Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions

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Authors: C. William Reiquam, MD; Elmer W. Koneman, MD
Reviewer: Barbara Cebulski, MS, MLS(ASCP)

This collection of informative case studies covers many current topics in red cell disorders. Topics include macrocytosis, intracellular RBC inclusions, echinocytes and acanthocytes, schistocytes, ovalocytes, and rouleaux. Numerous high-quality photomicrographs and real-life situations help ensure learning and retaining needed information.

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Continuing Education Credits

Objectives

  • Review normal and abnormal red blood cell morphologies.
  • Recall the criteria for performing and reporting peripheral blood smear reviews.
  • Demonstrate ability to evaluate red blood cell size, shape, and staining characteristics.
  • Correlate observations of key red blood cell abnormalities on peripheral smears with associated clinical conditions.
  • Recognize, via case studies, peripheral smear evaluations for red blood cell morphology and their clinical implications.

Course Outline

  • Introduction to Red Blood Cell Morphology
    • Normal Red Blood Cell Morphology
      • Normal Red Blood Cell (RBC) Characteristics
      • Initial Evaluation of RBC Morphology From Automated Analyzers
      • Criteria for Peripheral Blood Smear Review
    • The Peripheral Smear: Reviewing Red Blood Cell Morphology
      • Introduction to Red Blood Cell Morphology Reporting
      • Guidelines for Reporting Red Blood Cell Morphology
  • Abnormal Red Blood Cell Morphology Review
      • Red Cell Morphology Reference Tables
    • Size Variations in Red Blood Cells
      • Anisocytosis Reference Table
    • Variations in Hemoglobin Content
      • Hemoglobin Content Reference Table
    • Shape Variations in Red Blood Cells
      • Poikilocytosis Review Table
    • Abnormal Red Blood Cell Distribution
      • Rouleaux and Agglutination
      • Dimorphic (Double Cell) Population
    • Red Blood Cell Inclusions
      • Red Blood Cell Inclusions and Associated Conditions
  • Case Studies in Red Blood Cell Nonneoplastic Conditions
      • Introduction to Red Blood Cell Nonneoplastic Conditions Case Studies
    • Hemolytic Conditions with Spherocytosis
      • Hemolytic conditions with spherocytosis: Case Study OneA 12-year-old child presents with jaundice and scleral icterus. The image to the right captures...
      • Hemolytic conditions with spherocytosis: Case Study One, continued:Which hematologic condition could be associated with the findings shown in this ima...
      • Hemolytic conditions with spherocytosis: Case Study Two A known case of hemolytic disease of the newborn (HDN) is presented in the image on the right....
      • Hemolytic conditions with spherocytosis: Case Study ThreeA 49-year-old male with pneumonia was treated with high-dose intravenous penicillin. He becam...
    • Macrocytosis-Associated Conditions
      • Macrocytosis-associated conditions: Case Study One A complete blood count (CBC) was ordered for a patient recently admitted to the emergency departmen...
      • Macrocytosis-associated conditions: Case Study TwoA patient has an elevated MCV on the automated CBC and a peripheral blood smear is reviewed. A repre...
    • Intracellular RBC Inclusions
      • Intracellular RBC inclusions: Case Study OneA twenty-five-year-old asplenic male with disseminated lymphoma is admitted to the hospital. A CBC is orde...
      • Intracellular RBC inclusions: A toddler is being treated for lead poisoning. You observe the inclusions indicated by the arrows in many RBCs on the pe...
      • A 66-year-old man has been diagnosed with sideroblastic anemia. The inclusions indicated by the arrows in the image were seen in many of the RBCs on h...
      • A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclerae after taking the medication Primaquine. The immediat...
    • Dimorphic Red Blood Cell Populations
      • A blood smear represented by the photograph was submitted for hematologic review. Based on the erythrocyte morphology and the accompanying histogram, ...
    • Target cells and Sickle Cells
      • Hemoglobin E (HbE) and HbE/Beta Thalassemia
      • Case Study A five-month-old Asian child is brought to the pediatrician by her mother who is concerned because the child is not eating well. Upon exami...
      • A CBC and reticulocyte count are ordered on a 10-year-old African-American male who was brought to the emergency department with rapid, shallow breath...
      • Sickle cells along with target cells, as shown in this image, confirm a diagnosis of sickle cell disease (HbSS).
    • Schistocytes, Bite Cells, and Teardrop Cells
      • Case Study A patient is diagnosed with disseminated intravascular coagulation (DIC) based on clinical findings and laboratory results that include dec...
      • The top image on the right represents a Wright-stained microscopic field from a peripheral blood smear. The bottom image represents a microscopic fiel...
      • The cells indicated by the arrows provide a clue to the diagnosis of chronic idiopathic myelofibrosis (primary myelofibrosis). What is the identity of...
      • A 5-year-old girl was brought to the emergency department with bloody diarrhea and severe abdominal pain. A complete blood count produced these result...
    • Ovalocytes, Elliptocytes and Stomatocytes
      • Ovalocytes/Elliptocytes
      • Stomatocytes
      • Case StudyA 13-year-old healthy male presents to his physician for a sports physical. A complete blood count (CBC) is ordered. The automated count tri...
    • Multiple Erythrocyte Abnormalities
      • Case Study
      • Case Study, continued: Splenectomy Morphologies
      • Case Study, continued: Poikylocytosis and Basophilic Stippling
      • This slide is from a 28-year-old female who received a kidney transplant, which was preceded by a splenectomy six months prior to the kidney transplan...
  • References
      • References

Additional Information

Level of Instruction: Intermediate

Intended Audience: Clinical laboratory science students, and medical technologists and technicians seeking review, cross training, or continuing education opportunities. It is also appropriate for medical students and pathology residents.
 
Author information: C. William Reiquam, MD (1923-2015) was a clinical professor of pathology in the School of Medicine, University of Colorado. One of his areas of expertise was hematology.

Author information: Elmer W.Koneman M.D. is Professor Emeritus, Department of Pathology, University of Colorado School of Medicine. Dr. Koneman is a Board Certified Pathologist, former full Professor of Pathology University of Colorado School of Medicine. He is author of numerous journal articles and books.

Reviewer information: Barbara Cebulski, MS, MLS(ASCP) has over 40 years of experience in the medical laboratory profession as a technologist, hematology section supervisor, and laboratory manager. She was an Inspection and Technical Specialist for nine years with the College of American Pathologists in the Laboratory Accreditation Program and, until her retirement in 2015, was Program Director for MediaLab, Inc. Barbara holds a Masters in Instructional Technology from Georgia State University. 

Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions Keywords

These are the most common topics and keywords covered in Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions:

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This course is part of:
table macrocytes
table microcytes
table acantocyte
table burr cells
table sickle cells
table spherocytes
table target cells
table agglutination