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

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Approach to the Workup of Anemia CBC - define & characterize anemia Look at red cell indices Categorize the anemia based on RBC size Reticulocyte count - marrow response An elevated retic in the absence of bleeding indicates hemolysis Peripheral smear review Confirm the CBC findings Anisopoikilocytosis; types of “poikilocytes” Consider the differential diagnosis Plan your laboratory evaluation
The CBC in Classification of Anemia Parameters that define the anemia: RBC, Hgb, Hct Parameters that classify the type of anemia: MCV Low = microcytic High = macrocytic MCH & MCHC Low = hypochromic Normal or high = macrocytic RDW = degree of anisocytosis (on the smear a normal RBC is the size of a small mature inactive lymphocyte nucleus)
Page 1 and 2: Utility of the Peripheral Smear and
Page 3 and 4: Fetal Hematopoiesis Hematopoiesis s
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: Anemia Basics Mechanisms: Increa
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
Page 96 and 97:
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
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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
Page 122 and 123:
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
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What do you see? Acanthocytes (Spur
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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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