Utility of the peripheral smear and laboratory studies in the ...

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Objectives Review fetal and neonatal hematopoiesis Review normal values in pediatric hematology Special consideration of neonatal smears Use of peripheral smear morphology as an aid in differential diagnosis of hematologic disorders A “hands on” approach - case studies of anemia
Fetal Hematopoiesis Hematopoiesis starts in yolk sac, ends by 2nd month Liver is next – peak is 3rd –4th month, then tapers off In term infant, should have only few small foci of EMH that shut down after birth; any significant degree of EMH is abnormal Bone marrow picks up & is a major site by 4th & 5th months – dominant site by birth In preemies, may still have some EMH in liver & occasionally spleen, LN, or thymus
Page 1: Utility of the Peripheral Smear and
Page 5 and 6: Neonatal Erythropoiesis Hgb rela
Page 7 and 8: Laboratory Evaluation of the Neonat
Page 9 and 10: Notes on Pediatric Normal Hematolog
Page 11 and 12: Notes on Neonatal Platelets Co
Page 13 and 14: TCH MCV Normal Range Age FL 0-30 da
Page 15 and 16: TCH WBC Normal Range Age x103 /μL
Page 17 and 18: TCH Platelet Normal Range Platelet
Page 19 and 20: Anemia Basics Mechanisms: Increa
Page 21 and 22: The CBC in Classification of Anemia
Page 23 and 24: Approach to the PBS Start with th
Page 25 and 26: Utility of the PBS Review Anemic p
Page 27 and 28: Utility of the PBS Review WBC Co
Page 29 and 30: Immature Lymphoid Cells
Page 31 and 32: Mature Lymphocytes
Page 33 and 34: Look at the Forest for the Trees Ar
Page 35 and 36: “Private School” Lymphoblasts
Page 37 and 38: Special Considerations for the Peri
Page 39 and 40: Morphologic Findings on Peripheral
Page 41 and 42: Morphologic Findings on Peripheral
Page 43 and 44: Occasional nucleated red cells, tar
Page 45 and 46: Acanthocytes, target cells, immatur
Page 47 and 48: Howell Jolly body - normal in first
Page 49 and 50: Polychromasia - retic is higher in
Page 51 and 52: Case #1 15 month old girl
Page 55 and 56:
Hypochromic Microcytic Anemia: Diff
Page 57 and 58:
Iron Studies Serum iron = 5 ug/dl S
Page 59 and 60:
A word about Fe deficiency Most
Page 61 and 62:
Case #2 3 year old boy
Page 66 and 67:
What do we see? Microcytic hypochro
Page 68 and 69:
Iron Studies Serum iron = 30 ug/dl
Page 70 and 71:
Final Diagnosis Beta thalassemia tr
Page 72 and 73:
Diagnosis of Thalassemia Beta El
Page 74 and 75:
CBC Differences from Iron Deficienc
Page 78 and 79:
What do we see? Extreme hypochro
Page 80 and 81:
Hemoglobin Fractionation Hgb
Page 82 and 83:
Alpha Thalassemia 4 alpha gen
Page 84 and 85:
Case #4 6 year old girl with fatigu
Page 88 and 89:
What do we see? Spherocytes
Page 90 and 91:
Additional Labs LDH = 926 U/L In
Page 92 and 93:
Results Direct antiglobulin test
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Hereditary Spherocytosis Incidence
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Hereditary Spherocytosis Presents i
Page 98:
Case #5 16 year old boy
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Hereditary Elliptocytosis Seen in a
Page 107 and 108:
Diagnosis? Hereditary Pyropoikilocy
Page 109 and 110:
Hereditary Pyropoikilocytosis
Page 112 and 113:
What do we see? Spherocytes again L
Page 114 and 115:
Spherocytes on the Smear Sphe
Page 116:
CBC Hgb = 6.8 g/dL Hct = 18.5
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Differential Diagnosis TTP HU
Page 124 and 125:
Labs Elevated BUN/Cr Elevated
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Final Diagnosis Hemolytic Uremic Sy
Page 128 and 129:
Hemolytic Anemias - In General
Page 130 and 131:
CBC Findings in Hemolytic Anemia An
Page 132 and 133:
Hemolytic Anemia on PBS Usually nor
Page 134 and 135:
Hemolytic Anemia on PBS WBC usually
Page 136 and 137:
Peripheral Smear Clues Extravascula
Page 141 and 142:
What do you see? Acanthocytes (Spur
Page 143 and 144:
Differential Diagnosis for lots of
Page 145 and 146:
Acanthocytes Echinocytes Color Atla
Page 147 and 148:
Case #10 14 year old boy with anemi
Page 151 and 152:
Sickle Cells & Targets - Problem No
Page 153 and 154:
Case #10 Diagnosis Heterozygous sic
Page 155 and 156:
Sickle Cell Disease Hypochromia &
Page 157:
Any questions, y’all? Adapted fro
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