CAP Pro Course - Hematology - Erythrocyte Inclusions

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Author: Margaret A. Reinhart, MS, MT(ASCP)
Reviewers: Laurie Bjerklie, M.A., MLS(ASCP) and Rory Huschka, M.Ed., MLS(ASCP)

Continuing Education Credits

Objectives

  • Identify clinically relevant erythrocyte inclusions.
  • Choose the appropriate stain to aid in the identification of erythrocyte inclusions.
  • Differentiate erythrocyte inclusions from common peripheral blood smear observations.
  • Correlate clinical conditions with the presence of clinically relevant erythrocyte inclusions.

Course Outline

  • Identify clinically relevant erythrocyte inclusions.
      • Introduction to Erythrocyte Inclusions
      • Table 1. Erythrocyte Inclusions
      • What is the composition of the red cell inclusions in this Wright's stained peripheral blood film?
      • Which red blood cell inclusion can appear in a tetrad configuration resembling a Maltese cross formation?
      • What is the identity of the inclusions indicated by the arrows in the image on the right of a peripheral blood smear stained with Wright stain?
      • This Wright's stained peripheral blood film is from a 2-year-old child who had been living in an old urban home which his family was renovating. The p...
      • You observed these structures on the peripheral blood smear of a newly admitted anemic patient. A phone call to the patient’s physician indicate...
  • Choose the appropriate stain to aid in the identification of erythrocyte inclusions.
      • Staining Methods to Detect Erythrocyte Inclusions
      • Table 2. Recommended Stains for Various Erythrocyte Inclusions
      • If there is an increase in macrocytic, polychromatophilic erythrocytes on a routine blood smear, which laboratory stain could be used to visualize the...
      • Which red blood cell inclusion is visible on a Wright-stained blood smear and a smear stained with Prussian Blue?
      • Your supervisor has asked that peripheral blood smear slides be prepared and stained manually for routine microscopic smear review while the automated...
      • What stain would you select if asked to evaluate a patient's bone marrow smear for the presence of siderosomes?
      • A physician asks you to review a smear for the presence of malaria parasites. What type of smear would you choose?
  • Differentiate erythrocyte inclusions from common peripheral blood smear observations.
      • Extracellular Organisms, Cellular Blood Components, and Artifacts
      • Table 3. Conditions Impacting Erythrocyte Inclusion Identification
      • How would you identify these erythrocyte inclusions and what further action would you take?
      • You observed this structure indicated by the arrow on the peripheral blood smear of a patient with an immune system disorder. The patient’s admi...
      • An elevated result for which of these tests would help confirm the finding of polychromasia on a peripheral blood smear?
      • What is the identity of the erythrocyte inclusion seen on this peripheral blood smear stained with Wright stain?
      • What is the identity of the arrowed object seen in this image of a peripheral blood smear that was stained with Wright stain?
      • You notice the following morphology (pictured to the right) in patches throughout the slide on a Wright stained peripheral blood smear. Before reporti...
  • Correlate clinical conditions with the presence of clinically relevant erythrocyte inclusions.
      • Clinically Relevant Erythrocyte Inclusions
      • Table 4. Association of Erythrocyte Inclusions with Clinical Conditions
      • What erythrocyte inclusion containing DNA remnants can be commonly found on a peripheral blood smear of a person who has lost the functionality of the...
      • A child was recently brought to the emergency department after ingestion of a large amount of lead-based paint peeling from the basement wall of an ol...
      • A patient presents to the emergency department (ED) in Iowa with increasing fatigue, fever, and chills. The patient's symptoms appeared shortly after ...
      • There are many factors that influence the frequency of reported inclusion bodies seen during manual smear analysis. Of the factors listed below, which...
      • You reported the presence of Cabot rings in the erythrocytes of an elderly male patient. What clinical condition is consistent with this finding?
      • What is the clinical significance of observing Howell-Jolly bodies in the erythrocytes of a patient with sickle cell disease?
      • What is the clinical significance of the structure indicated by the arrow in this image?
      • Which clinical conditions are associated with Heinz bodies?
      • Which two clinical conditions are associated with Cabot rings?
      • Which of the following inclusions strongly suggests the presence of lead poisoning?
  • References
      • References

Additional Information

Level of Instruction:  Intermediate
Intended Audience:  This program is designed as an educational and training tool for MLS, MT, and MLT personnel, medical laboratory science students and interns, pathology residents, and practicing pathologists. 
Author Information: Margaret Reinhart, MS, MT(ASCP) is the MLS Program Director and Senior lecturer in Biological Sciences at the University of the Sciences in Philadelphia PA where she teaches hematology, clinical immunology, parasitology, and other related courses. She is also an adjunct instructor in Hematology at Pennsylvania Hospital, Philadelphia PA. She holds a Masters Degree in Biology and in Health Care Administration.
Reviewer Information:  Laurie Bjerklie, M.A., MLS(ASCP)CM is currently a Content Developer for MediaLab and LabCE. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 14 years of experience in higher education and has held faculty positions in both MLT and MLS programs. She most recently served as the Program Manager of Medical Laboratory Science at Saint Louis University.
Reviewer Information:  Rory Huschka, M.Ed., MLS(ASCP), currently works on the content development team at MediaLab.  He has experience as a plasma center manager and several years in the clinical laboratory in leadership roles.  With over 20 years of experience in higher education as a Program Director and Professor, Rory continues to work as an adjunct instructor at various MLT and MLS programs across the country.  
  
 

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