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|A peripheral blood smear made from an EDTA-anticoagulated blood specimen revealed the following results when stained with Wright-Giemsa stain and viewed with 1000X magnification. What red blood cell morphologies are indicated by the arrows?||View Page|
|Complete Blood Count Results|
The following table represents the complete blood count (CBC) results obtained for this patient:CBC ParameterPatient ResultReference IntervalsWBC 6.1 X 10 9/L 4.0 - 10.5 X 109/LRBC4.84 X 1012/L3.50 - 5.50 X 1012/LHemoglobin8.4 g/dL 12.0 - 16.0 g/dLHematocrit28.8%36.0 - 48.0%MCV59 fL 80.0 - 100.0 fLMCH17.4 pg 26.0 - 34.0 pgMCHC29.3 g/dL32.0 - 36.0 g/dLRDW 19.5 % 11.0 - 15.0 %Platelets591 X 109/L150 - 400 X 109/LEven though the RBC count is normal, it is increased for the amount of hemoglobin present. The concentration of hemoglobin in the RBCs is slightly decreased (hypochromic) and the cells are small (microcytic). The variation in RBC size is also slightly above the normal reference range as are the number of platelets.
|Alpha Thalassemia Major|
In alpha thalassemia major, anemia is actually fatal. Red blood cell (RBC) count is increased while hemoglobin is severely decreased. Both the MCV and MCHC are decreased. Red cell distribution width (RDW) is increased. RBC morphology shows slight hypochromic microcytosis with codocytes, schizocytes, nucleated RBCs. Reticulocytes are increased.Hemoglobin electrophoresis demonstrates abnormal pattern on cord blood: Hb A - absentHb Bart's - 80-90%Hb Portland - 0-20%Note: Bone marrow demonstrates marked erythroid hyperplasia.
|Case Study: Immune Alloantibody|
A 42-year-old male received 6 units of RBCs during open heart surgery 6 months ago. His antibody screen was negative at that time. He has returned for a follow up surgery and his antibody screen is now positive with both screen cells at the AHG phase.Reactions are occurring at AHG phase, which indicates a possible clinically significant antibody, Jka showing dosage. Refer to Case Study 1 panel below to see reactions of antibody panel.IS = Immediate Spin; AHG = Antihuman Globulin Phase; CC = Check Cells; AC = Auto Control; ND= Not doneCase study 1 conclusion:Patient's previous transfusion 6 months ago exposed him to the Jka antigen, causing the formation of this antibody, which is known for showing dosage.
|Naturally occurring antibodies found in the ABO blood group system may be due to exposure to which of the following?||View Page|
|Products Used to Facilitate Antibody Identification|
Monospecific anti-human globulin (IgG) enables sensitized red cells to cross-link so that agglutination is visible.Enhancement media are sometimes used to further promote agglutination and reduce incubation time. Low ionic strength saline (LISS) is the most common enhancement media. LISS reduces the ionic strength in the testing sample and causes reduction of the zeta potential. It increases antibody uptake and decreases incubation time. Polyethylene glycol (PEG): brings red blood cells (RBCs) closer together and concentrates antibodies by removing water molecules from the testing sample. It is the most sensitive of the enhancement media; strengthening almost all clinically significant antibodies. However, it will also enhance some clinically insignificant antibodies as well. Centrifugation should be avoided when PEG is used. PEG can cause aggregates to form if the sample (red cell - serum mixture) with PEG added is centrifuged. Reaction readings should only be done at the AHG phase. 22% albumin: reduces zeta potential, bringing the RBCs closer together and enhancing agglutination. Albumin does not contribute much to antibody uptake. Longer incubation time is needed with this media than with the previously discussed media. Detection of some IgG antibodies can be enhanced with enzyme test methods. Proteolytic enzymes (papain and ficin) denature some RBC antigens and remove negative charges from the RBC membranes. This reduces the zeta potential, bringing the cells closer together. Enzyme techniques are particularly useful in the identification of Rh antibodies and antibodies in the Kidd, Lewis, P and I systems. However, enzymes destroy some antigens including Fya, Fyb, M, and N. The effect of proteolytic enzymes on the S and s antigens are variable.
