White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions (Online CE Course)

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Authors: C. William Reiquam, M.D.; Elmer W. Koneman, M.D.

This collection of informative case studies covers current topics in white cell and platelet disorders. Topics include leukemoid reactions, leukocytosis, intracellular granules, intra-cytoplasmic inclusion bodies, platelet satellitism, and more. Excellent for continuing education for clinical laboratory science professionals.

Continuing Education Credits

• P.A.C.E.® Contact Hours (acceptable for AMT, ACSP / NCA, and state recertification): 3 hour(s)
• Florida Board of Clinical Laboratory Science CE - General (Hematology): 3 hour(s)

Objectives

• Recognize several peripheral white cell abnormalities and list the criteria necessary to request a morphological/clinical review.
• Recognize and list the criteria by which a leukemoid reaction is differentiated from leukocytosis with a left shift.
• Describe various intracellular white blood cell inclusions and correlate them with the metabolic, genetic, and reactive conditions with which they are associated.
• Estimate platelet counts from peripheral blood smear scans and discuss erroneous automated platelet results.

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Course Outline

• White Blood Cell Disorders and Platelets:
• Peripheral Smear Review Introduction
• Peripheral Blood Smear Preparation
• Evaluation Criteria: White Blood Cells and Platelets
• Criteria for Performing a Manual Review of the Smear
• Which of the images below represents an area of appropriate cell density to choose for performance of a manual differential?
• Smudge Cells
• Platelet Estimates
• An automated platelet count of 40.0 X 109/L was reported. Review of the peripheral blood smear (see image below) reveals single platelets in open fiel...
• Additional Comments
• Leukemoid Reaction and Toxic Changes
• Leukemoid Reaction
• Toxic Changes
• Thrombocytosis Associated with Toxic Granulation
• The neutrophils illustrated in this image are representative of those seen in a patient's peripheral blood smear. The total WBC was 28.5 X 109/L. The ...
• Toxic granulation noted in the neutrophils' cytoplasm reflects an increase in activity of the:(Choose all that apply)
• Cells that appeared similar to those illustrated in this image were repeatedly encountered as the smear was reviewed. The peripheral white blood cell ...
• A peripheral blood smear with many myeloid cells was presented for morphology review (see image on the right). Toxic granulation and vacuoles in the n...
• The association of increased platelets accompanying neutrophilia and toxic granulation, as illustrated in this image, is called thrombocytopenia.
• White Cell Nuclear and Cytoplasmic Abnormalities Related to Inherited Conditions
• Pelger-Huet Anomaly
• Chediak-Higashi Anomaly
• Alder Anomaly
• May-Hegglin Anomaly
• The inclusions noted in the cytoplasm of this white blood cell are most suggestive of which of these conditions?
• WBC inclusions: Summary
• Familial disorders: summary
• Case Study One:The patient is a 10 year-old boy from Florida who developed abdominal pain while on a skiing trip with his family in Colorado. He was b...
• Case One Follow-up
• 4. Intra-cytoplasmic Inclusion Bodies
• The pale-staining cytoplasmic bodies marked by the arrow in the image may be seen in each of the following conditions except:
• Case History
• Dohle Bodies: Review
• The cytoplasmic inclusion illustrated at the tip of the blue arrow is characteristic of:
• Auer Rod
• The white blood cell inclusions that are indicated by the arrows in the image are Auer Rods.
• 5. Miscellaneous Granulocytic Cells
• The peripheral blood smear presented here was submitted for morphological/clinical review. Conditions in which this picture may be seen include:
• Eosinophilia
• Eosinophil description
• The granulated neutrophil shown in this image may be found in each of the following conditions except:
• The image on the right represents a peripheral blood smear field. The white blood cell seen in the image is a mast cell.
• Basophils
• 6. Non Granulocytic White Blood Cells
• Case history
• Case History (cont.)
• Approximately 10% of the circulating white cells were similar to the one seen in this image. The patient was 42 years old and visited his physician be...
• Multiple myeloma
• A peripheral smear was submitted for morphology/clinical because of the number of monocytes as captured in the upper and lower images. This peripheral...
• The peripheral smear on the right was submitted for morphologic/clinical examination. The predominant cells comprised 70% of the total white blood cel...
• Hairy cell leukemia
• 7. Platelets
• Platelet satellites (see image to the right) may account for low platelet counts as determined by electronic counters. Satellitosis is initiated by:
• The large platelet captured in the center of this image is indicative of disordered megakaryocytopoiesis.
• A representative field from a peripheral blood smear, seen on the right, was held for morophological and clinical review as the total platelet count w...
• The peripheral blood smear shown in this image was held for review because of an increase in platelets, about double the normal average of 8 - 20 per ...
• This image is representative of a peripheral blood smear. Some automated instruments may report this platelet count as:
• 8. Miscellaneous Smear Reviews
• The small club-shaped, "drumstick" nuclear appendage attached to one lobe of a neutrophil (marked by the blue arrow in the image) may be found in:
• The cell in this image is known as a MOTT cell. The condition in which these cells are associated is:
• The smudge cells pictured in this image may be found in each of the following situations except:
• The cell indicated by the arrow in the image on the right is most consistent with Chediak-Higashi anomaly.
• A most useful follow-up test to consider when faced with hypersegmented neutrophils and oval macrocytes (see image) in a peripheral blood smear is:
• Erythrophagocytosis

Additional Information

Level of instruction: Intermediate

Intended Audience: Medical laboratory professionals, clinical laboratory science students and instructors of hematology.

General Information: This program provides several outstanding interactive case studies, which cover pertinent topics in white cell and platelet disorders. Numerous excellent photomicrographs enhance the text, and interactive questions help the student master the material.

Author Credentials: C. William Reiquam M.D. is a clinical pathologist at University of Colorado Health Sciences in Denver, CO. He has extensive experience in hematology and is currently focusing on evidence-based medicine and its implication for medial care outcomes.

Elmer W.Koneman M.D. is Professor Emeritus, Department of Pathology, University of Colorado School of Medicine. Residing in Breckenridge,CO, Dr. Koneman is a Board Certified Pathologist, former full Professor of Pathology University of Colorado School of Medicine. He is author of numerous journal articles and books.

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