Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions (Online Course)

C. William Reiquam, M. D., Elmer W. Koneman, M. D.

This collection of informative case studies covers many 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 learning and retaining needed information.

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Continuing Education Credits

• P.A.C.E.® Contact Hours: 3 hour(s)
• Florida Board of Clinical Laboratory Science CE - General (Hematology): 3 hour(s)

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.

Course Outline

Click on a link in the outline to view a sample page from this course.

• Erythrocyte Disorders
• Peripheral Smear Review: Introduction
• After a review of the peripheral smear represented by this photomicrograph, which report is the most appropriate for documentation of the findings?
• Qualitative reports: Follow-up
• Ways out of the dilemma
• You have been asked to review a peripheral blood smear. You note >10/OIF (oil immersion field) echinocytes (burr cells). Which of the following act...
• Criteria for peripheral blood smear review
• Guidelines for standard reports
• Reporting of laboratory data in regard to blood cell abnormalities
• References
• Smear Case 1: Jaundice and the Peripheral Smear
• A 10-year-old child presents with jaundice and scleral icterus. The photograph captures a section of the peripheral blood smear. The report should dir...
• Considering the predominance of microspherocytes on the blood smear, and the patient's jaundiced condition, what is the most likely diagnosis?
• Spherocytes and reticulocytes
• Warm antibody hemolytic disease
• Hemolytic disease of the newborn
• Smear Case 2: Macrocytosis
• 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 valu...
• Conditions suggested by the macrocytes and the neutrophil in the photograph to the right include:
• 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
• The RBC inclusions shown in the photograph represent which of the following?
• Leukoerythroblastosis
• The peripheral blood smear represented by this field was submitted for hematologic review. The RBC inclusions most likely are:
• Pappenheimer bodies
• G6PD deficiency
• Intracellular RBC Inclusions-G6PD (continued)
• Heinz body formation
• Reticulocyte identification
• Smear Case 4: Dimorphic Red Cell Population
• A blood smear represented by the photograph was submitted for hematologic review. Based on the erythrocyte morphology and the accompanying histogram, ...
• Dimorphic RBC population
• Smear Case 5: Target Cells and Associated Red Cell Abnormalities
• A peripheral smear with red blood cells photographed in a typical field was submitted for review. Which of the following conditions might be eliminate...
• A peripheral blood smear was submitted for review. The presence of sickle cells and target cells as shown is diagnostic of hemoglobin SC disease.
• Sickle cells
• 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...
• Atypical smear: Case follow-up
• 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 no...
• Hb E disease (continued)
• 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 an...
• Hemoglobin H disease
• Leptocytes and target cells
• Smear Case 6: Echinocytes and Acanthocytes
• The erythrocyte at the tip of the arrow is an echinocycte (burr cell).
• The peripheral blood picture shown in the photograph is most consistent with an artifact of smear preparation.
• An isolated acanthocyte most likely is of little importance on an otherwise normochromic, normocytic peripheral blood smear.
• The peripheral blood picture is consistent with each of the following conditions except:
• Smear Case 7: Schistocytes, Bite Cells, and Teardrop Forms
• The presence of erythrocytes with altered morphology (as photographed here) has a close association with each of the following conditions except:
• The underlying condition where the defective erythrocytes marked by arrows are of diagnostic importance is:
• The cells marked by blue arrows in the photograph are associated with all of the following conditions except:
• Smear with teardrop cells
• Schistocytes vs. bite cells
• 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: ...
• DIC: graft vs. host disease
• Cardiac hemolysis (Waring Blender Effect)
• Smear Case 8: Ovalocytes, Elliptocytes and Stomatocytes (Hydrocytes)
• 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 scant...
• Hereditary ovalocytosis and elliptocytosis
• Stomatocytes
• Smear Case 9: Rouleaux and Erythrocyte Agglutination
• The arrangement of erythrocytes on this peripheral blood smear may be seen in each of the following conditions except:
• Rouleaux
• The arrangement of the erythrocytes in this peripheral smear should be reported out as rouleaux formation.
• Smear Case 10: Multiple Erythrocyte Abnormalities
• Case History
• Howell -Jolly bodies/ other erythrocyte environmental alterations
• Normoblasts
• Poikylocytosis and Basophilic Stippling
• Hypersegmented Neutrophils
• Iron Deficiency

Additional Information

Acknowledgements:
Appreciation is expressed to Ms. Bette Jamison, MT (ASCP); Ms. Annie Elrod, MT (ASCP); John Ryder, MD; Peter Shen, MD; and other members of the University of Colorado Health Sciences Center Clinical Laboratory for their assistance in the acquisition of images and the proof reading of a large amount of textual material.