|Hematologic Findings For Various Types of Beta Thalassemia|
Beta Thalassemia MinimaBeta Thalassemia MinorBeta Thalassemia Intermedia Beta Thalassemia MajorDelta-Beta ThalassemiaAnemiaAbsentMild to absentModerateSevereMildRed blood cell (RBC) countNormalIncreasedDecreased to normalDecreasedDecreased to normalHemoglobin(Hb)NormalDecreased to normal (10 - 12 g/dL) Decreased (7 - 10 g/dL)Marked decrease (<7 g/dL)Decreased to normal (8 - 13 g/dL)Mean corpuscular volume (MCV)Slight to no decreaseMarked decreaseMarked decreaseMarked decreaseMay be slightly decreasedMean corpuscular hemoglobin concentration (MCHC)Slight to no decreaseMarked decrease Marked decreaseMarked decreaseMay be slightly decreasedRed blood cell distribution width (RDW)NormalNormal to slightly increasedIncreasedIncreasedNormalRBC morphologyNormalMarked hypochromia and microcytosis Codocytes (target cells) Possible basophilic stippling Nucleated RBCs are usually not presentMarked hypochromia and microcytosis Codocytes (target cells) Possible basophilic stippling Nucleated RBCs are usually not presentMarked hypochromia and microcytosis Codocytes (target cells) schistocytes ovalocytes basophilic stippling polychromasia nucleated RBCs Possible hypochromia and microcytosis Codocytes (target cells) Basophilic stippling Reticulocyte countNormalMay be slightly increasedSlightly increased (<5%)Mildly increased (5 - 10%)Mildly increasedHb electrophoresisNormal patternDecreased amount of Hb A Variable amounts of Hb A2 and Hb F Decreased amount of Hb A Variable amount of Hb A2 Hb F is usually increased Severly decreased amount of Hb A Variable amount of Hb A2 Usually an increased amount of Hb F Decreased amount of Hb A and Hb A2 Increased amount of Hb F (15 - 20%)If red blood cells are normochromic and normocytic, the RBC, Hb, and Hematocrit (HCT) test values follow in three-fold progression (i.e., RBC x 3 = Hb and Hb x 3 = HCT). This is sometimes referred to as "the rule of threes." This rule will usually not apply in cases of beta thalassemia, particularly beta thalassemia minor where the RBCs are not normochromic and are microcytic, and where there is a disproportionate number of RBCs for the amount of hemoglobin that is present.
|The CBC results in this case break the rule of three. What is the rule of three?||View Page|
|Laboratory Test Results|
TestPatient ResultReference Intervals (Adult female)White blood cell (WBC) count 3.7 x 109/L4.4 - 11.3 x 109/LRed blood cell (RBC) count5.6 x 1012/L4.1 - 5.1 x 1012/LHemoglobin (Hb)10.5 g/dL12.3 - 15.3 g/dLHematocrit (HCT)36.6%35.9 - 44.6%MCV65.8 fL80.0 - 96.0 fLMCH19.9 pg27.5 - 33.2 pgMCHC26.7%33.4 - 35.5%RDW14.0<14.5Platelets249.0 x 109/L100.0 - 450.0 x 109/LTotal serum iron165 µg/dL60 - 150 µg/dL Iron-binding capacity230 µg/dL250 - 400 µg/dLThe RBC count is increased for the amount of hemoglobin present. The concentration of hemoglobin in the RBCs is slightly decreased (hypochromic) and the cells are small (microcytic). The variation in RBC size (RDW) is within normal limits.
|Why is it important to note that the red cell distribution width (RDW) in this case is normal ?||View Page|
|Based on the following reactions indicate the correct blood group for each set of
|Which one of the following is not a benefit of using packed RBCs:||View Page|
|Which of the following types of whole blood would be the least satisfactory to transfuse to a type AB patient:||View Page|
|Which of the following types of packed RBCs could be transfused to a group O patient:||View Page|
|The use of the direct antiglobulin test is indicated in all the following except:||View Page|
|Which of the following is the proper storage temperature for frozen red cells:||View Page|
|Which of the following is the proper storage temperature for fresh frozen plasma:||View Page|
|Hemapheresis is used to harvest all of the following EXCEPT:||View Page|
|Normal Cell Counts|
Up to 5 WBCs per microliter are present in normal adult CSF.
