Slide 005
Slide 005:

Diagnosis: Hereditary spherocytosis. The disorder may be present at birth, producing neonatal jaundice and anemia, or it may appear late in adult life. Spherocytes are the most prevalent finding. They are still evident following splenectomy, but microspherocytes disappear. Anemia, jaundice, and splenomagaly are other common findings. Howell-Jolly bodies may be present following splenectomy.

History: 33 year- old female. This patient inherited the disease from her mother, and required transfusion at birth. She had a splenectomy at age four years; gall bladder removal at age nine. She becomes jaundiced occasionally.

Major cell findings pertaining to Slide 005 included:

spherocytes

and

Howell-Jolly bodies

. No error points were issued when indicating the presence or absence of

giant platelets

,bizarre platelets, clumped platelets, toxic granulation, basophilic stippling, or echinocytes. Thirty-six laboratories (8%) indicated the presence of

Pappenheimer bodies

. On Wright stained smears, Pappenheimer bodies appear as violet staining granules usually found along the periphery of the red cells, often in clusters. Confirmation must be made with a Prussian blue stain for the presence of iron. No error points were assigned when indicating the presence of Pappenheimer bodies. Two hundred eighty-six laboratories (60%) correctly identified the presence of spherocytes. One hundred eighty-seven (40%) failed to identify spherocytes. Two hundred eighty-five (285) laboratories passed this slide with a score of 80% or higher. One hundred eighty-eight (188) failed this slide with a score below 80%.

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Laboratory

Data

WBC

17.6 X 10

9

/ L

RBC

3.54 X 10

12

/ L

Hemoglobin

12.1 g/dL

Hematocrit

33.6 %

MCV

94.8fL

MCH

34.3pg

MCHC

36.2g/dL

Platelet

244 X 10

9

/ L