LABORATORY DIAGNOSIS
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Transcript of LABORATORY DIAGNOSIS
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LABORATORY DIAGNOSIS
RED BLOOD CELLS
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PRONORMOBLASTPRONORMOBLAST
Size: 12-20 umSize: 12-20 um Nucleus: round; Nucleus: round;
nucleoli (1-2); fine nucleoli (1-2); fine chromatinchromatin
Cytoplasm: dark blueCytoplasm: dark blue N/C ratio: 8:1N/C ratio: 8:1 Reference interval:Reference interval:
BM: 1%BM: 1% PB: 0%PB: 0%
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BASOPHILIC NORMOBLAST
• Size: 10-15 um
• Nucleus: round; nucleoli 0-1; slightly condensed chromatin
• Cytoplasm: dark blue
• N/C ratio: 6:1
• Reference interval:
BM: 1-4%
PB: 0%
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POLYCHROMATIC NORMOBLAST
• Size: 10-12 um
• Nucleus: round; nucleoli 0; quite condensed chromatin
• Cytoplasm: gray blue
• N/C ratio: 4:1
• Reference interval:
BM: 10-20%
PB: 0%
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ORTHOCHROMIC NORMOBLASTORTHOCHROMIC NORMOBLAST
Size : 8-10 umSize : 8-10 um Nucleus : round ; Nucleus : round ;
nucleoli = 0 ; fully nucleoli = 0 ; fully condensed chromatincondensed chromatin
Cytoplasm : blue to Cytoplasm : blue to salmonsalmon
N/C ratio : 0.5:1N/C ratio : 0.5:1 Reference interval : Reference interval :
BM : 5-10%BM : 5-10%PB : 0%PB : 0%
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Size : 8-8.5 umSize : 8-8.5 um Nucleus : absentNucleus : absent Cytoplasm : blue to Cytoplasm : blue to
salmonsalmon N/C ratio : NAN/C ratio : NA Reference interval : Reference interval :
BM : 1%BM : 1%PB : 0.5% - 2%PB : 0.5% - 2%
POLYCHROMATIC ERYTHROCYTEPOLYCHROMATIC ERYTHROCYTE
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Size : 7-8 umSize : 7-8 um Nucleus : absentNucleus : absent Cytoplasm : salmonCytoplasm : salmon N/C ratio : NAN/C ratio : NA Reference interval : Reference interval :
BM : NABM : NAPB : PredominantPB : Predominantcell typecell type
ERYTHROCYTEERYTHROCYTE
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ASSOCIATED WITH: ASSOCIATED WITH: iron def. anemia, iron def. anemia, sideroblastic anemia, sideroblastic anemia, thalassemia minor, thalassemia minor, chronic disease chronic disease (occasionally), lead (occasionally), lead poisoning, some poisoning, some hemoglobinopathieshemoglobinopathies
ERYTHROCYTE: VARIATIONS IN SIZEERYTHROCYTE: VARIATIONS IN SIZE
MICROCYTE
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Normal erythrocytes Normal erythrocytes are approximately the are approximately the same size as the same size as the nucleus of a small nucleus of a small lymphocytelymphocyte
ERYTHROCYTE: VARIATIONS IN SIZEERYTHROCYTE: VARIATIONS IN SIZE
NORMOCYTE
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ASSOCIATED WITH: ASSOCIATED WITH: liver disease, vitamin liver disease, vitamin B12 deficiency, folate B12 deficiency, folate deficiency, neonatesdeficiency, neonates
ERYTHROCYTE: VARIATIONS IN SIZEERYTHROCYTE: VARIATIONS IN SIZE
MACROCYTES
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ASSOCIATED WITH: ASSOCIATED WITH: transfusion, transfusion, myelodysplastic myelodysplastic syndromes, vit. B12, syndromes, vit. B12, folate, or iron folate, or iron deficiencies – early in deficiencies – early in treatment processtreatment process
DIMORPHIC POPULATION OF ERYTHROCYTESDIMORPHIC POPULATION OF ERYTHROCYTES
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Normochromic Normochromic erythrocyteserythrocytes
HEMOGLOBIN CONTENT OF ERYTHROCYTESHEMOGLOBIN CONTENT OF ERYTHROCYTES
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ASSOCIATED WITH: ASSOCIATED WITH: iron deficiency iron deficiency anemia, anemia, thalassemias, thalassemias, sideroblastic anemia, sideroblastic anemia, lead poisoning, some lead poisoning, some cases of chronic cases of chronic diseasedisease
HEMOGLOBIN CONTENT OF ERYTHROCYTESHEMOGLOBIN CONTENT OF ERYTHROCYTES
Hypochromia
