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8/4/2019 48271934 7 Morphologic Evaluation of Erythrocytes
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MORPHOLOGIC
EVALUATION OF
ERYTHROCYTES DISTRIBUTION
MORPHOLOGY
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DISTRIBUTION OF RBC♦Normal Distribution
− Attributed to the maintenance of thezeta potential
−
Cells repel one another− Freely move in the blood vessels
♦
Abnormal Distribution− Rouleaux formation− Agglutination
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♦ROULEAUX
FORMATION− Stacks of coins or
stacks of plates− Occurs due to
increase of plasmagamma globulin
• Hyperproteinemia• Multiple myeloma
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♦AGGLUTINATION− Cells aggregate in
random 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
RBC♦ NORMAL MORPHOLOGY
− Biconcave (discocyte)− Round w/ central pallor (non-nucleated)
−
Central pallor (1/3 of the cell’s dm)− diameter 7-8μm; thickness 2.5μm− stain red to pink (Wright’s stain)
♦ ABNORMAL MORPHOLOGY− Hgb Content, Size, Shape, Inclusion bodies
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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
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♦SHAPE (POIKILOCYTOSIS)− Variation in shape – poikilocytes
− Due to:• Developmental macrocytosis
• Membrane abnormality
• Trauma• Abnormal hemoglobin content
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Developmental
Macrocytosis♦OVALMACROCYTES− Due to Vitamin B12
or Folate Deficiency− Vit B12 and Folate
are essential for thesynthesis of purines
and pyrimidines
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Membrane
Abnormality♦SPHEROCYTES− Round cells lacking
central pallor− Appear smaller
than RBC− Due to SPECTRIN
DEFICIENCY• Hereditary
Spherocytosis• AHA
• Physical orChemical Injury tothe cells
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♦ELLIPTOCYTES− Hemoglobin are
concentrated atthe ends of thecells
− Due to defectiveCYTOSKELETON
• Hemolytic Anemias• IDA• Myeloidfibrosis
with myeloidmetaplasia
• Megaloblasticanemias
• Sickle cell anemia
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♦ECHINOCYTES− known as CRENATED cell− “echinos”: sea urchin−
Have evenly distributed,uniform-sized spicules orprojections
− Due to ANTICOAGULANT used during blood
collection orhyperosmolarity
− In vivo, decreased ATP
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♦BURR CELLS− Have irregularly sized
knobby projections−
Produced by therupture of the cellmembrane byenlarged vacuoles
−
Dx Implication:Renal Disease
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♦ACANTHOCYTES− Also known as SPUR
CELLS− “acantho”: thorn or spike− Irregularly spiculated cells
in which ends of thespicules are bulbous androunded
−
Due to changes in theRATIO OF PLASMA LIPIDS• Abetalipoproteinemia• Liver disease
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♦STOMATOCYTES− From “stoma”: mouth− Mouth-like or slit-like
area of the central pallor− Due to HIGH Na+ & LOW
K+ content of the cell• Cell takes up more fluid
than usual squeezing thecentral pallor in theprocess
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♦CODOCYTES− Also known as TARGET
CELLS; LEPTOCYTES− From “kodon”: bell− Central area of
Hemoglobin is surroundedby colorless ring•
Appear like a BELL or a MEXICAN HAT
− Due to loading of CHOLESTEROL andPHOSPHOLIPID
• 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
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♦
KERATOCYTES− Also known asBLISTER CELL• Presence of vacuole-
like area− Schizocytes w/ 1 or
more projections− Caught up on a
FIBRIN STRAND
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♦DACRYOCYTES− Also known as TEARDROP CELL− From “dakry”: tear−
Pear-shaped cell w/ blunt pointedprojection
− 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
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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
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Developmental
Organelles♦HOWELL-JOLLY BODIES− Small, round
remnants/fragments of
nuclear chromatin− Due to incomplete extrusion
of nucleus during maturation− Seen in:
•
Megaloblastic anemia• Hemolytic anemia
• After splenectomy
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♦BASOPHILICSTIPPLING− Fine or coarse, deep
blue to purplestaining inclusion
− Aggregates of ribosomes
− Due to lead or arsenic
intoxication− Seen in megaloblas-
tic anemia
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♦PAPPENHEIMERBODIES− Siderotic granules
(excess amount of iron store)− Small, irregular,
dark-staining− Appear near the
periphery of nRBC− Positive for PERL’S
PRUSSIAN BLUE
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♦POLYCHROMATOPHILIC RBC− Are diffusely basophilic RBC− Have NO nucleus but still contain RNA− Indicative of young form
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♦CABOT RINGS− Thin, ring-like
structure−
Figure-of-eight orloop-shaped
− Rings are probablymicrotubules
remaining from amitotic spindle
Ab l H b
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Abnormal Hgb
Precipitation♦HEINZ BODIES− Round, refractile
inclusion−
Are denatured globin− Stain w/ supravital
stains:• 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
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Protozoan Inclusion
♦MALARIA− P. vivax (SCHUFFNER’S DOTS)− P. ovale− P. malariae (ZEIMANN’S DOTS)− P. falciparum (MAURER’S DOTS)
♦BABESIA− Babesia microti
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P. vivax
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P. ovale
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P. malariae
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hi d li
P. falciparum