Peripheral blood film: Difference between revisions

Latest revision as of 11:59, 8 June 2023

Erythrocytes

Distribution

Agglutination: suggests IgM, either expected response to infection or autoimmune hemolytic anemia
Rouleaux: may be artifact from poor preparaction; otherwise, it is caused by an increase in certain proteins, such as immunoglobulins and fibrinogen, and can be seen in infection (acute or chronic), connective tissue disease, chronic liver disease, and myeloma and macroglobulinemia

paraproteinemia

Morphology

Anisocytosis: size
Poikilocytosis: shape
Spherocytosis: Hereditary Spherocytosis (HS) or autoimmune hemolytic anemia
Acanthocytes: irregular cellular projections seen in hyposplenism
Echinocytes (burr cells): regular cellular projections that is usually artefact
Bite cells: oxidative stress, like G6PD deficiency

Size

Microcytic red blood cells
- Iron-deficiency anemia
  - Anisopoikilocytosis
  - Target cells
  - Increased RDW
  - Increased platelets
- Thalassemia
  - Basophilic stippling
  - Increased RBC count to greater than 3x Hgb
  - Increased reticulocytes
  - Positive HbH test (in alpha-thal) or Hb electrophoresis (in beta-thal)
Macrocytic red blood cells
- Megaloblastic with hypersegmented neutrophils
  - Vitamin B12 deficiency or folate deficiency
  - Myelodysplastic syndrome
  - Medications: allopurinol, aminosalicylic acid (decreased folate), antacids (decreased B12), ampicillin and other penicillins (decreased folate), azathioprine, capecitabine, chloramphenicol (decreased folate), cladribine, cytosine arabinoside (ara-C), erythromycin (decreased folate), estrogens (decreased folate), fludarabine, fluorouracil, gadolinium, gemcitabine, histamine H2 blockers (decreased B12), hydroxyurea, imatinib, lamivudine, leflunomide, mercaptopurine, metformin (decreased folate), methotrexate, mycophenolate mofetil, nitrofurantoin (decreased folate), pentostatin, phenytoin (folate), primadone, proton pump inhibitors (decreased B12), sunitinib, teriflunomide, tetracyclines (decreased folate), thioguanine, trimethoprim, zidovudine
- Reticulocytosis
  - Hemolytic anemia
  - Medications causing hemolytic anemia in G6PD deficiency: dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, rasburicase
  - Bone marrow recovery after chemotherapy or hematopoietic stem cell transplant
  - Increased erythropoiesis following administration of erythropoietin, repletion of iron, vitamin B12, or folate
  - Recovery from bleeding episode
- Other
  - Alcohol
  - Liver disease
  - Hypothyroidism
  - HIV
  - Medications: triamterene, valproic acid

Leukocytes

CLL
- Smudge cells
- Soccer ball cells
Reactive changes
- Dohle bodies: diffuse blue dot in cytoplasm
- Hypergranulation
- Vacuolation
Left shift: increase in
- Promyelocytes
- Myelocytes
- Metamyelocytes
- Bands
- Neutrophils

@@ Line 4: / Line 4: @@
 * Agglutination: suggests IgM, either expected response to infection or autoimmune hemolytic anemia
+* Rouleaux: may be artifact from poor preparaction; otherwise, it is caused by an increase in certain proteins, such as immunoglobulins and fibrinogen, and can be seen in infection (acute or chronic), [[connective tissue disease]], [[chronic liver disease]], and [[myeloma]] and [[macroglobulinemia]]
-* Rouleaux: [[paraproteinemia]]
+[[paraproteinemia]]
 === Morphology ===
@@ Line 17: / Line 19: @@
 === Size ===
-* Microcytic red blood cells
+* '''Microcytic''' red blood cells
 ** [[Iron-deficiency anemia]]
 *** Anisopoikilocytosis
@@ Line 28: / Line 30: @@
 *** Increased reticulocytes
 *** Positive HbH test (in alpha-thal) or Hb electrophoresis (in beta-thal)
-* Macrocytic red blood cells
+* '''Macrocytic''' red blood cells
 ** [[Megaloblastic anemia|Megaloblastic]] with hypersegmented neutrophils
-*** [[Vitamin B12 deficiency]], [[folate deficiency]], medications, and [[myelodysplastic syndrome]]
+*** [[Vitamin B12 deficiency]] or [[folate deficiency]]
+***[[Myelodysplastic syndrome]]
-** Non-megaloblastic
+***Medications: [[allopurinol]], [[aminosalicylic acid]] (decreased folate), antacids (decreased B12), [[ampicillin]] and other [[penicillins]] (decreased folate), [[azathioprine]], [[capecitabine]], [[chloramphenicol]] (decreased folate), [[cladribine]], [[cytosine arabinoside]] (ara-C), [[erythromycin]] (decreased folate), estrogens (decreased folate), [[fludarabine]], [[fluorouracil]], [[gadolinium]], [[gemcitabine]], histamine H2 blockers (decreased B12), [[hydroxyurea]], [[imatinib]], [[lamivudine]], [[leflunomide]], [[mercaptopurine]], [[metformin]] (decreased folate), [[methotrexate]], [[mycophenolate mofetil]], [[nitrofurantoin]] (decreased folate), [[pentostatin]], [[phenytoin]] (folate), [[primadone]], proton pump inhibitors (decreased B12), [[sunitinib]], [[teriflunomide]], [[tetracyclines]] (decreased folate), [[thioguanine]], [[trimethoprim]], [[zidovudine]]
-*** [[Alcohol]], [[liver disease]], [[hypothyroidism]]
+** Reticulocytosis
+***Hemolytic anemia
+***Medications causing hemolytic anemia in G6PD deficiency: [[dapsone]], [[methylene blue]], [[nitrofurantoin]], [[pegloticase]], [[primaquine]], [[rasburicase]]
+***Bone marrow recovery after chemotherapy or hematopoietic stem cell transplant
+***Increased erythropoiesis following administration of [[erythropoietin]], repletion of iron, [[vitamin B12]], or [[folate]]
+***Recovery from bleeding episode
+**Other
+*** [[Alcohol]]
+***[[Liver disease]]
+***[[Hypothyroidism]]
+***[[HIV]]
+***Medications: [[triamterene]], [[valproic acid]]
 == Leukocytes ==