Children have slightly higher counts, while in newborns a count of up to 30 leukocytes per microliter is within normal limits.
CSF containing up to 200 WBCs or 400 RBCs per microliter may appear clear or only slightly hazy, so all specimens must be examined microscopically.
|WBC Correction for Traumatic Tap|
A calculation is used to correct CSF WBC counts which are falsely increased due to a traumatic tap:
WBCs added = WBC(blood) x RBC(CSF) / RBC(blood)The blood WBC count is multiplied by the ratio of the cerebrospinal fluid RBC count to blood RBC count.The result is the number of artificially introduced WBCs. The true CSF white cell count is then calculated by subtracting the artificially introduced WBCs from the actual CSF WBC count.
If the patient's peripheral WBC and RBC counts are within normal limits, some laboratories use the following formula:
Subtract one white cell from the CSF WBC count for each 750 RBC counted in the spinal fluid.
|Table of Normal CSF Properties|
The following table lists the properties of normal CSF in adults and children: Condition Appearance Predominant Cell normal adult clear, colorless lymph 60% monocytes 30% neutrophil 2% 0-5 WBC / ul 0 RBC / ul normal neonate clear, colorless lymph 20% monocytes 70% neutrophil 4% 0-30 WBC / ul variable RBC Adapted from Saunders Manual of Clinical Laboratory Science. Craig A. Lehrmann, Ed. WB Saunders, 1998.
|The cells present in this illustration are:||View Page|
|Which of the following analytes would not be significantly increased in a plasma sample as a result of hemolysis:||View Page|
|The measurement of total glycosylated hemoglobin A1c is an effective means of assessing the average blood glucose levels:||View Page|
|Which of the following cells when found upon microscopic examination of the urine
would be most indicative of kidney disease:||View Page|
|In a patient with acute glomerulonephritis you would expect to find all but the following
in the urine except:||View Page|
|Which of the following statements best describes Pappenheimer bodies?||View Page|
|Which of the following cells when found upon microscopic examination of the urine would be most indicative of kidney disease:||View Page|
|Hematocrit is:||View Page|
|Choose the term that describes the most prominent finding in this peripheral smear:||View Page|
|The RBCs found in this illustration are the result of:||View Page|
|The abnormal RBCs seen in this illustration are indicative of:||View Page|
|The abnormal RBCs seen in this smear, such as those shown by the arrow are typically seen in:||View Page|
|The abnormal RBCs shape seen in this illustration is:||View Page|
|The RBCs indicated by the arrows in this illustration are indicative of:||View Page|
|The RBCs seen in this illustration are indicative of:||View Page|
|The intracellular precipitates seen in the RBCs in this illustration is termed:||View Page|
|Which of the following observations would best explain why a peripheral blood smear is exhibiting polychromasia:||View Page|
|Hypochromia can best be described as:||View Page|
|The reticulocyte count is used to assess which of the following:||View Page|
|Which of the following is not associated with RBC macrocytosis?||View Page|
|Which of the following would best describe what you might observe after a traumatic CSF tap:||View Page|
|Match the blood types from the drop-down boxes with the appropriate descriptions to the right of the boxes.||View Page|
|Why does agglutination (clumping) sometimes occur when red blood cells (RBCs) from one individual are mixed with serum from another?||View Page|
|Match the blood types in the drop down boxes with the characteristics on the right.||View Page|
|In order to determine the ABO type, known antisera are mixed with patient RBCs and known red cells are mixed with patient serum.||View Page|
|The H gene|
Three separate loci (ABO, Hh, and Se) contain the genes that control the location and occurrence of the A and B antigens. Hh and Se genes are closely linked on chromosome 19. The precursor substance is acted upon by the H gene and is converted to H substance. The product of the H gene is an enzyme fucosyltransferase, responsible for attaching fucose to the terminal galactose of the precursor substance on the RBC membrane and thus forming H substance. There are only two recognized alleles at this locus: the active form, H, and an amorph, h. The H gene is a high-incidence gene. People who inherit hh are extremely rare. Since the h gene is amorphic, it does not act on the precursor substance.
