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A 50-year-old female patient presen ts for evaluation of pancytopenia. She has hepatitis C. Laboratory evaluation shows leukocyte count 3, 1 00/JLL, hemoglobin 1 0.8 g/dL, and platelet count 78.000/ JLL. Physical exam is notable for splenomegaly. The peripheral smear is shown below.
What is the typical peripheral blood smear findings in a patient with hypersplenism?
- Howell-Jolly bodies and hyposegmented neutrophils
- Normal blood cells
- Giant platelets
- Nucleated red cells
- Tear drop red cells
Medicine
B. As depicted in the above image, the blood smear is usually normal in most patients with hypersplenism, although comorbid disease may cause the appearance of abnormal forms. Howell-Jolly bodies are seen in splenectomized patients and in cases of hemolytic anemia or megaloblastic anemia.
Hyposegmented neutrophils are seen in myelodysplastic syndromes (MDS). Giant platelets indicate a marrow response to peripheral destruction of cells or may be seen in MDS and myeloproliferative neo-plasms. Nucleated RBCs may be observed in myelophthisic conditions, as well as acute hemolytic anemia, acute hemorrhage, and several other hematologic disorders. Tear drop red blood cells (dacrocytes) are seen with myelophthisic anemia and with extramedullary hematopoiesis.
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