Erythrocyte Disorders

Question 1

Anemia

Answer 1

A decrease in the O2 carrying capacity of blood caused by a decrease or abnormality in hgb (Congenital, Acquired disorders, Hemorrhage, etc); Anemia is an expression of an underlying disorder (symptom not disease, so the origin of the anemia must be identified for effective treatment)

Question 2

Anemia Treatment

Answer 2

There is no universal treatment, Blood transfusion may be effective in some anemia’s but may be toxic in others; Some simply require vitamin or mineral supplementation

Question 3

Anemia Characteristics

Answer 3

Increased respiration and cardiac output in an effort to increase oxygenated blood flow; Tachycardia, shortness of breath
Prolonged anemia may lead to heart failure
Increased hematopoiesis may cause BM hyperplasia also may involve fetal organs

Question 4

Anemia - Increased oxygen utilization

Answer 4

2,3 BPG concentration elevates so Oxygen is pushed off of hgb more readily (Prolonged 2,3 BPG elevation may be detrimental)
O2 is released prematurely, Distal tissues may become hypoxic, Poor energy production, Fatigue

Question 5

Normal RBC Characteristics

Answer 5

Size: Normal RBC is 6-8μm in diameter
Shape: Round, biconcave

Question 6

MCV Changes During Development

Answer 6

Average MCV
Birth: 108fL, macrocytic
6 mo-2 years: 77fL, microcytic
18 years +: 90fL, normocytic

Question 7

Anisocytosis

Answer 7

Elevated RDW (variation in RBC size), but may have a normal MCV

Question 8

Microcytosis

Answer 8

Smaller than lymph nucleus, Decreased MCV

Frequently, but not always, accompanied by hypochromia

Question 9

Macrocytosis

Answer 9

Larger than lymph nucleus

Increased MCV

Question 10

Hypochromia

Answer 10

Decreased hgb

Increased central pallor

Question 11

Polychromatophilia

Answer 11

Indicates erythropoiesis
Reticulocytes
Light purple due to residual RNA

Question 12

Poikilocytes

Answer 12

Acanthocytes
Schistocytes
Drepanocytes
Spherocytes
Dacrocytes
Echinocytes
Ovalocytes
Stomatocytes
Codocytes

Question 13

Acanthocytes

Answer 13

Also known as Spur or thorn cells
Multiple unevenly spaced thorn-like or rounded projections, No central pallor
Clinical Conditions: Liver disease, Lipid metabolism disorders, Fat malabsorption, Anything that may cause increased membrane cholesterol

Question 14

Schistocytes

Answer 14

Fragmented RBCs
Several subtypes including keratocytes (helmet cells)
Variable sized “pieces” of an RBC, May or may not show central pallor
Clinical Conditions: Microangiopathic hemolytic anemia, Uremia, Hemolytic disease of the newborn (HDN), Disseminated intravascular coagulation (DIC)

Question 15

Drepanocyte

Answer 15

Sickle cells
Thin, elongated, pointed ends, No central pallor, Caused by polymerization of Hgb S
Clinical Conditions: Sickle cell anemia, Hgb SC disease

Question 16

Spherocytes

Answer 16

Spherical, Densely stained, No central pallor, Sometimes appear smaller than other RBCs
Clinical Conditions: Hereditary spherocytosis, PK deficiency, Severe burns, Immune mediated hemolysis
*Never report spherocytes unless you are finding them in a “good” area of the slide

Question 17

Dacrocytes

Answer 17

Teardrop cells
Pear shaped, Pointed or elongated at one end
Clinical Conditions: Diseases of the bone marrow, Sign of extramedullary hematopoiesis, Myelophthisic anemia, Most any type of anemia, Disorders causing hypersplenism (Formed as the spleen pits inclusions, Thalassemia)

Question 18

Echinocytes

Answer 18

Burr cells, Crenated RBCs
Evenly distributed short spikes, Central pallor
Clinical Conditions: Uremia, Liver disease, Stomach cancer
Only sometimes clinically significant (May be an artifact of slide making, Caused by an increased dry time- Cold temperature, Slide too thick)
Correlate your findings with a diagnosis if available; Clinically significant Burr cells are usually randomly distributed, Insignificant Burr cells are usually seen in high numbers

Question 19

Ovalocytes

Answer 19

Elliptocytes
Oval shape, May be slightly oval to very stretched, Central pallor, Rounded ends
Clinical Conditions: Hereditary ovalocytosis, Several miscellaneous anemia’s, Thalassemia, Iron deficiency, Sickle cell anemia

Question 20

Stomatocytes

Answer 20

Mouth cells
Slit-like area of central pallor, Uniconcave disc shape
Clinical Conditions: Abnormal membrane ion exchange, Hereditary stomatocytosis, Liver disease, Lead poisoning

Question 21

Codocytes

Answer 21

Target cells
Target or bull’s-eye appearance, Bell shaped cells, Caused by excessive cell membrane
Clinical Conditions: Thalassemia, Liver disease, Misc.. anemia

Question 22

Erythrocyte Inclusions

Answer 22

RBCs are non-nucleated and free of any internal structures- presence of an inclusion always indicates a pathological condition
Inclusions: Basophilic stippling, Howell-Jolly bodies, Pappenheimer bodies, Heinz bodies

Question 23

Basophillic Stippling

Answer 23

Numerous bluish-black inclusions distributed across entire cell composed of aggregated ribosomes (rRNA)
Clinical conditions: Lead poisoning, Thalassemia, Sideroblastic anemia, Misc. anemia’s

Question 24

Howell-Jolly Bodies

Answer 24

Dark purple spherical inclusion, Residual nuclear DNA, Usually only one per cell
Clinical conditions: Post-splenectomy, Hemolytic anemia, Megaloblastic anemia

Question 25

Pappenheimer Bodies

Answer 25

Siderotic granules
Aggregated iron, Appear as clusters of small granules, ID can be confirmed using the Prussian blue (iron) stain
Clinical conditions: Post-splenectomy, Sideroblastic anemia, Megaloblastic anemia, Hemoglobinopathies

Question 26

Heinz Bodies

Answer 26

Small round inclusions near the periphery composed of precipitated hemoglobin, Only visible with supravital stains
Clinical conditions: G6PD deficiency, Results in excessive oxidation of heme (forms precipitates), Hemoglobinopathies, Supravital

Question 27

Russell Bodies

Answer 27

Large round areas of built-up IG that cannot be released from the Plasma cells, look like a bag of marbles
Distinguished from vacuoles by the appearance of stain within these areas