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ASSOCIATED WITH: ASSOCIATED WITH: acute and chronic acute and chronic hemorrhage, hemorrhage, hemolysis, effective hemolysis, effective treatment for anemia, treatment for anemia, neonatesneonates
HEMOGLOBIN CONTENT OF ERYTHROCYTESHEMOGLOBIN CONTENT OF ERYTHROCYTES
Polychromasia
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Acanthocyte (Spur Cell)
ASSOCIATED WITH: abetalipoproteinemia, severe liver disease, splenectomy, malabsorption,
hypothyroidism, vit. E deficiency
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Echinocytes (Burr Cell)
ASSOCIATED WITH: uremia, pyruvate kinase def., microangiopathic hemolytic anemia, artifact
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Spherocytes
ASSOCIATED WITH: hereditary spherocytosis, some hemolytic anemias, transfused cells, severe
burns
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Codocyte (Target cell)
ASSOCIATED WITH: hemoglobinopathies, thalassemia, iron deficiency anemia, splenectomy,
obstructive liver disease
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Drepanocyte (Sickle cell)
ASSOCIATED WITH: Homozygous hemoglobin S disease
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Stomatocyte
ASSOCIATED WITH: Hereditary stomatocytosis, alcoholism, liver disease, Rh null phenotype,
artifact
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Elliptocytes
ASSOCIATED WITH: Hereditary elliptocytosis or ovalocytosis, thalassemia major, iron deficiency
anemia, megaloblastic anemias (macro ovalocytes), myelopthisic anemias
Ovalocytes
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Schizocyte (Schistocyte)ASSOCIATED WITH: Microangiopathic hemolytic
anemia (DIC), severe burns, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura,
renal graft rejection
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Dacryocyte (Tear Drop Cell)ASSOCIATED WITH: Myelofibrosis with myeloid
metaplasia, thalassemias, myelophthisic anemias, other causes of extramedullary hematopoiesis
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
Rouleaux formationASSOCIATED WITH: Increased concentrations of
globulins and/or paraproteins
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VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR
AutoagglutinationASSOCIATED WITH: Antigen/ antibody reactions
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INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES
Color : Dark blue to purpleColor : Dark blue to purple Shape : round to ovalShape : round to oval Size : 1 umSize : 1 um Number per cell : usually Number per cell : usually
1; maybe multiple1; maybe multiple Composition : DNAComposition : DNA Associated with : Associated with :
Splenectomy, Splenectomy, hyposplenism, hyposplenism, megaloblastic anemia, megaloblastic anemia, hemolytic anemiahemolytic anemia
Howell-Jolly bodies
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INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES
Color : Dark blue to purpleColor : Dark blue to purple Shape : fine or coarse Shape : fine or coarse
granulesgranules Number per cell : Number per cell :
numerous with fairly even numerous with fairly even distributiondistribution
Composition : RNAComposition : RNA Associated with : Lead Associated with : Lead
intoxication, thalassemia, intoxication, thalassemia, abnormal heme synthesisabnormal heme synthesis
Basophilic stippling
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INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES
Color : light blueColor : light blue Shape : fine irregular Shape : fine irregular
granules in clustersgranules in clusters Number per cell : usually one Number per cell : usually one
clusters; may be multiples. clusters; may be multiples. Often at periphery of cellOften at periphery of cell
Composition : IronComposition : Iron Associated with : Associated with :
Splenectomy, hemolytic Splenectomy, hemolytic anemia, sideroblastic anemia, sideroblastic anemia, megaloblastic anemia, megaloblastic anemia, hemoglobinopathiesanemia, hemoglobinopathies
Pappenheimer bodies (Siderotic granules)
