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Difficulty: MediumHematology and Oncology

Match each patient's clinical presentation with the most likely predominant finding on their peripheral blood smear.

  • A 72-year-old man presents with progressive fatigue, early satiety, and massive splenomegaly; his bone marrow aspiration yields a "dry tap".Teardrop cells (dacrocytes)
  • A 68-year-old man presents with painless cervical lymphadenopathy; laboratory studies show marked leukocytosis with an absolute lymphocytosis composed of small, mature-appearing cells.Smudge cells
  • A 35-year-old woman presents with altered mental status, fever, elevated creatinine, and severe thrombocytopenia.Schistocytes
  • A 28-year-old man of Mediterranean descent has asymptomatic microcytic anemia with a normal ferritin level and an elevated hemoglobin A2.Target cells (codocytes)

Answer

Primary myelofibrosis pairs with teardrop cells; Chronic Lymphocytic Leukemia pairs with smudge cells; Thrombotic Thrombocytopenic Purpura pairs with schistocytes; and Beta-thalassemia trait pairs with target cells.
Each peripheral smear finding is classically linked to its corresponding clinical presentation: teardrop cells with bone marrow fibrosis, smudge cells with the fragile lymphocytes of CLL, schistocytes with the microvascular shearing of TTP, and target cells with the hemoglobinopathies like thalassemia.

Step-by-Step Solution

1
Diagnose the underlying hematologic condition presented in each clinical vignette.
Patient 1 has primary myelofibrosis. Patient 2 has chronic lymphocytic leukemia (CLL). Patient 3 has thrombotic thrombocytopenic purpura (TTP). Patient 4 has beta-thalassemia trait.
Recognizing the disease based on clinical and laboratory clues is required to anticipate the peripheral smear findings.
2
Identify the pathognomonic or highly characteristic peripheral blood smear findings associated with each diagnosed condition.
Myelofibrosis features teardrop cells. CLL features smudge cells. TTP features schistocytes. Thalassemia features target cells.
Red blood cell and white blood cell morphology provide critical diagnostic confirmation for these respective diseases.

Key Concept

Pathognomonic peripheral blood smear findings in hematologic disorders
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Topics

Hematology and Oncology

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