|The cell diameter of a normal RBC is slightly smaller than the nucleus of a small lymphocyte.||View Page|
In stained blood films, only the flattened surfaces of the RBC's are seen. Therefore, they appear circular with an area of central pallor corresponding to the indented area. The central pallor occupies about 1/3 of the diameter of the cell.
|Function and Kinetics|
Erythrocytes are produced in the bone marrow and released into the peripheral blood where they may remain for approximately 120 days before senescence.Their main function is the transport of the respiratory gases (oxygen and carbon dioxide) between the lungs and body tissues.Each erythrocyte can be thought of as an "envelope" containing hemoglobin.Each hemoglobin molecule contains iron which has a high affinity for oxygen.As a result, when an erythrocyte passes through one of the capillaries of the lungs, it picks up oxygen.The oxygen is transported through the blood to the tissues where it is released.Carbon dioxide from the tissues then diffuses into the RBC where it undergoes chemical changes.About 70% of the altered carbon dioxide diffuses into the plasma, 25% binds to the hemoglobin molecule, and 5% goes into simple solution within the red cell.In each of these three ways carbon dioxide is transported from the body tissues back to the lungs, where it is released.
|All of the following methods can be used to transport carbon dioxide to the lungs EXCEPT:||View Page|
|Erythrocytes or Red Blood Cells (RBC's)|
The first group is composed of erythrocytes or red blood cells (RBC's). The main function of the erythrocytes is the transport of oxygen from the lungs to the body tissues. Most of the cells in this Wright's stained peripheral blood smear are red cells. On is shown at the arrowhead.
|Glossary of Terms A through M.|
Antibody - A modified type of serum globulin synthesized by lymphoid tissue in response to antigenic stimulus. By virtue of specific combining sites each antibody reacts with only one antigen. Anucleate - Having no nucleus. Azurophilic granules - The well-defined large reddish granules (lysosomes) which may be present in large lymphocytes. They are called "azurophilic granules" because they stain blue with the azure stains which were originally used. Basophilic granules - Specific granules present in the cytoplasm of basophils. These granules are large and stain purple-black due to their strong affinity for basic stain. B-cell - Bone marrow derived lymphocytes which produce humoral antibodies. Biconcave - Having two concave surfaces. Cellular Immunity - The capacity of a small proportion of lymphoid population to exhibit response to a specific antigen. Chromomere - The centrally located granular portion of the platelet. Clone - A population of cells descended from a single cell. Delayed Hypersensitivity - (part of cellular immunity) that develops slowly over a period of 24-72 hours after an antigenic stimulus. It consists of an accumulation of cells around small vessels and/or nerves. Example: Tuberculin skin test reaction. Digestive Enzyme - A substance that catalyzes or accelerates the process of digestion. Eosinophilic Granules - Specific granules present in the cytoplasm of eosinophils. These granules are large, refractile spheres which stain reddish-orange due to their strong affinity for acid stain. Erythrocyte (red blood cell, RBC) - One of the elements found in peripheral blood. Normally the mature form is a non-nucleated, circular, biconcave disk adapted to transport respiratory gases. Fixed Macrophage - A phagocyte that is non-motile. Free Macrophage - An ameboid phagocyte present at the site of inflammation. Graft Rejection - A transplanted tissue that is rejected by the body's antibodies. Graft vs. Host Reaction - A complication that occurs when an implanted piece of tissue, which contains antibodies, rejects the host's tissue. Granulocyte - A leukocyte which contains granules in its cytoplasm, i.e., neutrophilic, eosinophilic, or basophilic granules. Half-life - is the length of time it takes for half of the cells circulating at a given time to leave the blood for the tissues. Hemocyte - Any blood cell or formed element of the blood. Hemostasis - A mechanism of the vascular system to arrest an escape of blood. It involves an interaction between blood vessels, platelets, and coagulation. Heparin - A mucopolysaccharide acid which, when present in sufficient amounts, functions as an anticoagulant by inhibiting thrombin. Histamine - A powerful dilator of capillaries and a stimulator of gastric secretions. Humoral Immunity - Acquired immunity produced after response to an antigenic stimulus in which B cells produce circulating antibodies. Hyalomere - the clear, blue non-granular zone surrounding the chromomere of a platelet. Immune Response - The interaction of a cell and an antigen that results in a proliferation of the cell and a capacity to produce antibodies. Isotonic Fluid - A fluid whose elements have an equal osmotic pressure. Leukocyte (white blood cell, WBC) - One of the formed elements of the blood; involved primarily with the body's defense. Lysosome - A microscopic body within cell cytoplasm; contains various enzymes, mainly hydrolytic, which are released upon injury to the cell. Megakaryocyte - A giant cell of the bone marrow from which platelets are derived. Mononuclear - A cell having a single nucleus.
