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Peripheral Blood Smear

As a medical student, you might be shown a peripheral blood smear after being given a specific disease scenario on the USMLE Step 1, Step 2CK, or Step 3.  You will also review this topic during your first year of medical school. Here is a quick review of peripheral blood smears and RBC morphology and its associated conditions.

Peripheral Blood Smear


Peripheral blood smear: RBC morphology

Size: Anisocytosis –> Abnormal size variation

Etiology: Any severe anemia

Size: Macrocytes –> (MCV>100)

Etiology: Megaloblastic anemia, liver disease, hemolysis, liver disease, hypothyroid

Size: Microcytes –> MCV< 80

Etiology: Iron deficiency, sideroblastic anemia, thalassemia, lead poisoning

Shape: Acanthocytes  -> small cells with thorn-like projections

Etiology: Hereditary or post-splenectomy

Shape: Burr cells  –> Indented, shriveled cells

Etiology: Hemolysis, uremia, DIC

Shape: Ovalocytes –> oval-shaped cells

Etiology: Hereditary, iron deficiency

Shape: Poikilocytosis –> abnormal shape variation

Etiology:  any severe anemia

Shape: Schistocytes –> fragmented cells

Etiology: intravascular hemolysis, post-splenectomy

Shape: Sickle cells –> twisted crescent shape

Etiology: sickle cell

Shape: spherocytes  –> sphere shaped cells

Etiology: hereditary, extravascular hemolysis, transfusion

Shape: Stomatocytes  –> slit-like center (vs normally round center)

Etiology: Hemolysis, thalassemia, burns, SLE, lead poisoning, liver disease

Shape: Target cells  –> dark center in the middle of the normally clear center of the cell

Etiology: Liver disease, thalassemia, hemoglobinopathy

Shape: Teardrop cells  –>  teardrop-shaped cells

Etiology: Myeloproliferative, thalassemia

Inclusions: basophilic stippling –> small, dark dots (lead, iron)

Etiology: Hemolysis, lead poisoning, thalassemia

Inclusions: Heinz bodies  –> dark inclusions (denatured hemoglobin)

Etiology: G6PD with hemolysis, some hemoglobinopathies

Inclusions: Howell-Jolly bodies –> purple spheres (nuclear debris)

Etiology: Hyposplenism, pernicious anemia, thalassemia

Inclusions: Nucleated RBC –> Nuclei still present (young RBC)

Etiology: Hemolysis, myeloproliferative disease like leukemia, polycythemia vera, marrow infiltration, multiple myeloma, any severe anemia

Inclusions: Pappenheimer bodies –> blud granules (iron)

Etiology: Sideroblastic (iron-loading) anemias, post-splenectomy

source

SOAP Internal Medicine

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