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What are the main lineages of cells in the peripheral blood?
Erythroid lineage

Myeloid lineage

Megakaryocyte lineage

Lymphoid lineage
What is the most abundant white cell in the blood?
Neutrophil
What is neutrophilia and what can cause it?
A high number of neutrophils that can be caused by:
- Infection
- Inflammation
- Necrosis
- Physical agents
- Drugs / Toxins
- Neoplasia
- Metabolic disturbances
- Hormonal disturbances
- Endocrine disturbances
- Hematologic abnormalities
What is lymphocytosis and what can cause it?
An increase in the number of lymphocytes in the blood that can be caused by:
- Viral infections
- Toxoplasmosis
- Infectious mononucleosis
What is Bordatella pertussis and with what hematologic condition is it associated?
Whooping cough bacterium

Associated with Lymphocytosis
What is eosinophilia and what can cause this condition?
High number of eosinophils that can be caused by:
- Hypersensitivity
- Allergic disorders
- Parasitic infections
- Certain malignancies
What conditions are most causative of a decline in the number of neutrophils?
Conditions that abnormally affect bone marrow such as:
- Infection
- Alcoholism
- B12 deficiency
- Folic acid deficiency
What is polycythemia vera and how does it affect the blood?
A bone marrow disease that leads to an abnormal increase in the number of blood cells (particularly RBCs)

High HCT

Whole blood hyperviscosity
What would happen to RBC count in hypoxic conditions?
RBC count would increase
Why are RBCs in the shape of oblate spheroids?
The dimpling of the center of the cell allows Hb to be more distributed towards the edges of the cell
What is eryhtrocytosis?
An increase of circulating RBCs
What is anemia?
A decrease of circulating RBCs
What are platelets?
Small blood cells lacking a nucleus that are vital to the initiation of blood clotting
What is thrombocytosis?
Increased platelet count
What are the main causes of thrombocytosis?
Hemorrhage

Iron deficiency
What are conditions that are associated with a decreased platelet count?
Conditions that adversely affect the bone marrow such as:
- Aplastic anemia
- Megaloblastic anemia
- Myelofibrosis
- Radiation toxicity
What are the red cell indicies that are directly measured by the blood analyzer?
RBC (red blood cell count)

MCV (mean corpuscular volume)

HGB (Hb concentration)
What is hematocrit (HCT)?
The fraction of a volume of bloodthat is comprised only of RBCs
What is Mean Corpuscular Hemoglobin (MCH)?
Average Hb content of a red cell
What is Mean Corpuscular Hemoglobin Concentration (MCHC(?
Average concentration of Hb in an individual red cell
What is Red Cell Distribution Width and why is this important?
A measurement of the variability of red cell size

This is useful to examine a wider than normal range of sizes in RBCs
What is megaloblastic anemia and how does it affect RBCs?
Anemia caused by B12 or folic acid deficiency

Increases Mean Corpuscular Volume (MCV)
How does iron deficiency anemia affect RBCs?
Decreases Mean Corpuscular Volume (MCV)
What are reticulocytes?
Premature red blood cells made by the bone marrow
What does the reticulocyte count measure and what must you take into consideration when using this metric?
Reticulocyte count is a percentage of cerculating red cells that are actually reticulocytes

You must consider a change in hematocrit when looking at "retic" measurements to understand whether the bone marrow has increased production of reticulocytes

Retic count (%) x (HCTpatient / HCTnormal)
What is microcytosis and to what condition is it usually secondary to?
Abnormally small RBCs

Secondary to iron deficiency
What would result in anemia, macrocytosis, and a lower than normal HCT:HBG relationship?
Cold agglutinis causing RBCs to agglutinate
What are cold agglutinins and what is cold agglutinin disease?
Cold agglutinins are large autoantibodies (usually IgM) that bind RBC surfaces and cause agglutination

Cold agglutinin disease is when patients develop higher titer cold agglutinins that occur at a temperature near that of normal body temperature
What is the sequence of neutrophil maturation?
Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band → Neutrophil
What cell is this?
Neutrophil:
- Segmented nucleus (3-4 lobes)
- Poorly staining granules
What cell is this?
Eosinophil:
- Segmented nucleus (2 lobes)
- Alkaline pink/red granules
- Binds acidic dye, eosin
What cell is this?
Band neutrophil:
- Immature neutrophil with mature cytoplasm that has not undergone nuclear segmentation
What cell is this?
Basophil:
- Segmented nucleus (2-3 broad flat lobes)
- Acidic granules taking up basic hematoxylin
What cell type is this and when do you see it?
Hypersegmented neutrophil:
- At least 6 nuclear lobes
- Seen in patients with megaloblastic anemia (B12 / folic acid deficient)
- Sometimes seen in myelodysplastic syndromes
What cell type is this and when is it seen?
Hyposegmented neutrophil:
- 1 or 2 (usually 2) nuclear lobes)
- Seen in myelodysplastic syndromes
- Seen in inherited Pelger-Huet anomaly
What cell type is this and when is it seen?
Neutrophil with toxic granulations:
- Seen acute bacterial infection
What is the distinction between these two cells?
Small lymphocyte:
- Round nucleus
- Coarse, condensed chromatin
- Scanty blue cytoplasm

Reactive (atypical) lymphocyte:
- Larger
- Pale blue cytoplasm
- No granules
- Large round/oval nucleus
-
In what conditions are atypical lymphocytes seen?
Viral infections such as hepatitis and mononucleosis
What cell type is this?
Monocyte
- No nucleoli
- Indented or folded nucleus
- Gray-blue foamy cytoplasm
- Vacuoles
- Few granules
What are these and what do they do?
Platelets:
- Specialized anucleate cells
- Important in hemostasis
What is the condition pictured on the right and what can cause this to manifest?
Hypochromic erythrocytes
- Iron deficiency
Compare size of RBC with the nucleus of a normal small lymphocyte
What is anisocytosis?
Variation of red cell size on the same peripheral blood film
What are these variations in red cell shape and when are these conditions seen??
Spherocytes:
- Heriditary spherocytosis
- Immune hemolytic anemia

Teardrop cells:
- Bone marrow invaded by fibrosis, tumor, granuloma

Schistocytes:
- Thrombotic microangiopathic states
- Mechanical red cell trauma

Sickle cells:
- Sickle cell disease
- Sickle cell anemia

Target cells:
- Liver disease
- Obstructive jaundice

Hemoglobin C
- Hemoglobin C homozygotes
What are these red blood cell inclusions and when do they occur?
Basophilic stippling:
- Lead poisoning
- Sideroblastic anemia
- Thalassemia

Howell-Jolly Bodies
- Post-splenectomy states
- Myelodysplastic syndrome

Heinz bodies:
- Glucose 6-phosphate dehydrogenase deficiency
- Unstable hemoglobins