Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
C. William Reiquam, M. D., Elmer W. Koneman, M. D.
This collection of informative case studies covers the current topics in red cell disorders. Topics include macrocytosis, intracellular RBC inclusions, echinocytes and acanthocytes, schistocytes, ovalocytes, and rouleaux. Numerous high-quality photomicrographs and real-life situations help ensure that you learn and retain the information you need to know.
Continuing Education (CE) Credits
Other Hematology Courses
Other Case Studies Courses
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Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions Objectives
- At the conclusion of this course, the student will be able to perform the following three tasks with 70% + confidence:
- Understand and transmit repRODucible information about qualitative estimates of ERYTHROCYTE size, shape, and staining characteristics.
- Link observations of key ERYTHROCYTE ABNORMALITIES noted on peripheral smear to associated CLINICAL entities.
- Recognize through case studies that peripheral smear EVALUATION for size and shape of ERYTHROCYTES, and the presence of STAINABLE CYTOPLASMIC INCLUSIONS, may have CLINICAL implications.
Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions Outline
- ERYTHROCYTE Disorders
- Peripheral Smear Review: IntRODuction
- Smear Case 1: JAUNDICE and the Peripheral Smear
- Smear Case 2: MACROCYTOSIS
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The BLOOD study from which this smear was obtained revealed an MCV of 115 FEMTOLITERS (fl).Normal MCV values in adults= 80 - 90 fl.Normal MCV values in full-term infants= 98 -108 fl.Which of the following conditions may be indicated by the results seen on this PERIPHERAL BLOOD SMEAR?
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Conditions suggested by the MACROCYTES and neutrophils in the photograph to the right include:
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The arrow on this PHOTOMICROGRAH points to a MACROCYTE. The oval shape should be noted on the patient report.
- Smear Case 3: INTRACELLULAR RBC INCLUSIONS
- Smear Case 4: DIMORPHIC Red Cell Population
- Smear Case 5: Target Cells and Associated Red Cell ABNORMALITIES
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A peripheral smear with RED BLOOD CELLS photographed in a typical field was submitted for review. Which of the following conditions might be eliminated because of the cell population found here?
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A PERIPHERAL BLOOD SMEAR was submitted for review. The presence of SICKLE cells and target cells as shown is DIAGNOSTIC of HEMOGLOBIN SC DISEASE.
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SICKLE cells
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The photograph here is of a peripheral smear sent for HEMATOLOGIC review. No CLINICAL information for the patient was sent with the slide. What is the first course of action that the reviewer should take to assist him/her in interpreting the findings on this BLOOD smear?
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Atypical smear: Case follow-up
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The photograph is representative of the PERIPHERAL BLOOD SMEAR of a five-month-old immigrant from Asia. Her mother was concerned that the child was not eating well. Her spleen was palpable.The HEMOGRAM revealed the following:Hb 9.6g/dL (normal 12.0 - 16.0 g/dL)RBC 5.48 X 1012/L (normal 4.2 - 5.9 X 1012/LHCT 30.4% (normal 37 - 48%)MCV 55.4 fl (normal 86 - 98 fl)MCH 17.5 pg (normal 27 - 32 pg)MCHC 31.6 g/dL (normal 31 - 37 g/dL)RDW 34.9% (normal 11 - 15%)RETICULOCYTE count 10.9% (normal 0.5 - 1.5%)Select the most likely DIAGNOSIS based on the CLINICAL information and peripheral BLOOD findings.
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Hb E DISEASE (continued)
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The patient, an 8-month-old girl, was ANEMIC, JAUNDICEd, and had SPLENOMEGALY. Her family had immigrated from the Middle East. Based on the history and the peripheral BLOOD picture, the most probable DIAGNOSIS is THALASSEMIA.
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HEMOGLOBIN H DISEASE
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LEPTOCYTES and target cells
- Smear Case 6: ECHINOCYTES and ACANTHOCYTES
- Smear Case 7: SCHISTOCYTES, Bite Cells, and Teardrop Forms
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The presence of ERYTHROCYTES with altered MORPHOLOGY (as photographed here) has a close association with each of the following conditions except:
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The underlying condition where the defective ERYTHROCYTES marked by arrows are of DIAGNOSTIC importance is:
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The cells marked by blue arrows in the photograph are associated with all of the following conditions except:
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Smear with teardrop cells
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SCHISTOCYTES vs. bite cells
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A 5-year-old girl was brought to a PHYSICIAN's office because of fever and VIRAL-TYPE ILLNESS SYMPTOMS. Her BLOOD pressure was elevated.HEMOGRAM: HEMOGLOBIN 9.1g/dL (normal 12.0 - 16.0 g/dL), HEMATOCRIT 28% (normal 37 - 48%), MCV 80 fl (normal 86 - 98 fl), RDW 13.1% (normal 11 - 15%), PLATELETS 90.1 X 109/L (normal 150 - 450 X 109/L) WBC 9.6x109/L (normal 4.3 - 10.8 x 109/L).The PERIPHERAL BLOOD SMEAR is represented in the photograph.Which of the following are the most likely associated conditions?
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DIC: graft vs. host DISEASE
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CARDIAC HEMOLYSIS (Waring Blender Effect)
- Smear Case 8: OVALOCYTES, ELLIPTOCYTES and STOMATOCYTES (Hydrocytes)
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A frail 85-year-old woman living in an extended care facility was found lying on the floor. Her eating habits had been irregular and food intake scanty. Her skin had tissue paper-like quality, with a pearly grey sheen. In good light a faint lemon-yellow color became evident.Her HEMOGLOBIN was 9.2 mg/dl. The PERIPHERAL BLOOD SMEAR (upper and lower photographs) is most consistent with:
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Hereditary OVALOCYTOSIS and ELLIPTOCYTOSIS
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STOMATOCYTES
- Smear Case 9: ROULEAUX and ERYTHROCYTE AGGLUTINATION
- Smear Case 10: Multiple ERYTHROCYTE ABNORMALITIES
Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions Keywords Click on a term below to see its use in this Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions course and other available MediaLab courses.
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