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

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Morphologic Findings on Peripheral Smear RBC morphology often difficult to appreciate Hct is so high Polychromasia Lots of reticulocytes Macrocytes – naturally higher MCV Poikilocytosis – funny shapes Immaturity of spleen – not remodeling cells Howell-Jolly bodies may be seen in first few days before spleen fully matures
Morphologic Findings on Peripheral Smear Nucleated RBC’s & immature granulocytes Usually not a lot, but may see more if preemie, or ill infant NRBC’s common 1st day 3-5 day of life, disappear by In preemies may persist longer than a week May appear mildly megaloblastic, may have some mildly irregular nuclear contours If persist longer, than suggests hemolysis, hypoxic stress, or acute infection
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 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: Special Considerations for the Peri
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
Page 94 and 95:
Hereditary Spherocytosis Incidence
Page 96 and 97:
Hereditary Spherocytosis Presents i
Page 98:
Case #5 16 year old boy
Page 102 and 103:
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
Page 122 and 123:
Differential Diagnosis TTP HU
Page 124 and 125:
Labs Elevated BUN/Cr Elevated
Page 126 and 127:
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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