Hematology Tables Morphology Of Rbcs 643x1

ABNORMAL MORPHOLOGY (Hb content) MCH MCHC Central Pallor size Cause

Associated Ds.

HYPOCHROMIA <27 pg <31 % ↑

HYPERCHROMIA >32 pg >36 % ↓

ANISOCHROMIA

Impairment in Hb synthesis (Thin rim of Hb)

No true hyperchromia Surface: volume ratio is reduced making it seem Hb is ↑

Presence of both HYPOCHROMIC and NORMOCHROMIC cells

w/ Microcytosis (Hypochromic, Microcytic)  IDA  Sideroblastic anemia  Thalassemia w/ Normocytosis -defect in Iron release from macrophages  Rheumatoid arthritis  Chronic infx  Inflammation

 

Microspherocytosis in burn px Sickle red cells

Denotes:  Effectivity of treatment  Severity of disease

Abnormal Morphology Size (ANISOCYTOSIS) MACROCYTOSIS >8.5 – 9 µm >100 fL  Vit B9 & B12 deficiency  Chronic alcoholism  Hemolytic anemia w/ reticulocytosis  Leukemia  Lymphomas  HDN – hemolytic ds of the Newborn  Liver disease

RBC SIZE MCV Causes

MICROCYTOSIS <6 µm <80 fL Iron stores are very ↓ or completely depleted  IDA  Thalassemia  Sideroblastic anemia

Poikilocytosis 1. Poikilocytosis 2° to defect in RBC DEVELOPMENT Poikilocyte Oval Macrocytes

Other Name Macrocytes

Defect/Cause

Asso. Diseases

Maturation of RBC Vit B9 & B12 deficiency MCV: >125 fL

Megaloblastic anemia

2. Poikilocytosis 2° to defect in RBC MEMBRANE Poikilocyte

Other Name -

Defect/Cause

Appearance

↑BUN in serum

Elliptocytes

Ovalocytes

Cytoskeletal protein band 4.1 (P. protein)

Echinocytes

Echinos – Urchin or Sea urchin

*artifact Old blood samples -↓ATP, ↑pH

Unevenly spaced, POINTED, irregularly-sized spicules Egg-shaped Oval/sausageshaped Rod-shaped Pencil forms Crenated RBCs Evenly spaced, BLUNT, uniformsized spicules

Burr cells Reversible

Invitro – reverse Invivo irreverse Spherocytes

Codocytes

Acanthocyte s irreversible

Stomatocyte s

-

Kodon Bell cells; Target cells; Mexican hat cells; Dart board cells

Acantho – thorn/spike Spur cells

Stoma – smiling mouth

Hereditary: Spectrin deficiency

Round cellslacks central pallor Normocytic or microcytic

↑cholesterol & ↑phospholipids in RBC membrane

Central area of Hb w/ colorless ring at periphery

↑ Surface:Volume ratio (↑OFT)

Always- acquired

Pathologic: found in all throughout examination area Lipid metabolism

Damage to Na+ K+ pumps located in RBC membrane Na:K ratio Maybe retained to spleen – shape & deformability

Unevenly spaced, SLIGHTLY POINTED, clubshaped spicules

Elongated, slitlike area in central pallor

Asso. Diseases

Acquired  IDA  Megaloblastic anemia  Thalassemia

Hereditary  MAHA – microangiopathic hemolytic anemia  Immune-hemolytic anemias  Physical or chemical injury to cells  Thalassemia  Hemoglobinoathies SS, CC, DD and EE  Obstructive liver disease  IDA

 

Abetalipoproteinemia Pyruvate kinase deficiency  Alcoholic cirrhosis w/ hemolytic anemia  Postsplenectomy  Lipid malabsorption  Lipid metabolism disorders Acquired  Alcoholism  Cirrhosis  Obstructive liver disease  RH null disease

3. Poikilocytosis 2° to defect in TRAUMA Poikilocyte

Other Name

Defect/Cause

Appearance

Microspherocyte

Pyro – fire Pyropoikilocyte s (severe burns)

Severe burns Thermal damage to RBC membrane (spectrin) -contains HEINZ bodies -inclusions cannot through small sinuses of spleen thus remain behind (stretched)

Smaller than spherocytes

-a schistocyte >1 horn-like projections -RBCs through intravascular fibrin clot -vacuole RBCs through fibrin clots

>1 horn-like projections

s

Dacrocytes

Dakry – tear Teardrop cell

Keratocytes

Keras – horn

Schistocytes

Schistos – cloven Schizo – half Schizocytes

Teardrop

Asso. Diseases



   

Forming a Blister





    

