the power of peripheral blood smears: apparent diagnostic...
TRANSCRIPT
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The Power of Peripheral Blood Smears:
Apparent Diagnostic Clues
(October 20, 2011)
By
Gene Gulati, Ph.D., SH(ASCP)Gene Gulati, Ph.D., SH(ASCP)
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Conflict of Interest
NoneNone
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Plan for the Course
Review blood smears, identify abnormal morphologic findings, and relate them to appropriate clinical condition(s)
Part 1: Red cell and platelet abnormalitiesPart 1: Red cell and platelet abnormalities
10 minutes interval
Part 2 : White cell abnormalities
• Audience interaction encouraged throughout the course
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Format of Presentation
A. Present an image of a blood smear (faculty)
B. Identify the abnormal findings
(audience +/- faculty)
C. Summarize the pertinent abnormalities C. Summarize the pertinent abnormalities
(faculty)
D. Relate the findings to appropriate clinical
condition(s) (audience and faculty)
(with the use of audience response system)
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Normal
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Case 1
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Case 1
Question: Select the most likely clinical condition associated with the morphologic findings seen in this blood smear:
A. Thalassemia minorA. Thalassemia minor
B. Thalassemia major
C. Iron deficiency anemia
D. Anemia of chronic disease
![Page 8: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/8.jpg)
Case 1: Answer
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Case 2
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Case 2
Question: The most likely clinical condition
associated with the morphologic findings
of this blood smear is:
A. Thalassemia minor
B. Thalassemia major
C. Anemia of chronic disease
D. Metastatic carcinoma
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Case 2: Answer
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Case 3
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Case 3
Question: The red cell morphology seen in this
blood smear of an adult is most consistent with:
A. G-6-PD deficiency A. G-6-PD deficiency
B. Hereditary stomatocytosis
C. Autoimmune hemolytic anemia
D. Status post packed red cell transfusion
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Case 3: Answer
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Case 4
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Case 4
Question: The morphologic findings seen in
this blood smear are most consistent with:
A. Folate deficiencyA. Folate deficiency
B. Iron deficiency
C. Copper deficiency
D. Zinc deficiency
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Case 4: Answer
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Case 5
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Case 5
Question: The morphologic findings seen in this blood smear of a 14 year old male with a MCV of 90 fL are most consistent with:
A. Sickle cell traitA. Sickle cell trait
B. Sickle cell anemia
C. Sickle-beta-thalassemia
D. Sickle-alpha-thalassemia
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Case 5: Answer
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Case 6
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Case 6
Question: The morphologic findings seen in this blood smear of a 33 year old female with MCV of 89 fL are most consistent with:
A. Sickle cell traitA. Sickle cell trait
B. Sickle cell anemia
C. Sickle-thalassemia
D. Hemoglobin SC disease
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Case 6: Answer
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Case 7
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Case 7
Question: The morphologic findings seen in
this blood smear are most consistent with:
A. Hemoglobin SC diseaseA. Hemoglobin SC disease
B. Hemoglobin C disease
C. Hemoglobin D disease
D. Hemoglobin E disease
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Case 7: Answer
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Case 8
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Case 8
Question: The morphlogic finding of this
blood smear is most consistent with:
A. Hereditary elliptocytosisA. Hereditary elliptocytosis
B. Hereditary pyropoikilocytosis
C. Renal disease
D. Liver disease
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Case 8: Answer
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Case 9
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Case 9
Question: The morphologic finding of this blood smear is most consistent with :
A. Sickle cell crisis
B. Hemoglobin SC diseaseB. Hemoglobin SC disease
C. Hemolytic crisis in hereditary
spherocytosis
D. Oxidant-induced hemolysis in a G6PD
deficient patient
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Case 9: Answer
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Case 10
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Case 10
Question: The morphologic abnormality seen in
this blood smear is most consistent with:
A. Thrombotic thrombocytopenic purpura (TTP)A. Thrombotic thrombocytopenic purpura (TTP)
B. Disseminated intravascular coagulation (DIC)
C. Senile purpura
D. March hemoglobinuria
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Case 10: Answer
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Case 11
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Case 11
Question: The findings of this blood smear of a 50
year old female with a platelet count of 750 x
103/uL are most consistent with:
A. Thrombocytosis (reactive)
B. Thrombocythemia
C. Polycythemia vera
D. Chronic myeloproliferative neoplasm,
unclassifiable
![Page 38: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/38.jpg)
Case 11: Answer
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Case 12
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Case 12
