Systemic approach:
Red Cells
1. Agglutination? - Hemolysis
2. Rouleux (Stacking)? - Indicative of Paraproteinemia (MM)
3. Nucleated Red Blood Cells? - Hemolysis/Bone marrow stress
4. Polychromasia (Increase in Reticulocytes) -Hemolysis/Blood loss (Increased Demand)/Response to Treatment (Ironsubs. in Iron Def. Anemia)
5. Quantity/Size - MCV, Anisocytosis?
6. Quality - Poikilocytosis
7. Red Cell Inclusions -
a. Howell jolly bodies (un-removed nucleus parts/Hyposplenism); normal in neonates; hemolysis and megalobastic anemia
b. Basophilic stippling (ribosomal RNA; best seen in Reticulocytes) - Hemoglobinopathy, MDS, Heavy Metal poisoning (Lead)
c. Pappenheimer bodies (Hemosiderin granules) - Postspelenectomy, Iron-overload, Sideroblastic anemia
d. Malaria
White Cells:
1. Quantity: estimate the Count, Differential
2. Quality: check, Nucleus+Cytoplasma - reactive?dysplasia?malignant population?
a. pleomorphic (reactive) vs monomorphic (malignant)
b. size - small/mature (as lymphocyte), medium (as monocyte), large/immature (as promyelocyte),
c. Nucleus to cytoplasma ratio (N/C) - high, moderate
d. Nucleus - immature/open/uncondensed/see-through chromatin (blasts) - mature/condensed chromatin/opaque (mature cells); cleft(visible groove)/cleaved(divided)/overlapping/indented -nucleus
e. Cytoplasma
- color: clear, pale grey (monocyte); faint basophilic (lymphocyte), deep basophilic (plasma cells)
- inclusions: granules, vacuoles, auer rods?
f. company? - other cytopenias/dysplasia/rouleaux/leukoerythrombastic/tear drops?
g. Lymphocytes - reactive/atypical (pleomorphic + abundant cytoplasma) vs malignant (monomorphic, high N/C)
h. Neutrophiles:
- toxic neutophilia: left shift, toxic granulation, toxic vacuolation, dohle bodies, WC count < 40
- hypo-/hypergranulation
- segments (normal 3-4 sausage like, joined by narrow bridge): hypersegmented (Medication - Hydroxycaramid, MTX; B12/Folic acid deficiency, Dysplasia, rarely Iron Deficiency), hyposegmented (such as pseudo-pelger-huet - Dysplasia) and Tacrolimus.
Platelets:
1. Quantity - estimate the count,
2. Quality - size variation, granulation
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