Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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  • AXIOM: as with pseudothrombocytopenia, surprise, unexpected findings that seem to not make sense ought to be investigated ASAP by (1) blood smear review and either a (2) re-run of that specimen or (3) retesting on a new-drawn specimen!!!
  • WBC (white blood cell count)
    • decreased (increased consumption vs. under-production):
      • neutrophiles: 1000-1500 is borderline neutropenia (and should be infection competent [CP10-16]; 500-1000 is neutropenia (risk of infection) & <500 has a severe infection risk.
    • increased: there is a tendency among Jews & Melungeon (mixed American Indian, black & white...tri-racial) people to run an elevated total WBC & a proportion may reflect "familial Mediterranean fever" [FMF...a cause of night sweats, fever]).
  • RBC (red blood cell count)
    • decreased (a softer definition of anemia; increased destruction vs. under-production)
    • increased
  • HGB (hemoglobin, total blood level)
    • decreased (the prime definition of anemia)
    • increased
  • HCT (hematocrit)
    • decreased (a softer definition of anemia)
    • increased
  • MCV (mean red-cell corpuscular volume)...normal 76-99
    • decreased (microcytosis...typically reflects abnormal HBG synthesis))
    • normal range (normocytic)
    • increased (macrocytosis...typically reflects abnormal nuclear maturation)
  • MCH (mean red-cell corpuscular volume)
    • decreased
    • increased
  • MCHC (mean red-cell corpuscular HGB concentration)
    • decreased (hypochromic)
    • not decreased (normochromic)
  • RDW  (red-cell
    • not increased (homogeneous RDW)
    • increased (heterogeneous RDW)
  • PLT (platelet count)
    • decreased (thrombocytopenia):
      1. consumptive (as in ITP) has enlarged platelets & increased marrow megs (can be sure of hyperplasia when see megs side-by-side) & may or may not have splenomegally (ITP usually not enlarged spleen).
      2. hypoproduction has small platelets (very few larger ones) & no marrow meg hyperplasia & usually no splenomegally.
    • increased (thrombocytosis)
      • primary: myeloproliferative syndrome & myelodysplastic syndrome
      • secondary
  • MPV (mean platelet volume)
    • % and/or quantity of lymphocytes
    • % and/or quantity of monocytes
    • % and/or quantity of neutrophiles, segs
    • % and/or quantity of neutrophiles, bands
    • % and/or quantity of neutrophiles, metas
    • % and/or quantity of neutrophiles, promy
    • % and/or quantity of neutrophiles, myelos
    • % and/or quantity of eosinophiles
    • % and/or quantity of basophiles
  • PANCYTOPENIA: When all components are decreased, it makes a difference whether the patient is acutely ill with this temporary status or has a chronic ongoing condition just now being confronted for diagnosis. While there are some nutritional difficiency and medication or suppliment related causes in this latter group, there are two non-reversible causes: (1) the broad and complex category of MDS (myelodysplastic syndrome...tends to have elevated LDH...and morphology clues [BM]) and (2) a more narrow entity of PNH (paroxismal nocturnal hemoglobinuria...may be discerned by flow cytometry).
  • CBC morphological clues (where no links to images), search the term in Google's image search engine.
    • RBCs:
      • parasites, intra-erythrocytic (Google images or check ref. #3 HERE):
        1. babesiosis: malaria-like bodies;the screening test is from a CBC EDTA tube and ordered as "smears for parasites "
        2. malaria: the screening test is from a CBC EDTA tube and ordered as "thick & thin smears for malaria".
        3. borreliosis:
        4. trypanosomiasis (Chaga disease).
      • sickle cells
      • elliptocytes (cigar cells)
      • acanthocytes
      • echinocytes
      • target cells
      • microcytes
      • macrocytes
      • ovalocytes
      • puzzlecytes
      • pyknocytes
      • pyropoikilocytosis: a mix of elliptocytes, teardrops, spherocytes & microspherocytes (micropoikilospherocytes)
      • teardrop cells
      • spherocytes
      • stomatocytes: when very exaggerated = purse cells; due to gain of red cell solute & water.
      • xerocytosis: a loss of red cell solute & water so that RBCs have variably dense areas and pale areas
    • WBCs morphological clues:
      • neutrohile series:
        1. blasts: likely heralds leukemia
        2. Pelger or Pelger-Huett cells: these hypo-lobated or unlobated nuclei may be inherited or secondary to certain medications.
        3. toxic granulation, left shift, & Dohle bodies: lean toward an infectious problem.
        4. Malassezia furfur yeast: intracytoplasmic purple, bowling pin shaped body.
        5. bacteria in cytoplasm: (1) if also with associated clear cytoplasmic vacuoles = dramatic septic emergency; (2) otherwise = could be blood drawn through catheter with infected tip needing replacement.
        6. histoplasmosis yeast: one or more small purple, rounded arcs around a cental pale area within cytoplasm.
        7. anaplasmosis (formerly ehrlichia): looks almost like an engulfed light purple platelett.
      • lymphocyte series:
        • blasts may herald leukemia.
        • atypical lymphs may reflect viral illness.
      • monocyte series:
    • Platelets: any evidence of pseudothrombocytopenia due to artifacts?


  1. "Pearls", W. R. Armstrong, M. D., board-certiied, our long-time hematopathologist.
  2. "Pearls", John B. Carter, M. D., our long-time practitioner of hematopathology who trained under Dr. Brunning & along with Dr. McKenna, above.
  3. Blevins SM, "Blood Smear Analysis...", Cleveland Clinic Journal of Medicine, 75(7):521-530, July 2008.
  4. Karen Titus, Nothing Peripheral About Assessing the Other Cytopenias, CAP Today, April 2015, pages 56-58



(posted 2002; latest addition 29 April 2015)

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