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INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES
Color : dark blue to purpleColor : dark blue to purple Shape : loop, ring, or Shape : loop, ring, or
figure of eight; may look figure of eight; may look like beads on a stringlike beads on a string
Number per cell : 1-2Number per cell : 1-2 Composition : thought to Composition : thought to
be remnants of mitotic be remnants of mitotic spindlespindle
Associated with : Associated with : Myelodysplastic syndrome, Myelodysplastic syndrome, megaloblastic anemiamegaloblastic anemia
Cabot ring
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INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES
Stained with New Stained with New Methylene BlueMethylene Blue
Cell : anuclear Cell : anuclear immature erythrocytesimmature erythrocytes
Composition : Composition : precipitated RNAprecipitated RNA
Number : Number : ≥2/cell≥2/cell Color : dark blueColor : dark blue Associated with: Associated with:
erythrocyte maturationerythrocyte maturation
Reticulocytes
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INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES
Stained with New Stained with New Methylene BlueMethylene Blue
Cell : mature RBCCell : mature RBC Composition : precipitated Composition : precipitated
hgbhgb Number : single or Number : single or
multiple, generally multiple, generally membrane boundmembrane bound
Color : dark blue to purpleColor : dark blue to purple Associated with: Unstable Associated with: Unstable
hgb, some hgb, some hemoglobinopathies, some hemoglobinopathies, some RBC enzyme deficienciesRBC enzyme deficiencies
Heinz bodies
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
Iron Deficiency Anemia
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
Thalassemia minorPB : microcytosis, slight hypochromia, codocytes, basophilic stippling
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
Thalassemia majorPB : numerous nucleated RBC’s, microcytes, hypochromia, codocytes, basophilic stippling, many dacyocytes, many schizocytes, polychromasia
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
Macrocytic anemia (nonmegaloblastic type)PB : round macrocytes (MCV = 112 fl), leukocyte and platelet counts usually normalBM : no megaloblastic changes
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
Megaloblastic anemiaPB : pancytopenia, oval macrocytes, Howell-Jolly bodies, nucleated RBC’s, basophilic stippling, hypersegmentation of neutrophils, giant platelets, codocytes, schizocytes, spherocytes, dacrocytes
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
Aplastic anemiaPB : pancytopenia, normocytic, normochromic (occasional macrocytes)BM : hypocellular; lymphocytes may predominate
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : spherocytes, schizocytes, polychromasia, nucleated RBC’s
Immune Hemolytic Anemia
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : increased number of nucleated erythrocytes, macrocytic/normochromic, polychromasia, spherocytes
Hemolytic Disease of the Newborn
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : Spherocytes (variable in number), polychromasia; nucleated erythrocytes possible
Hereditary Spherocytosis
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : >25% elliptocytes, usually >60% elliptocytes; indices are normocytic, normochromic
Hereditary Elliptocytosis
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : Codocytes, spherocytes, microcytes, polychromasia, intracellular or rod-shaped crystals possible
Hemoglobin CC disease
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : Drepanocytes (in crises), codocytes, nucleated rbc’s, schizocytes, Howell-Jolly bodies, basophilic stippling,
polychromasia, increased leukocyte count with neutrophilia, increased platelet count
Hemoglobin SS disease
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DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES
PB : Few sickle cells, codocytes, intraerythrocytic crystals. Crystalline aggregates of hemoglobin SC may protrude from the
erythrocyte membrane
Hemoglobin SC disease