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

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Laboratory Evaluation of the Neonate: Things to Keep in Mind That Affect the CBC Gestational age of the infant Age in hours after delivery Illness in mom or baby Level of support required Site of sampling Capillary versus venous Capillary usually higher – Warmed versus unwarmed extremity Timing of sampling can be a significant difference
Notes on Pediatric Normal Hematology Ranges Normal values vary with age At birth, Hgb & MCV are high Between birth and 3 mo, Hgb & MCV decrease 3-6 mo., Hgb rises to around 12 g/dL Remains stable until around age 6 years, then comes up to 12.5 g/dL Age 6-12 years, rises to about 13.5 g/dL Then moves up to more adult levels, age 12-18 years WBC # & differential vary with age Platelets relatively stable throughout
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: Laboratory Evaluation of the Neonat
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
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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
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What do we see? Spherocytes
Page 90 and 91:
Additional Labs LDH = 926 U/L In
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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
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Diagnosis? Hereditary Pyropoikilocy
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Hereditary Pyropoikilocytosis
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What do we see? Spherocytes again L
Page 114 and 115:
Spherocytes on the Smear Sphe
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CBC Hgb = 6.8 g/dL Hct = 18.5
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Differential Diagnosis TTP HU
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Labs Elevated BUN/Cr Elevated
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Final Diagnosis Hemolytic Uremic Sy
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Hemolytic Anemias - In General
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CBC Findings in Hemolytic Anemia An
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Hemolytic Anemia on PBS Usually nor
Page 134 and 135:
Hemolytic Anemia on PBS WBC usually
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Peripheral Smear Clues Extravascula
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What do you see? Acanthocytes (Spur
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Differential Diagnosis for lots of
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Acanthocytes Echinocytes Color Atla
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Case #10 14 year old boy with anemi
Page 151 and 152:
Sickle Cells & Targets - Problem No
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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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