|Nucleus of Lymphocyte|
The nucleus is slightly larger than a normal RBC. It is usually round or oval in shape, but may be slightly indented. The chromatin is very dense and clumped.
|Match the following terms relating to the life cycle of select Sporozoa to their respective definitions:||View Page|
|A 27 year old West African immigrant went to the local clinic complaining of fever, chills, and joint pain. The physician immediately ordered blood for parasitic examination. The Giemsa-stained thin blood smear revealed the three suspicious forms below. This patient is most likely suffering from an infection with:||View Page|
Hemolysis can easily be caused by improper phlebotomy techniques. Hemolysis occurs when RBCs are broken up and hemoglobin is released into the plasma, causing it to become pink rather than its natural straw color. Hemolysis can occur by using too small a needle, pulling a syringe plunger too rapidly, expelling blood vigorously into a tube, or shaking a tube of blood too hard. Hemolysis can cause falsely increased potassium, magnesium, iron, and ammonia levels, and other aberrant lab results.In this case, Marcie did not properly wipe the site with gauze after cleaning it with alcohol, and alcohol contacting the blood could have caused RBCs to break up or hemolyze. Marcie also squeezed the baby's foot too hard, causing hemolysis.Relevant topics:Site selection and preparation, Heelstick: Puncture, Hemolysis, Causes of hemolysis
|Size and Appearance of Cellular Elements|
Type of Cell Size Shape Stain Epithelial cells 25 microns irregular pink/red White blood cells 12 microns round pink/red Red blood cells 7 microns round pink/red Yeast 7 microns ovoid blue Bacteria 0.5 - 1 micron variable blue or red Epithelial cells are larger than white blood cells and red blood cells, and contain a single nucleus. White blood cells (neutrophils contained in pus) usually show a segmented nucleus. Red blood cells are 1/2 to 2/3 as large as white blood cells, contain no nucleus, and are Gram negative. Hyphae are gram positive tubular filamentous fungal elements which may show branching or intertwining. Yeast cells are round to oval, often budding, Gram positive fungal elements, about the same size as RBCs. They are generally much larger than bacteria.
|The MCHC value is 39 gm/dl of RBC. Which of the following is the most likely explanation?||View Page|
Examples of hypochromic cells are seen in this slide. Notice the thin rim of hemoglobin and the large area of central pallor present in most of these cells. Hypochromic cells are cells that are unusually thin, or in which the hemoglobin concentration is decreased. Decreased hemoglobin concentration can be caused by decreased amounts of iron available for hemoglobin production. The MCHC for this patient was significantly decreased (26 gm/dL of RBCs), indicating a severe degree of hypochromia. When hypochromia is less severe, not all cells will be affected; thus some cells may appear almost normal whereas others are hypochromic.
|Another Example of Hyperchromia|
Another example of "hyperchromic" cells seen at the edge of a smear. If MCHC is above 36 gms/dl of RBC, recheck hemoglobin and hematocrit; technical error is most likely the cause.
Preanalytical Error What is it? How does it happen? What is the result? Hemolysis Red blood cells (RBCs) break and release contents of cell into plasma. Needle incorrectly positioned in vein; cells forced to squeeze through opening. Needle gauge too small; slow blood return into tube. Vigorous mixing or shaking of tube. Alcohol on skin that has not had sufficient time to dry. Some test results may be falsely elevated. (Potassium is especially affected by hemolysis.) Patient may have to be re-drawn. Clotted specimen Clumped or clotted cells in specimen that requires anticoagulated or whole blood Insufficient mixing of blood with anticoagulant in tube. Delay in mixing tube. Slow filling tube. Inaccurate test results for cell counts and clotting studies. Patient may have to be re-drawn. Tube filled to incorrect volume Too little or too much blood in tube. Tube removed from needle too quickly. Vacuum in tube has been compromised due to use of tube past the expiration date (Results in a short fill). Manual fill of tube may lead to over-fill. Test results may be unreliable due to dilution errors. Patient may have to be re-drawn.
