Thrombocytopenia Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Thrombocytopenia and links to relevant pages within the course.
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| An increase in the predominant cell type in this illustration is indicative of: | View Page |
| Match the clinical findings with the associated type of leukemia: | View Page |
| Bone marrow examinations may aid in the diagnosis of: | View Page |
| Leukoerythroblastosis Illustrated in this field is a normoblast and a myelocyte, representing leukoerythroblastosis, a term associated with the release of immature cells from a disrupted marrow. Metastatic disease in the bone marrow, particularly in patients with primary breast or prostate cancer, is usually the culprit. Leukoerythroblastosis in the absence of anemia or thrombocytopenia is a signal to search for cancer metastic to the marrow. Nucleated RBCs were not identified on the blood smear seen here but were detected by an automated analyzer.The mortality rate of elderly patients with increased NRBCs, especially following accidents or general surgery, is greater. | View Page |
| Cardiac hemolysis (Waring Blender Effect) Two photographs of a peripheral blood smear are submitted for review . The smears are from a 9-month-old baby with a heart valve replacement. In the upper photograph is a nucleated RBC and platelets are decreased. Nucleated red cells and occasional giant platelets indicate an active marrow response. In the process of forcing blood cells through the heart valve, erythrocytes are damaged, schistocytes are formed, and platelets are destroyed leading to thrombocytopenia. In the lower field are schistocytes, acanthocytes, echinocytes (burr cells), spherocytes, and the absence of platelets. The presence of burr cells could represent an artifact of smear preparation, but with the history of valve replacement, the red cell changes are likely the result of red cell damage as the cells circulate through the new valve. This situation is described as Waring Blender Effect because of damage to blood cells passing through the new valve, looking as if they had suffered the onslaught of a blender. Target cells and mild hypochromia may reflect iron deficiency through the loss of iron from destruction of RBC's. Iron loss through red cell destruction may be reflected in some hypochromia. | View Page |
| More on May-Hegglin May-Hegglin bodies stain blue and appear to have a more definite shape than Dohle bodies. When examined under electron microscopy, they appear to be aggregates of thread-like structures in a crystal-like arrangement. May-Hegglin inclusions are RNA material believed to be derived from the endoplasmic reticulum.
May-Hegglin bodies can be seen in monocytes and platelets as well as in all mature granulocytes.
The platelets in May-Hegglin anomaly are very bizarre in appearance and thrombocytopenia is usually noted.
When examining a slide that has bizarre platelets and blue-appearing bodies in the cytoplasm, thought should be given to the possibility of the May-Hegglin anomaly. | View Page |
| May-Hegglin Bodies May-Hegglin anomaly is an autosomal dominant condition characterized by the presence of pale blue inclusions in neutrophils, giant platelets, and sometimes thrombocytopenia.
Inclusions can also occur in eosinophils, basophils, and monocytes.
May-Hegglin inclusions resemble Dohle bodies but are larger and more prominent.
Acquired forms of this anomaly may also occur as a result of the use of cytotoxic drugs. May-Hegglin bodies seen under these circumstances are considered pathological. | View Page |
| The combination of neutrophil cytoplasmic inclusions(see upper photograph) and giant platelets (lower photograph) are found in each of the following conditions except: | View Page |
| An electronic platelet count of 40,000/cumm was reported. Review of the peripheral blood smear(see photograph)reveals single platelets in open fields and platelet clumps. The platelet count is likely incorrect. | View Page |
| The peripheral blood smear noted in the photograph was held for morophological and clinical review as the total platelet count was 10,000/cumm. Conditions fitting this picture include: | View Page |
| The May -Hegglin anomaly Illustrated in the upper photograph is a poorly defined cytoplasmic inclusion somewhat resembling a Doehle body. Note, however, that this inclusion is well defined and there is no evidence of toxic granulation in the cytoplasm.When Doehle-like bodies are identified, May-Hegglin anomaly should be considered in the differential diagnosis even though this entity is rare.The May-Hegglin anomaly is an inherited dominant condition in which large 2 - 5 um, basophilic and pyronophilic inclusions are present in granulocytes, including neutrophils, eosinophils, basophils, and monocytes.Similar to Doehle bodies, the May-Hegglin inclusions also are composed of RNA, probably derived from the rough endoplasmic reticulum. May-Hegglin anomaly includes giant platelets containing few fine granules (lower photograph).Sometimes the platelets have bizarre shapes and variable sizes. Variable degrees of thrombocytopenia complicated by mild bleeding problems and purpura may accompany the aberrant platelets. | View Page |