Question: The morphologic abnormality seen in this blood smear is seen primarily in the blood specimen anticoagulated with:
A. Ethylenediaminetetraacetate (EDTA)A. Ethylenediaminetetraacetate (EDTA)
B. Sodium citrate
C. Sodium heparin
D. Lithium heparin
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Case 12: Answer
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Case 13
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Case 13
Question. An increase in the number of white cells seen in this blood smear of a 19 year old female is most consistent with:
A. Bacterial infectionA. Bacterial infection
B. Viral infection
C. Parasitic infection
D. Ricketsial infection
![Page 44: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/44.jpg)
Case 13: Answer
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Case 14
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Case 14
After albumin
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Case 14
Question: The findings of this blood smear
of a 68 year old male are most consistent
with:
A. Chronic lymphocytic leukemia
B. Acute lymphoblastic leukemia
C. Prolymphocytic leukemia
D. Leukemic phase of large cell lymphoma
![Page 48: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/48.jpg)
Case 14: Answer
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Case 15
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Case 15
Question: The findings of this blood smear
of a 65 year old male are most consistent
with:
A. Chronic lymphocytic leukemia
B. Prolymphocytic leukemia
C. Hairy cell leukemia
D. Plasma cell leukemia
![Page 51: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/51.jpg)
Case 15: Answer
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Case 16
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Case 16
Question: The findings of this blood smear
of a 50 year old male are most consistent
with:
A. Monocytosis
B. Monocytic leukemia
C. Hairy cell leukemia
D. Plasma cell leukemia
![Page 54: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/54.jpg)
Case 16: Answer
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Case 17
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Case 17
Question: The findings of this blood smear of a 55
year old female, with blasts accounting for 10 %
of all white cells, are most consistent with:
A. Acute myeloblastic leukemia
B. Acute promyelocytic leukemia
C. Chronic myelogenous leukemia (accelerated)
D. Granulocytic leukemoid reaction
![Page 57: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/57.jpg)
Case 17: Answer
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Case 18
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Case 18
Question: The findings of this blood smear of a 28
year old male are most consistent with:
A. LymphocytosisA. Lymphocytosis
B. Atypical lymphocytosis
C. Chronic lymphocytic leukemia
D. Acute leukemia
![Page 60: The Power of Peripheral Blood Smears: Apparent Diagnostic …dn3g20un7godm.cloudfront.net/2011/AM11SA/83.pdf · Question: The findings of this blood smear of a 55 year old female,](https://reader035.vdocument.in/reader035/viewer/2022071215/604678cef1109f73753cbefc/html5/thumbnails/60.jpg)
Case 18: Answer
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Case 19
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Case 19
Question: The findings of this blood smear
are most consistent with:
A. Acute lymphoblastic leukemiaA. Acute lymphoblastic leukemia
B. Acute myeloblastic leukemia
C. Acute promyelocytic leukemia
D. Acute leukemia
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Case 19: Answer
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Case 20
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Case 20
Question: The findings of this blood smear
are most consistent with:
A. Acute myeloblastic leukemiaA. Acute myeloblastic leukemia
B. Acute myelomonocytic leukemia
C. Acute promyelocytic leukemia
D. Reactive monocytosis
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Case 20: Answer
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Case 21
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Case 21
Question: The findings of this blood smear
of a 30 year old female are most
consistent with:
A. Acute leukemia
B. Acute monocytic leukemia
C. Acute promyelocytic leukemia
D. Large Granular lymphocytic leukemia
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Case 21: Answer
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Case 22
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Case 22
Question: The findings of this blood smear of a 42
year old female are most consistent with:
A. Hairy cell leukemiaA. Hairy cell leukemia
B. Plasma cell leukemia
C. Lymphoblastic leukemia
D. Megakaryoblastic leukemia
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Case 22: Answer
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Case 23
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Case 23
Question: The findings of this blood smear
of an 80 year old female are most
consistent with:
A. Myelofibrosis
B. Leukemoid reaction
C. Chronic myelogenous leukemia
D. Chronic myelomonocytic leukemia
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Case 23: Answer
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Case 24Case 24
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Case 24
Question: The findings of this blood smear
of a 65 year old male are most consistent
with:
A. B12 deficiency
B. Folate deficiency
C. Myelodysplastic syndrome
D. Chronic myeloproliferative neoplasm
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Case 24: Answer
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References
1. Blood Cells: An Atlas of Morphology with Clinical Relevance by Gulati, G and Caro, M (ASCP Press, 2007) *
2. Color Atlas of Hematology
Editor: Glassy, EF (CAP, 1998)
3. Blood Cell Morphology Grading Guide
by Gulati, G (ASCP Press, 2009) *
4. Case Studies in Hematology and Coagulation
Editors: Gulati G, Filicko-O’Hara J, and Krause J
(ASCP Press, 2012) *
(*Available for purchase at ascp.org)