1. Normocytic 2. Macrocytic 3. Microcytic

RBC ABNORMALITIES Flashcards by Unknown Unknown

> even distribution of RBCs in the thin
portion adjacent to the feather end of the film

Ideal

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RBCs should be slightly separated
from one another or barely touching without
overlapping; should represent 1/3 of the entire
film

Thin area

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may overlap or lie on top of one
another, making them unsuitable

Thicker portions

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Not separated with each
other; appear in
short/long stacks
resembling coins

ROULEAUX

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Happens when their
biconcave surfaces are in
apposition

ROULEAUX

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Increased ESR

ROULEAUX

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Increased
fibrinogen(tissue
necrosis)= long stacks

ROULEAUX

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Hyperproteinemia, MM,
macroglobulinemia

ROULEAUX

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Cells are in clusters or
masses when exposed to
antibodies

2) AGGLUTINATION

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normal or in disease
state ( atypical
pneumonia or hemolytic
anemia)

Autoagglutination

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clumping at below 25°C

COLD AGGLUTININ DSE

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Increased MCV in
automated machine-
(artifactual) since clumps
are counted as one.

2) AGGLUTINATION

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Increasing central pallor,
decreasing hemoglobin
concentration
Caused by impaired Hb
synthesis
Associated most often with
microcytosis; (e.g. IDA,
thalassemia, sideroblastic
anemia)

HYPOCHROMIC

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Clear central pallor (1/3)

NORMOCHROMIC

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lack of central pallor
aasociated with
macrocytosis
MCHC is elevated in
true hyperchromia
Examples are HA,
including hemolysis
caused by burns

HYPERCHROMIC

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SIZE (1-3)

Normocytic
Macrocytic
Microcytic

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MACROCYTIC

If diameter exceeds _______ and MCV exceeds _________
* Low Vitamin B12, alcoholism with or w/out liver
disease, cancer chemotherapy, chronic HA with
reticulocytosis, myeloma etc.
* Diffusely basophilic (polychromatophilic red
cells)/Prematurely released red cells called ________
cells, occurs as a result of stimulated erythropoiesis

8.5-9µm
100fL
“shift”

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MICROCYTIC

Small RBC, occurs when MCV is below ______
Characteristic of IDA

80 fL

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lack central pallor and appear to have
increased Hb seen in HA,hereditary spherocytosis

Spherocytes

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thinner than normal and have a
colorless center; increased surface area that is out of
the proportion to the volume; Smaller leptocytes are
seen in thalassemia, Hb C, steatorrhea, may be
normocytic or microcytic

Leptocytes

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Red cells showing variation in
population size or diameter in
the blood

ANISOCYTOSIS

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This is correlated with Red
Cell Distribution Width

ANISOCYTOSIS

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An estimate of erythrocyte
variation in sizes, calculated in
most automated analyzers, and
is used as index of red cell
population heterogeneity

RED CELL DISTRIBUTION
WIDTH (RDW)

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Principle (Coulter S-plus):
Using a 256 channel pulse
height discriminator, RBCs are
enumerated in the three
RBC/Plt apertures as particles
from 36 – 360 fl

RED CELL DISTRIBUTION
WIDTH (RDW)

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RED CELL DISTRIBUTION WIDTH (RDW) * Reference values: _______ - ________

11.5 – 14.5 %

-Large oval shaped cells with marked increased MCV

1. OVAL MACROCYTES (MACROOVALOCYTES)

-Occur due to nuclear maturation defect in the early marrow cells caused by Vit B12 or folate deficiency; strongly suggest MEGALOBLASTIC ANEMIA.

1. OVAL MACROCYTES (MACROOVALOCYTES)

Elliptical egg-shaped/oval to sausage shaped - N:<10%, H or A, of decreased skeletal membrane protein band 4.1 Seen: Hereditary Elliptocytosis, IDA, MMM

1. Elliptocytes (Ovalocytes)

- Round, small red cells, lacks central pallor, showing an intense staining affinity. -H or A, seen in: HS, Acquired HA, Burned patient

2. SPHEROCYTE

-central area of Hb surrounded by a relatively colorless ring, appear like a bell or tall hat shaped, or Mexican hat shell -A; Membrane surface is increased after loading of the membrane with cholesterol and phospholipids

3. Codocytes (Target Cells) (Gr. kodon – bell)

- Having many UNIFORM tiny (blunt) spicules on their surfaces; represent artifact on films; should not be reported COMMON CAUSES: - Films made from long hour standing (stored) anticoagulated blood; depleted ATP levels - Due to release of basic substances from glass slide that changes the pH -Using a moist saline preparation of red cells in an elevated pH

. ECHINOCYTES (Crenated Cells) (Gr. Echinos – sea urchin)

- Having IRREGULARLY SIZED AND UNEVENLY spaced spicules, that differs from echinocytes, and should be reported when seen. - Related to INCREASE IN BUN (Uremia).