Semilunar bodies

Crescent cells Half-moon cells

Always ACQUIRED Ghost cells – membrane remaining after RBC has released its contents

 

MMM – Myelofibrosis w/ Myeloid Metaplasia Myelophthisic anemia Pernicious anemia Beta-thalassemia Heinz body formation due to drug ingestion

MAHA – microangipathic hemolytic anemia TTP – Thrombotic Thrombocytopenia Purpura March hemoglobinuria Traumatic hemolytic anemia Severe burns Renal graft rejection Glomerulonephritis Malaria Conditions that cause overt hemolysis

4. Poikilocytosis 2° to defect in ABNORMAL Hb Poikilocyte

Drepanocytes

Hemoglobin

Other Name Drepan e– sickle Sickle cells

-

CC crystals

Hemoglobin SC crystals

-

Defect/Cause

Appearance

Asso. Diseases

Polymerization of HbS (unstable/quick polymerization)

Thin, elongated & pointed cells filled w/ Hemoglobin

Commonly Hb SS – Homogeneous (Sickle cell disease)

Occurs bc of INHERITED HbS

Rare Hb AS – Heterogeneous (Sickle cell trait)

Cell membrane is not visible

Hemoglobin condenses and distort the RBC membrane

Hexagonal crystals w/ blunt ends that stain darkly

Washington Monument Shape

Others  Hb SC  Hb S Beta-thalassemia  Hb C – Harlem  Hb S - Memphis Commonly Hb CC – Homogeneous (Hb C disease) Rare Hb AC – Heterogeneous (Hb C trait) Hb SC diseaase

RED BLOOD CELL INCLUSIONS 1. Developmental ORGANELLES INCLUSION

Howell-Jolly Bodies

Basophilic Stippling

Pappenheime r bodies (Siderotic granules)

APPEARAN CE Small round fragments of the nucleus

Fine or coarse stipplings that appear EVENLY throughout RBC

Fine or coarse granules that appear NEAR THE PERIPHERY of RBC

REASON OF FORMATION Incomplete nuclear fragmentation

Wright stain

REDDIS H BLUE

  

Metarubricyte defect (ortho)

Feulgen reaction

DNA – red RNA green



Wright Stain

Deep blue to Purple



Result of karyokinesis Remnants of ribosome

STAIN

DISEASE

COLOR

Negative to Pearl’s Prussian Blue



   

Degrade ferritin (ferric) Siderocyte granules – mature RBC Sideroblast – immature RBC

Wright stain

Darkly stained

Positive to Pearl’s Prussian Blue confirmatory

   

Sickle cell anemia Hemolytic anemia Megaloblastic anemia Congenital absence of spleen Splenic atrophy after multiple infarctions PYRIMIDINE-5’NUCLEOTIDASE DEFICIENCY Thalassemia Megaloblastic anemia Alcoholism Lead & Arsenic intoxication Sideroblastic anemia Thalassemia Hyposplenism After splenectomy

Polychromato philic Red Cells

Cabot rings

Young mature RBC still have RNA

↑ EPO stimulation of the BM

Thin, Ringlike Figure of 8 Incomplete rings

Remnants of Mitotic spindle and microtubules

Wright stain Supravital stain reticulocytes Wright stain

Diffusel y blue

Reddis h Violet

  

Lead poisoning Megaloblastic anemia Severe anemias

2. Abnormal Hemoglobin Precipitation INCLUSION Heinz Bodies

APPEARAN CE Round & refractile inclusions Large-singly Small-many

Hemoglobin H Inclusions

Pitted golf ball – multiple Heinz bodies Small, greenishblue inclusion bodies

REASON OF FORMATION Denaturation of globin of Hb – precipitating of Hb *pitted in the spleen = bite cells

Precipitation of Hb H (Hb variant) – unstable Hb prone to oxidation & precipitation

STAIN

COLOR

Not visible in Wright stain

Crystal Violet

Inclusions w/ reticulin



 

Visible: supravital stains

Supravital stain

DISEASE AROMATIC COMPOUND POISONING G-6-PD deficiency Severe anemias

Brillian t Cresyl Blue

New Methyl ene blue

3. Protozoans Inclusions INCLUSION Malaria

Babesia

APPEARAN CE Sausage, crescent, bananashaped Maltese cross formation

Organism 

M. falciparum  M. vivax  M. ovale  M. malariae Babesia microtii

Vector

STAIN

Female Anopheles mosquito

Giemsa (Best)

(Wuchereria bancrofti)

Acridine Orange

Female Anopheles mosquito

Giemsa

(Wuchereria bancrofti)

DISEASE Malaria

Babesia