Erythrocyte Abnormalities

Erythrocyte AbnormalitiesClinical Pathology,Ms. Canga

Erythrocyte Morphology Different species have different _________ RBCs with varying degrees

of ___________________________.

Dogs have _____________ RBCs (~________ µm in diameter)

Cats, horses, cows, sheep, goats (3-4 µm)

Llamas and camels have ______________________ (oval) RBCs

Deer have _________________-shaped RBCs

Birds, fish, amphibians, and reptiles have ______________________, elliptical RBCs.

Human RBCs are about the same size as those of ______________.

Relative sizes of RBCs

Chicken Llama

Reptile Deer

Feline blood. Normal erythrocyte morphology. Feline RBCs are smaller than dog erythrocytes, exhibit a slight amount of crenation, and have a minimal area of central pallor

Normal RBC Morphology

Review

There are 5 ways to classify erythrocytes as normal or abnormal: 1) ________________________________________________ 2) ________________________________________________ 3) ________________________________________________ 4) ________________________________________________ 5) ________________________________________________

Arrangement on a Blood Film How should cells appear on film?

Abnormal formation _____________________ formation _________________________________________

Rouleaux Formation

Rouleaux formation Grouping of RBCs that appear ________________ Normal in _________________ Seen with increased _______________ or

___________________ concentration in blood May appear as an _________________ Refrigerated blood not allowed to return to room

temperature May be seen if blood has been held too long before

preparation of smear

Rouleaux as an Artifact

As you learned in Lab Pro, rouleaux formation may be an artifact.

If it IS an artifact and not a true medical condition in the patient, ____________ may be added to the sample.

Rouleaux Formation

Agglutination/Auto-agglutination

Agglutination is caused by an __________________ that coats the RBC causing bridging or clumping of the cells.

Typically occurs in _________________________ disorders

Agglutination MAY appear as __________________ on occasion

To differentiate between agglutination and rouleaux, saline is added to the sample.

On the next slide, are the EXACT procedures for adding saline to your sample:

Adding Saline to Confirm Rouleaux

When rouleaux is suspected, ____________________ all tubes in question.

Carefully remove ___________ /____________with transfer pipette, leaving the cells undisturbed. Discard/use plasma or serum

Add 2 drops of ________________ to test tube and mix well.

________________________the tube

Gently re-mix the red cells and perform smear

_________________ will disperse, ______________________________will NOT

Comparison in the Monolayer

Agglutination can Affect WBCs too!

Variation in Color

Called _______________________

____________________________

____________________________

Calculated through the ___________ (Remember the formula?) Classifies cells as ____________________ or

_______________________

Polychromasia Variation in color usually associated with

__________ and ____________________

________ production begins right before cell loses nucleus

____________ intensity decreases as metabolic activity ____________________

________ increases in intensity as ________ production ______________________.

Polychromasia Recall that the _______________ the cell in the RBC

maturation series, the more dark blue the staining due to increased __________________ activity.

Mature RBCs stain _________ because they have their full complement of ________.

______ production begins right before cell loses ______________; immature RBCs with some Hb present stain ______________________ because there is still some metabolic activity going on within the cell.

Hypochromasia ____________ staining intensity of RBCs

Caused by insufficient ________ concentration due to _________ deficiency (Chronic ____________ loss or ______________________)

Cell will appear normally stained around __________________ with a much paler central region.

Hypochromasia is almost always accompanied by _____________________ . (Decreased __________)

Determined by a decreased ______________

Hypochromasia

Hyperchromasia Increased staining intensity of RBCs

Immature RBCs = larger and darker

Hyperchromasia based on _______ concentration (_______) cannot exist…

Presence of _______________, ___________________, and _____________can interfere with tests and _______________________ increase MCHC

_____________________ often seen are __________________and __________________but can have

normal cell volume. (Cell may be ________________) May be seen in mismatched _________________________

Hyperchromasia/Spherocytes

Canine blood. Regenerative anemia with spherocytes. Anisocytosis is due to macrocytic cells and spherocytes, which are smaller than normal and lack central pallor. Spherocytes are associated with hemolytic anemias due to immune disease or fragmentation. The polychromatophilic RBC with a rod- shaped area of central pallor (arrow) is a stomatocyte

Variations in the __________________ of RBCs

(poikil ~ irregular)

Not a __________________________

A general term to encompass nondescript variations in ______________ of erythrocytes that are scattered throughout the blood film.

Poikilocytosis

Poikilocytosis

Note: Poikilocytosis, anisocytosis, and polychromasia are present on this slide.

RBC fragments resulting from shearing of red blood cell by _________________________________.