|Balancing the risks|
Life-Threatening HemorrhageDespite potential risk, sometimes immediate transfusion is necessary, even for patients with red cell antibodies. In such cases transfusion service staff should alert the medical director, who can discuss options with clinical staff.The medical director will generally talk to the staff attending the patient and indicate that, if possible, they should hold off transfusion. But if it is a case of massive bleeding where exsanguinating hemorrhage is likely, it is better to give some blood and monitor for a delayed hemolytic transfusion reaction than to let the patient bleed to death.Transfusing when bleeding is brisk will result in much of the autologous and incompatible blood bleeding out, with the possibility of a delayed hemolytic reaction once the patient's antibody rebounds and destroys still present antigen-positive donor red cells.Some transfusion services also try to minimize the risk of unmatched blood by typing their emergency supply of O Rh negative RBCs for the K antigen, since anti-K is a relatively common clinically significant antibody. See Resources for two papers that discuss the risks of transfusing un-crossmatched emergency blood.
|ABO, Rh and antibody screen|
These ABO, Rh, and antibody screen results were obtained by the TS using the blood specimen that was collected prior to starting the emergency transfusion with O Rh-negative RBCs. ABO and Rh typing ABO Forward Group ABO Reverse Group Rh anti-A anti-B A1 cells B cells anti-D 0 0 4+ 4+ 3+ Antibody screen Cells Gel IAT* Screen Cell I 3+ Screen Cell II 2+ Screen Cell III 2+ * IAT = indirect antiglobulin test
|The antibody screen is positive but the transfusion of the O Rh-negative RBCs is already in progress. What are the transfusion service (TS) laboratory's priorities in this case?Place the following procedures that will be followed by the TS in the appropriate order of priority.||View Page|
These are the results of the crossmatch that was being performed in the transfusion service laboratory while the patient was receiving the two units of O Rh-negative RBCs. Cells Gel IAT* Donor I** 2+ Donor 2** 2+ Donor 3 3+ Donor 4 3+ Donor 5 2+ Donor 6 3+ * IAT = indirect antiglobulin test ** O Rh-negative RBC (Donors 3 - 6 are O Rh-positive)
|Which of the following statements about mixed-field agglutination (MFA) are true? Select all that are correct.||View Page|
|In this case, which red blood cells (RBCs) do you think are agglutinating in the DAT and why? ||View Page|
|Which of the following findings may correlate with the presence of a yeast infection?||View Page|
|What is the identity of the cells that are indicated by the arrow in this image?||View Page|
|True or false? The cells that are indicated by the arrows in this urine sediment (using phase contrast microscopy) are red blood cells (RBCs).||View Page|
|Many white blood cells (WBCs) are present in this image of urine sediment that is observed using brightfield microscopy.||View Page|
|Match the following:||View Page|
|Red Cell Casts|
Red cell casts appear as clear cylinders containing red blood cells and may have an orange-red tinge. Their presence indicates bleeding into the nephron. Red cells within the cast are rapidly hemolyzed and the cast becomes a hemoglobin cast, having an orange color and a homogeneous ground-glass texture. In order for a cast to be considered an RBC cast, the outline of the red cells must be clearly visible in at least one area of the cast.
|Red and White Cells|
There are many red and white cells in this high power field. There are a group of five red cells that can be identified on the lower right-hand side of the field. It is important to use the fine focus adjustment on the microscope when trying to differentiate RBCs from WBCs.Supravital stain can help to distinguish RBCs from WBCs. Two RBCs are indicated by blue arrows and a WBC is indicated by the red arrow in the lower image of a supravital-stained sediment/
In contrast, RBCs appear swollen in dilute or alkaline urine, having taken on water from their surroundings.
