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Difficulty: MediumHematology and Oncology

Match each patient's clinical presentation with the most characteristic peripheral blood smear finding.

  • A 65-year-old man with massive splenomegaly, fatigue, and a bone marrow biopsy showing extensive collagen deposition.Teardrop-shaped erythrocytes (dacrocytes) and nucleated red blood cells.
  • A 24-year-old woman with systemic lupus erythematosus who rapidly develops jaundice and severe anemia.Small, densely staining erythrocytes lacking a central zone of pallor (spherocytes).
  • A 45-year-old man with severe sepsis who develops diffuse oozing from venipuncture sites and acute kidney injury.Fragmented erythrocytes with sharp, irregular edges (schistocytes).
  • A 19-year-old man who develops dark urine and scleral icterus three days after taking trimethoprim-sulfamethoxazole.Erythrocytes with semi-circular sections of the cell membrane missing (bite cells).
  • A 50-year-old woman with chronic alcohol use disorder, distal extremity numbness, and an elevated mean corpuscular volume.Large, oval-shaped erythrocytes (macro-ovalocytes) and neutrophils with six or more nuclear lobes.

Answer

Myelofibrosis pairs with teardrop cells. Warm AIHA pairs with spherocytes. DIC pairs with schistocytes. G6PD deficiency pairs with bite cells. Vitamin B12 deficiency pairs with macro-ovalocytes and hypersegmented neutrophils.
Each clinical presentation contains classic pathognomonic features that correspond to a specific mechanism of red blood cell destruction or altered production. Understanding the underlying pathophysiology—marrow fibrosis (teardrop cells), immune-mediated membrane loss (spherocytes), mechanical shearing (schistocytes), oxidative damage (bite cells), and impaired DNA synthesis (macro-ovalocytes/hypersegmented neutrophils)—allows for direct matching of the disease process to its microscopic manifestation.

Step-by-Step Solution

1
Analyze the first vignette: A 65-year-old with massive splenomegaly and marrow collagen deposition.
Identify primary myelofibrosis, which leads to extramedullary hematopoiesis and structurally deformed erythrocytes.
Bone marrow fibrosis physically distorts red blood cells as they exit the marrow space, producing dacrocytes (teardrop cells).
2
Analyze the second vignette: A 24-year-old with SLE presenting with acute jaundice and anemia.
Identify warm autoimmune hemolytic anemia (AIHA).
SLE frequently causes warm AIHA. Splenic macrophages remove sections of antibody-coated RBC membranes, causing the cells to round up into spherocytes.
3
Analyze the third vignette: A 45-year-old with sepsis, oozing from venipuncture sites, and renal failure.
Identify disseminated intravascular coagulation (DIC), a microangiopathic hemolytic anemia.
Systemic activation of the coagulation cascade forms microthrombi (fibrin webs) that shear passing red blood cells into schistocytes.
4
Analyze the fourth vignette: A 19-year-old with acute hemolysis after taking a sulfa drug.
Identify Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency.
Oxidative stress leads to hemoglobin denaturation (Heinz bodies). The spleen plucks out these inclusions, leaving bite cells (degmacytes).
5
Analyze the fifth vignette: A 50-year-old with alcohol use disorder, neuropathy, and macrocytosis.
Identify megaloblastic anemia, likely due to Vitamin B12 deficiency.
Defective DNA synthesis leads to nuclear-cytoplasmic asynchrony, producing large, oval red blood cells and hypersegmented neutrophils.

Key Concept

Correlation of peripheral blood smear findings with specific hematologic and oncologic disorders.
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Topics

Hematology and Oncology

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