5. Burr cells

Small, densely stained RBCs having few irregular, large pointed spicules or thorn like projections -H or A; caused by changes in ratio of plasma lipids (LS ratio) Seen: Abetalipoproteinemia (rare congenital syndrome with HA, retinal degeneration, and steatorrhea) Alcoholic cirrhosis with HA; Postsplenectomy; Lipid Membrane Disorders

6. Acanthocytes (Gr. Acantho: thorn or spike)

- Having an elongated or slit like area of central pallor (mouth shaped) - H or A membrane defect in the Na+:K+ transport ratio (high IC Na+ and low K+) and a greatly increased rate of active cat ion trn

6. Stomatocytes (Gr. Stoma:mouth)

Undergoes cleavage and fragmentation (fragmented cells) - Process is associated with either small blood vessel disease or fibrin in small blood vessel and results in intravascular fragmentation - Indicates hemolysis seen n: MAHA, Severe burns, Renal graft rejection, Glomerulonephritis, Vasculitis

1. Schistocytes (Schizocytes) (gr. Schistos: cloven or schizon split)

schistocyte w/ 1 or more horn like projections.; a rare phenomenon; should be reported as SCHISTOCYTE

Keratocyte

A result of RBC being caught on a fibrin strand w/c could cut it to two. When this escapes, it may have a vacuole like area (blister cell)-asso with G6PD

poilkilocytes

Teardrop or pear shaped cells -Red cells containing Heinz bodies that squeeze through the splenic (micro-) sinuses, hence, will have its original shaped stretched. -Seen in: n in: MMM Heinz body anemia Myelophthisic Anemia

2. Dacrocytes/Dacryocytes (Teardrop Cells) Gr. Dakry (tear)

Usually seen in severe burns as small, round cells, as a result of thermal damage to the membrane, and Pyropoikilocytes

3. MICROSPHEROCYTES

-Rare hereditary HA associated with heat sensitivity at 45° C (Normocytes fragment at 49°C)

3. MICROSPHEROCYTES

Are large fragments of red cell membrane with their contents being extruded, and stain pale pink forming a half moon or crescent shape cell

4. Semilunar Bodies

- Frequently seen in malaria

4. Semilunar Bodies

Are large fragments of red cell membrane with their contents being extruded, and stain pale pink forming a half moon or crescent shape cell

1. Drepanocytes (Sickle Cells) (Drepanos –Sickle)

- Frequently seen in malaria

1. Drepanocytes (Sickle Cells) (Drepanos –Sickle)

3 POIKILOCYTES SECONDARY TO ABNORMAL HEMOGLOBIN CONTENT

1. Drepanocytes (Sickle Cells) (Drepanos –Sickle) 2. Hemoglobin CC Crystals 3. Hemoglobin SC Crystals

Intracellular hexagonal crystals with blunt ends and stains darkly; forms within the red cell membrane when Hb C crystallizes.

2. Hemoglobin CC Crystals

Dark-hued crystals of condensed Hb that distorts RBC membrane.

3. Hemoglobin SC Crystals

2 forms: Crystalline projections often straight with parallel sides and one blunt, pointed, protruding, end (Washington monument shape) - One or more fingerlike blunt pointed projections, that protrude from the cell membrane in different directions

3. Hemoglobin SC Crystals

RBC INCLUSION BODIES ABNORMAL DEVELOPMENTAL ORGANELLES

1. HOWELL – JOLLY BODIES 2. Basophilic Stippling (Punctate basophilia)

-small round fragments of a metarubricyte and stain reddish blue in Wright’s; result from kharyorrhexis or from incomplete extrusion of nucleus during mitosis, give positive Feulgen reaction

1. HOWELL – JOLLY BODIES

Irregularly shaped basophilic (deep blue with Wright’s) granules; represents aggregates of ribosomes

2. Basophilic Stippling (Punctate basophilia)

due to increased red cell population, seen with increased polychromatophilia

FINE STIPPLING

due to abnormal instability of RNA in the young cells, seen in lead poisoning, thalassemia, megaloblastic anemia, and severe anemia.

GRANULAR STIPPLING

two forms of Basophilic Stippling

Fine stappling Granular stippling

Round refractile bodies of denatured hemoglobin precipitates, not visible in Wright’s stain; pitted golf appearance if multiple

1. HEINZ BODIES

Best stained with SUPRAVITAL STAINS incubation with acetylphenylhydrazine (an oxidant) for a long period induces heinz body formation

1. HEINZ BODIES

-Seen in hereditary G6PD deficiency

1. HEINZ BODIES

small greenish-blue inclusion bodies  Precipitated Hb H  Hb H dse.(α-thalassemia)

Hemoglobin H inclusions

Plasmodium spp transmitted to man by Anopheles mosquito

 MALARIA

Schuffner’s stippling four maturation stages infects the RBC-enlarged

P. vivax

same but RBC not enlarged

P. malariae

small delicate ring forms, gametocytes are banana shaped

P. falciparum

RBC is oval, Schuffner’s stippling present

P. ovale

Babesia microti

BABESIOSIS

 Rare transmission to humans by tick bites  Resemble ring stages of malarial parasites  Tiny rings 1-5 µm  Tetrad formation  RBC not enlarged

BABESIOSIS

RBC ABNORMALITIES Flashcards

(66 cards)