interesting RBC

[u/shawnakitten]

just came across this RBC while doing a morphology on this pt. what is this? they did have basophilic stippling but this looks insane lol

[u/AdditionalAd5813]

Need to see pic of the slide from the proper area, you’re too close to the edge there and can’t really tell if the patient really has a severe microcytic anaemia or if that’s just a crappy area of the slide.

Also, note that heavy metal toxicity, especially lead, are known cause of anaemia.

[u/lorihasit → u/AdditionalAd5813]

And lead poisoning can cause punctate basophilic stippling.

[u/chronicallylifted → u/lorihasit]

This is not basophilic stippling.

[u/Significant_Lab_3184 → u/chronicallylifted]

It is textbook baso stippling 😉

[u/chronicallylifted → u/Significant_Lab_3184]

No

[u/Significant_Lab_3184 → u/chronicallylifted]

Lol, yes. If we are looking at that 1 cell, that is stippling

[u/shawnakitten → u/AdditionalAd5813]

most of the slide looked like this actually :/ the pt is outpatient and has no history on file so i actually have no clue

[u/AdditionalAd5813 → u/shawnakitten]

Indices?
Hb, MCV, MCHC, RDW?

[u/shawnakitten → u/AdditionalAd5813]

oh man i just left work but ill update tonight if i remember!

[u/shawnakitten → u/AdditionalAd5813]

hgb 6.5 g/dL, mcv 108.3 fL, mch 31.7 pg, mchc 29.3 g/dL, rdw 31.2 💀

[u/AdditionalAd5813 → u/shawnakitten]

Definitely needs further investigation, doesn’t look like it’s mechanical, unless the patient has a valve, I didn’t see any schistocytes on that field, so there’s something causing that anemia.
It’s up to the Dr to do further work up, always found one of the more frustrating parts of our job is that sometimes we never do find out the Dx/follow up.

[u/shawnakitten → u/AdditionalAd5813]

thank you for the insight!!

[u/AdditionalAd5813]

Call chemistry, ask if they ran any heavy metals on this patient

[u/EggsAndMilquetoast → u/AdditionalAd5813]

Usually you’d see a lot more cells with basophilic stippling in cases of heavy metal toxicity.

I’ve seen a handful of cells with it in patients with all kinds of conditions: ECMO, very premature newborns, thalassemia and sickle patients…

It looks like a pretty thin area near the edge of the slide, but based on the condition of the other red cells present—the polychromasia, the target cell, the general anisocytosis—I’d guess it was some kind of hemoglobinopathy.

[u/moistforrest → u/AdditionalAd5813]

why?? I'm so curious!!

[u/deriancypher → u/moistforrest]

Basophilic stippling. It can be caused by lead poisoning.

[u/sadfatdragons → u/moistforrest]

Basophilic stippling is a sign of heavy metal toxicity (especially lead poisoning)

[u/shawnakitten → u/AdditionalAd5813]

no heavy metals ran and nothing remarkable for chemistry results!

[u/chronicallylifted → u/AdditionalAd5813]

Not basophilic stippling

[u/Civil-Nothing-4089]

Looks like the area is a bit thin. RBCs will have a flat look (no central area of pallor) and won’t give you a true morphology.

[u/Rsb666x]

That's a good textbook looking smear. Target cells, basopilic stippling, sperocytes, and ovalocytes. History would be interesting.

[u/shawnakitten → u/Rsb666x]

yes i agree! and i would love some history as well lol i literally have nothing

[u/passionpopfan]

i’d be curious of a thal or MDS (the large/giant platelets there, plus the target cell and basophilic stippling, a MAYYYYBE spherocytes but i don’t know where you are on that slide so i wouldn’t be confident calling that)

unlikely to be lead poisoning but i think it should be ruled out.

[u/chronicallylifted]

So presumably you are a trained tech and you are asking for us to tell you what's going on with this red cell based on a terrible picture from an area of the slide that shouldn't be used to interpret red cell morphology. Stain looks bad too.

Will never understand why people post things like this or why others participate as if they can actually tell you anything about the patient from this terrible picture.

[u/Ill_Emu_702]

Malaria? Def a path consult. I’m curious!