Yeast can appear as single cells or in the budding form. As single cells they can be confused with RBCs because they are about the same size. In the budding form, yeast is easily identified as demonstrated on this slide. Yeast can be found in patients with cystitis due to yeast, usually candida, or as a vaginal contaminant from patient's with vaginal candidiasis.
|Which of the following are characteristic of normal RBCs under high power (400X magnification) brightfield microscopy? (Choose all that apply.)||View Page|
|All of the following are characteristic of WBCs under high power (400X magnification) brightfield microscopy EXCEPT that they:||View Page|
|Cell Types Observed in Urine Sediment|
Cells which may be present in the urine include epithelial cells, white blood cells (WBCs) and red blood cells (RBCs). The epithelial cells in the urine may originate from any site in the genitourinary tract. It is normal to find a few epithelial cells in the sediment. WBCs may enter the urinary tract anywhere from the glomerulus to the urethra. The WBCs are mostly neutrophils. RBCs may originate in any part of the urinary tract. Normally, RBCs do not appear in the urine, although the presence of a few RBCs is not considered abnormal.
|Red Blood Cells||View Page|
|In concentrated urine, red blood cells (RBCs) may appear:||View Page|
|Specimen #4 - Adult Male|
The results of this specimen are abnormal but the abnormalities correlate with each other. The turbidity can be explained by the presence of bacteria and crystals. The presence of RBCs in the microscopic explains the blood found on the dipstick. The casts, bacteria and WBCs can account for the increased protein. The results may be reported.
|Match each element to the appropriate method of recording. Note: Answers may be used more than once.||View Page|
Next the number of RBCs, WBCs, epithelial cells, parasites, and fat will be counted.Move to the center of the coverslip and examine 10 fields under high power (40X objective) brightfield. Use phase-contrast as needed. Determine the average number of each element found and record the findings as number per high power field (HPF). An abundance of any one element may be recorded as >100/HPF when 1/4 field is counted and the total field is estimated to be greater than 200/HPF.
|The cells included in the composite image were found in the peripheral blood smear of a patient with the following results:total WBC of 24.5 x 109/L. Differential count:myelocytes 1 metamyelocytes 4 band neutrophils 15 segmented neutrophils 40 monocytes 8 eosinophils 2 basophils 1 lymphocytes 29This hematologic picture is most consistent with:||View Page|
|The upper image of a peripheral blood smear reveals RBC rouleaux formation. Several blood cells that are similar in appearance to the one indicated by the arrow in the bottom image are also seen on the smear. Which of the following conditions is associated with both of these findings?||View Page|
|The peripheral blood smear shown in this image was held for review because of an increase in platelets. Conditions in which platelets are increased as noted in this image include:||View Page|
|A peripheral blood smear is observed during a manual differental review. The patient is a 10 year-old boy with symptoms suggesting appendicitis and an appendectomy is being considered. The total WBC is 18.5 X 1000/uL, RBC's = 5.45 X 1M/uL, hemoglobin = 16.0 g/dL, hematocrit 48.2%.WBC differential:Segs = 53%, bands = 42% (two of which are shown in the image) monocytes = 2% lymphocytes= 2% These findings support the diagnosis of appendicitis.||View Page|
|Case History Two|
An 80-year-old man was seen in the emergency room with sudden onset of right-side chest pain accentuated on inspiration. His cough was productive of yellow sputum, and he was short of breath. His temperature was 101.2°F. A chest X-ray revealed right middle lobe pneumonia. A complete blood count (CBC) was ordered. The results were as follows:CBC ParameterPatient ResultReference IntervalWBC33.0 x 109/L4.0 - 11.0 x 109/LRBC4.5 x 1012/L4.5 - 5.9 x 1012/LHemoglobin15.2 g/dL13.5 - 17.5 g/dLHematocrit44%41 - 53%Platelet200 x 109/L150 - 450 x 109/LSegmented neutrophil6540 - 80%Band neutrophil100 - 5%Lymphocyte 525 - 35%Eosinophil 30 - 5%Basophil 20 - 2%Monocyte252 - 10%A peripheral smear was reviewed based on the elevated WBC and increased monocyte count. A representative field from the Wright-Giemsa stained smear (1000X magnification) is shown on the right. The cells indicated by the blue arrows are atypical monocytes. They have abundant cytoplasm that is more blue than the typical gray-blue cytoplasm of normal monoctes. A few scattered vacuoles are also present. The atypical monocytes, in company with toxic neutrophils (indicated by the red arrow), appeared to be a response to infection. The patient had a past history of tuberculosis, which may account for the monocytosis.