 Bite cells with Heinz bodies. See Plate 34. (Courtesy Dr. Robert W. McKenna, Department of Pathology, University of Texas Southwestern Medical School, Dallas, Texas.)

image “Bite cells” (classically, glucose-6-phosphatase deficiency; other hemolytic anemias; Fig. 17-6; Plate 34).

image Howell-Jolly bodies (asplenia; Fig. 17-7; Plate 35).

image
Figure 17-7 Howell-Jolly bodies in peripheral blood erythrocytes. These nuclear remnants indicate lack of splenic filtrative function. See Plate 35. (From Orkin SH, et al. Nathan and Oski’s hematology of infancy and childhood. 7th ed. Philadelphia: Saunders: 2009, Fig. 14-4.)

image Teardrop-shaped RBCs (myelofibrosis; Fig. 17-8; Plate 36).

image
Figure 17-8 Teardrop red blood cells (RBCs), usually seen in myelofibrosis. See Plate 36. (From Goldman L, Ausiello D. Cecil medicine. 23rd ed. Philadelphia: Saunders, 2008, Fig. 161-13.)

image Schistocytes, helmet cells, and fragmented RBCs (intravascular hemolysis; Fig. 17-9; Plate 37).

image
Figure 17-9 Schistocytes and helmet cells. Red blood cell (RBC) fragments seen with microangiopathic hemolytic anemia and disseminated intravascular coagulation (DIC). See Plate 37. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders, 2006, Fig. 29-19.)

image Spherocytes and elliptocytes (hereditary spherocytosis and elliptocytosis; Fig. 17-10; Plate 38).

image
Figure 17-10 Hereditary elliptocytosis. Blood film reveals characteristic elliptical red blood cells (RBCs). See Plate 38. (From McPherson RA, Pincus MR. Henry’s clinical diagnosis and management by laboratory methods. 22nd ed. Philadelphia: Saunders, 2011, Fig. 30-16.)

image Acanthocytes and spur cells (abetalipoproteinemia; Fig. 17-11; Plate 39).

image
Figure 17-11 Acanthocytes. Irregularly spiculated red blood cells (RBCs), frequently seen in abetalipoproteinemia or liver disease. See Plate 39. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders, 2006, Fig. 29-20.)

image Target cells (thalassemia, liver disease; Fig. 17-12; Plate 40).

image
Figure 17-12 Target cells are frequently seen in hemoglobin C disease and liver disease. See Plate 40. (From McPherson R, Pincus M. Henry’s clinical diagnosis and management by laboratory methods. 21st ed. Philadelphia: Saunders, 2006, Fig. 29-18.)

image Echinocytes, including “burr” cells and acanthocytes (uremia; Fig. 17-13; Plate 41).

image
Figure 17-13 Echinocytes, or burr cells (arrows), are the hallmark of uremia. See Plate 41. (Hoffman R, et al. Hematology: basic principles and practice. 5th ed. Philadelphia: Churchill Livingstone, 2008, Fig. 156-1.)

image Polychromasia (from reticulocytosis; should alert you to the possibility of hemolysis; Fig. 17-14; Plate 42).

image
Figure 17-14 Microangiopathic hemolytic anemia demonstrating red blood cell (RBC) fragments, anisocytosis, polychromasia, and decreased platelets. See Plate 42. (From Tschudy MM, Arcara KM, editors. The Harriet Lane handbook. 19th ed. Philadelphia: Mosby, 2011, Plate 7.)

image Rouleaux formation (multiple myeloma; Fig. 17-15; Plate 43).

image
Figure 17-15 Rouleaux formation of stacked red blood cells (RBCs) seen in multiple myeloma. See Plate 43. (From Goldman L, Ausiello D. Cecil Medicine. 23rd ed. Philadelphia: Saunders, 2008, Fig. 161-19.)

image Parasites inside red blood cells (RBCs) (malaria [Fig. 17-16; Plate 44], babesiosis).

image
Figure 17-16 Malaria. Peripheral blood film examples of various stages of Plasmodium falciparum. A, Small ring forms. B, A crescentic gametocyte with centrally placed chromatin. See Plate 44. (From Hoffman R, et al. Hematology: basic principles and practice. 5th ed. Philadelphia: Churchill Livingstone, 2008, Fig. 159-5.)

image Iron inclusions in RBCs of the bone marrow (sideroblastic anemia; Fig. 17-17; Plate 45).

image
Figure 17-17 Ringed sideroblasts seen in sideroblastic anemia. See Plate 45. (From Goldman L, Ausiello D. Cecil medicine. 23rd ed. Philadelphia: Saunders, 2008, Fig. 163-5.)

9 What are the classic causes of microcytic, normocytic, and macrocytic anemia? Which of these tends to have an inappropriately low reticulocyte count?

MICROCYTIC NORMOCYTIC
With normal or elevated reticulocyte count With normal or elevated reticulocyte count
Thalassemia/hemoglobinopathy (e.g., sickle cell disease) Acute blood lossHemolytic (multiple causes)Medications (antibody-causing)
With low reticulocyte count With low reticulocyte count
Lead poisoningSideroblastic anemiaAnemia of chronic disease (some cases)Iron deficiency Cancer/dysplasia (e.g., myelophthisic anemia, acute leukemia)Anemia of chronic disease (some cases)Aplastic anemia/medications causing bone marrow suppressionEndocrine failure (thyroid, pituitary)Renal failure
MACROCYTIC  
All types have low reticulocyte count  
Folate deficiencyVitamin B12 deficiencyMedications (methotrexate, phenytoin)Alcohol abuse (interferes with folate use)Cirrhosis, liver disease  

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Apr 8, 2017 | Posted by in NURSING | Comments Off on Hematology

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