7 Morphologic Evaluation of Erythrocytes

8/7/2019 7 Morphologic Evaluation of Erythrocytes

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MORPHOLOGIC

EVALUATION OF

ERYTHROCYTES

DISTRIBUTION

MORPHOLOGY


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DISTRIBUTION OF

RBCjNORMAL DISTRIBUTIONAttributed to the maintenance of the

zeta potential

Cells repel one another

Freely move in the blood vessels

jABNORMAL DISTRIBUTIONRouleaux formation

Agglutination


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jROULEAUX

FORMATION

Stacks of coins orstacks of plates

Occurs due toincrease of plasmagamma globulin

Hyperproteinemia Multiple myeloma


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jAGGLUTINATION

Cells aggregate inrandom clusters or

masses Due to the presence of

plasma agglutinins

Hemolytic anemia

Atypical pneumonia Staphylococcal infection

Cold agglutinin disease


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MORPHOLOGY OF

RBCj 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)

j ABNORMAL MORPHOLOGY

Hgb Content, Size, Shape, Inclusion bodies


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Abnormal Morphology

jHEMOGLOBIN CONTENT

Normochromic

Hypochromic Larger central pallor

Hyperchromic

Lack central pallor

Anisochromasia

2 different cell population is present


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jSIZE (ANISOCYTOSIS)

Variation in RBC population size (asto cell volume rather than diameter)

NORMOCYTIC 80-100 fL

MACROCYTIC

>100 fL; Vit B12 deficiency

MICROCYTIC


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jSHAPE (POIKILOCYTOSIS)

Variation in shape poikilocytes

Due to:

Developmental macrocytosis

Membrane abnormality

Trauma

Abnormal hemoglobin content


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Developmental

MacrocytosisjOVAL

MACROCYTES

Due to Vitamin B12or Folate Deficiency

Vit B12 and Folateare essential for thesynthesis of purines

and pyrimidines


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Membrane AbnormalityjSPHEROCYTES

Round cellslacking centralpallor

Appear smallerthan RBC

Due to SPECTRINDEFICIENCY

HereditarySpherocytosis

AHA

Physical orChemical Injury to

the cells


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jELLIPTOCYTES

Hemoglobin areconcentrated atthe ends of thecells

Due to defective

CYTOSKELETON

Hemolytic Anemias

IDA

Myeloidfibrosiswith myeloidmetaplasia

Megaloblasticanemias

Sickle cell anemia


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jECHINOCYTES

known as CRENATED cell

echinos: sea urchin

Have evenly distributed,uniform-sized spicules orprojections

Due to ANTICOAGULANTused during blood

collection orhyperosmolarity

In vivo, decreased ATP


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jBURR CELLS

Have irregularly sizedknobby projections

Produced by therupture of the cellmembrane byenlarged vacuoles

Dx Implication:Renal Disease


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jACANTHOCYTES

Also known as SPURCELLS

acantho: thorn or spike Irregularly spiculated

cells in which ends of thespicules are bulbous androunded

Due to changes in theRATIOOF PLASMA LIPIDS Abetalipoproteinemia

Liver disease


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jSTOMATOCYTES

From stoma: mouth

Mouth-like or slit-like

area of the central pallor

Due to HIGHNa+ &LOWK+ content of the cell

Cell takes up more fluid

than usual squeezing thecentral pallor in the process


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jCODOCYTES

Also known as TARGET

CELLS; LEPTOCYTES From kodon: bell

Central area ofHemoglobin issurrounded by colorless

ring Appear like a BELL or aMEXICANHAT

Due to loading ofCHOLESTEROL and

PHOSPHOLIPID Obstructive Jaundice

Postsplenectomy state

Thalassemias

Hemoglobin diseases

Hypochromic anemias


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Due to Trauma

jSCHISTOCYTES

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


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jKERATOCYTESAlso known asBLISTERCELL

Presence of vacuole-

like area

Schizocytes w/ 1 ormore projections

Caught up on aFIBRINSTRAND


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jDACRYOCYTES

Also known as TEARDROP CELL

From dakry: tear

Pear-shaped cell w/ blunt pointedprojection

Caught up in FIBRIN

Associated w/H

einzBodies

Seen in cases ofMyelofibrosis andtuberculosis


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jMICROSPHEROCYTES

Also known as PYROPOIKILOCYTES

Tiny, round, fragmented cells

Due to altered SPECTRINcontent

jSEMILUNAR BODIES

Also known: HALF-MOON/CRESCENT CELL

Red Blood Cell ghost

Due to infection with MALARIA


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Abnormal Hemoglobin

ContentjDREPANOCYTES

Also known as SICKLE CELL

From drepane: sickleThin and elongated

Due to the presence ofHb S

Hb CC &Hb SC

Appearance ofTarget Cell

Condensation ofHb crystals


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jINCLUSIONS

Granulation found in the cytoplasm ofRed Blood Cell

Due to:

Developmental organelles

Abnormal Hemoglobin Precipitation

Protozoan Inclusion


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Developmental Organelles

jHOWELL-JOLLY BODIES

Small, roundremnants/fragments of

nuclear chromatin Due to incomplete extrusion

of nucleus during maturation

Seen in:

Megaloblastic anemiaHemolytic anemia

After splenectomy


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jBASOPHILIC

STIPPLING

Fine or coarse, deep

blue to purplestaining inclusion

Aggregates ofribosomes

Due to lead or

arsenic intoxication Seen in megaloblas-

tic anemia


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jPAPPENHEIMER

BODIES

Siderotic granules

(excess amount of iron store)

Small, irregular,dark-staining

Appear near the

periphery of nRBC Positive for PERLSPRUSSIANBLUE


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jPOLYCHROMATOPHILIC RBC

Are diffusely basophilic RBC

H

aveNO

nucleus but still containRN

A Indicative of young form


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jCABOT RINGS

Thin, ring-likestructure

Figure-of-eight orloop-shaped

Rings areprobably

microtubulesremaining from amitotic spindle


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Abnormal Hgb

PrecipitationjHEINZ BODIES Round, refractile

inclusion

Are denatured globin Stain w/ supravital

stains: crystal violet, methylene

blue, brilliant cresyl blue


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jHGB H INCLUSION

Small, greenish-blue inclusion

D

ue to failure to synthesize alphaglobin chain

Stains w/ 1% BCB


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Protozoan Inclusion

jMALARIA

P. vivax(SCHUFFNERS DOTS)

P. ovaleP. malariae (ZEIMANNS DOTS)

P. falciparum (MAURERS DOTS)

jBABESIA

Babesia microti


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P. vivax


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P. ovale


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P. malariae


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P. falciparum

7 Morphologic Evaluation of Erythrocytes

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