MORPHOLOGIC EVALUATION OF ERYTHROCYTES

Click to edit Master subtitle style DISTRIBUTION MORPHOLOGY

DISTRIBUTION OF RBC
Normal Distribution Attributed to the maintenance of the zeta potential Cells repel one another Freely move in the blood vessels Abnormal Distribution Rouleaux formation Agglutination

 ROULEAUX

FORMATION

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Stacks of coins or stacks of plates Occurs due to increase of plasma gamma globulin

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Hyperproteinemia Multiple myeloma

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 AGGLUTINATION

Cells aggregate in random clusters or masses Due to the presence of plasma agglutinins

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Hemolytic anemia Atypical pneumonia Staphylococcal infection Cold agglutinin disease

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MORPHOLOGY OF RBC
NORMAL MORPHOLOGY Biconcave (discocyte) Round w/ central pallor (non-nucleated) Central pallor (1/3 of the cells dm) diameter 7-8m; thickness 2.5m stain red to pink (Wrights stain)

ABNORMAL MORPHOLOGY Hgb Content, Size, Shape, Inclusion bodies

Abnormal Morphology
HEMOGLOBIN CONTENT

Normochromic Hypochromic

Larger central pallor

Hyperchromic

Lack central pallor

Anisochromasia

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 SIZE (ANISOCYTOSIS)

Variation in RBC population size (as to cell volume rather than diameter) NORMOCYTIC

80-100 fL

MACROCYTIC

>100 fL; Vit B12 deficiency

MICROCYTIC

<80 fL; IDA

 SHAPE (POIKILOCYTOSIS)

Variation in shape poikilocytes Due to:

Developmental macrocytosis Membrane abnormality Trauma Abnormal hemoglobin content

Developmental Macrocytosis
OVAL

MACROCYTES

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Due to Vitamin B12 or Folate Deficiency Vit B12 and Folate are essential for the synthesis of purines and pyrimidines

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Membrane Abnormality SPHEROCYTES

Round cells lacking central pallor Appear smaller than RBC Due to SPECTRIN DEFICIENCY

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Hereditary Spherocytosis AHA Physical or Chemical Injury to the cells

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 ELLIPTOCYTES

Hemoglobin are concentrated at the ends of the cells Due to defective CYTOSKELETON

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Hemolytic Anemias IDA Myeloidfibrosis with myeloid metaplasia Megaloblastic anemias Sickle cell anemia

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 ECHINOCYTES

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echinos: sea urchin Have evenly distributed, Second Outline uniform-sized spicules or Level projections Third Outline Due to ANTICOAGULANT used during blood Level collection or hyperosmolarity Fourth In vivo, decreased ATP

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 BURR CELLS

Have irregularly sized knobby projections Produced by the rupture of the cell membrane by enlarged vacuoles Dx Implication: Renal Disease

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 ACANTHOCYTES

Also known as SPUR CELLS acantho: thorn or spike Second Outline Irregularly spiculated cells Level in which ends of the spicules are bulbous and Third Outline rounded Level Due to changes in the RATIO OF PLASMA LIPIDS Fourth

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Abetalipoproteinemia Liver disease

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 STOMATOCYTES

From stoma: mouth Mouth-like or slit-like area of the central pallor Second Outline Due to HIGH Na+ & LOW Level K+ content of the cell to edit the ClickThird Outline

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Cell takes up more fluid than usual squeezing the central pallor in the process

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 CODOCYTES

Also known as TARGET CELLS; LEPTOCYTES From kodon: bell Click to edit the Central area of outline text format Hemoglobin is surrounded by colorless ring

Appear like a BELL or a MEXICAN HAT

Due to loading of CHOLESTEROL and PHOSPHOLIPID

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Obstructive Jaundice Postsplenectomy state Thalassemias Hemoglobin diseases Hypochromic anemias

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Due to Trauma
SCHISTOCYTES

schisto: cloven or schizo: split Cells are caught up in the SPLEEN

Fragmented RBCs (helmet, triangular) Indicate the presence of hemolysis

Megaloblastic anemia Severe burns Microangiopathic anemia

 KERATOCYTES

Also known as BLISTER CELL

Presence of vacuolelike area

Schizocytes w/ 1 or more projections Caught up on a FIBRIN STRAND

 DACRYOCYTES

Also known as TEARDROP CELL From dakry: tear Pear-shaped cell w/ blunt pointed projection Caught up in FIBRIN Associated w/ Heinz Bodies Seen in cases of Myelofibrosis and tuberculosis

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 MICROSPHEROCYTES

Also known as PYROPOIKILOCYTES Tiny, round, fragmented cells Due to altered SPECTRIN content

SEMILUNAR BODIES

Also known: HALF-MOON/CRESCENT CELL Red Blood Cell ghost Due to infection with MALARIA

Abnormal Hemoglobin Content

DREPANOCYTES

Also known as SICKLE CELL From drepane: sickle Thin and elongated Due to the presence of Hb S Hb CC & Hb SC

Appearance of Target Cell Condensation of Hb crystals

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 INCLUSIONS

Granulation found in the cytoplasm of Red Blood Cell Due to:

Developmental organelles Abnormal Hemoglobin Precipitation Protozoan Inclusion

Developmental Organelles

HOWELL-JOLLY BODIES to edit the Click

Small, round outline text format remnants/fragments of Second Outline nuclear chromatin Due to incomplete extrusion Level of nucleus during maturation Third Outline Seen in: Level Megaloblastic anemia Hemolytic anemia Fourth After splenectomy Outline

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 BASOPHILIC

STIPPLING

Fine or coarse, deep blue to purple staining inclusion Aggregates of ribosomes Due to lead or arsenic intoxication Seen in megaloblastic anemia

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 PAPPENHEIMER

BODIES

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Siderotic granules (excess amount of iron store) Small, irregular, dark-staining Appear near the periphery of nRBC Positive for PERLS PRUSSIAN BLUE

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 POLYCHROMATOPHILIC RBC

Are diffusely basophilic RBC Have NO nucleus but still contain RNA Indicative of young form

 CABOT RINGS

Thin, ring-like structure Figure-of-eight or loop-shaped Rings are probably microtubules remaining from a mitotic spindle

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Abnormal Hgb Precipitation

HEINZ BODIES

Round, refractile inclusion Are denatured globin Stain w/ supravital stains:

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crystal violet, methylene blue, brilliant cresyl blue

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 HGB H INCLUSION

Small, greenish-blue inclusion Due to failure to synthesize alpha globin chain Stains w/ 1% BCB

Protozoan Inclusion
MALARIA

P. P. P. P.

vivax (SCHUFFNERS DOTS) ovale malariae (ZEIMANNS DOTS) falciparum (MAURERS DOTS)

BABESIA

Babesia microti

P. vivax

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P. ovale

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P. malariae

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P. falciparum

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