May be seen with _______________________________________ (DIC) or with ________________________

Expect to also see ________________________________ on blood film of animals with DIC

Can be caused by excess _______________deposition, malformation of _______________________, or excessive _________________________in the blood

Common name is “__________________________”

Schistocytes “Helmet Cell”

Schistocytes

Have irregular membrane projections of _______________________ length and diameter with __________________________tips

_______________________sized and spaced

May be seen in blood smear of: Cats with _____________________________________, Dogs with ___________________disease or ____________________________of the liver

Represent __________________ alteration rather than ________________________

Commonly called “________________”

Acanthocytes “Spur Cells”

Acanthocytes

__________________ change

Resulting from _____________ change in blood, altering cell _____________________

May appear __________________ or ruffled, with relatively _____________ sized and spaced, short, _________ projections

Associated with ____________ disease, ____________________ or rattlesnake _________________________in dogs

Can be _____________________ if excess of _______ is present

Echinocytes “Burr Cells”

Echinocyte formation

Echinocytes

__________________ Change ______________________ Slow ________________ of blood film _____________________EDTA tube Affects the ________________ of the cells on a blood film

Echinocytes as“Crenation”

Crenation

________________________ with pointed ends

Result of alteration in __________ due to low ___________ tension

Normal finding in ___________, Angora _________, and some ___________

Drepanocytes “Sickle Cells”

Drepanocytes

Also called “________________”

Keratocytes are believed to result from ____________________________________

Can also result from _________________ injury found with ___________ deficiency

Presence of keratocytes has also been associated with ____________________, _________________, ________________________, and various _________________ diseases.

Keratocytes “Helmet cell”

Keratocytes and Pre-keratocytes

____________ shaped RBCs that form as a result of a loss of the membrane ____________________.

Cell cannot return to normal shape after passing through a narrow _____________________.

May be seen in any _______________ disease.

Can also occur due to low _______ concentration or as an ____________________.

Anulocytes “Punched-out cells”

Anulocytes (Punched-out cells)

_________________ shaped RBCs with a single ____________________ or _______________end

May be seen in _________________________ diseases or ____________ and ________________ disorders of dogs.

Can be an ______________ . Check to see if the _______________ are all pointing in the __________ direction.

Dacryocyte “Teardrop cells”

Dacryocytes “Tear-drop Cells”

Eccentrocyte Characterized by a shifting of the _______________ to one side

of the RBC

____________ portion of membrane is ragged and poorly _______________________________.

Form under conditions of ___________________ stress

May be seen with ____________________________Anemia

Eccentrocyte

Codocytes (Leptocytes)

Characterized by an increase in membrane _________________ _________

Include all of the following cells: __________________________ __________________________ __________________________ __________________________

Resembles a ____________ with a bulls-eye Have central area of _____________ surrounded by area of

pallor _________________ of cell contains band of _______ A few may be seen in _____________ smears May be associated with __________ deficiency, _________,

___________ diseases, and some _______________ disorders.

Target Cells (Bull’s eye Cell)

Target Cells

Folded cells have a ______________ _____appearing central pallor

_____________________ have a transverse, raised fold extending across the center of the cell and a clear, _________-like pale region in the center.

Both may be caused by a change in membrane _____________ associate with ______________ disease

Both are considered an ___________________ if the areas of pallor are ________________________ to the feathered edge.

Folded cells and Stomatocytes

Stomatocyte

Stomatocytes

Folded Cells

Knizocytes (Barr Cells) Appear to have a bar of _________ through the central pallor.

Commonly observed in chronic ______________ disease

May be observed in any acute ______________ dysfunction

Caused by an alteration in the ______________ content of cell membrane

Knizocytes or “Barr Cells”

Some Poikilocytes at a glance

Test yourself!

Presence of Structures on/in Erythrocyte Many different abnormalities caused by variety of different

conditions. __________________________ __________________________ __________________________ __________________________ __________________________ __________________________

__________________________ __________________________ __________________________

Howell-Jolly bodies __________________________ nuclear remnants observed in

young RBCs during their response to __________________________ anemia

Normally, as cells containing nuclear remnants pass through the _______________ , _________________ cells remove the remnants.

Therefore, HJBs may be seen with ________________ disease or in an animal with the _____________removed.

Howell-Jolly bodies

Observed in RBCs that contain abnormal, residual ___________.

Small, dark blue “__________________” within the RBC.

Occasionally seen in __________________ RBCs in _____________ cats.

Characteristic finding with __________________________ in dogs.

Basophilic Stippling

Basophilic Stippling

Particles of __________________________, resulting from oxidative injury, attach to RBC _______________________.

They stain blue with _________________________________ and appear as a _________________ area with Diff-quick stain.

Seen in _________________________ and ______________ ingestion in cats and dogs

HBs are often increased in concentration with diseases such as _____________________ , ______________________, and ______________________________ in cats

Normal cat blood may have up to _____%

Heinz Bodies

Heinz bodies

Reticulocytes Immature RBC; contains _________________ (ribosomes) and

residual RNA that are lost as the cell matures.

A.k.a. ‘____________________________ RBC’ (when stained with _______________________ and not NMB)

NMB causes visualization of clumping of residual organelles, referred to as ‘______________________’.

Cats have two forms: ___________________ and _____________________.

Reticulocytes

Canine Distemper Viral Inclusions Seen in RBCs of dogs with _________________.

__________________________

Variable in _________, __________, ________ and _________(faint blue to magenta).

More frequently seen in ________________________ RBCs than _______________RBCs.

Can also be seen in ___________________ and _____________________.

Viral Distemper inclusions

Blood Parasites that Affect RBCs Parasites may be present ____________ or _____ the

surface of RBCs

Stain ___________________ and drying ________________ are sometimes confused with RBC parasites.

Babesia spp. _____________________ or __________shaped,

______________________, paired inclusions

Transmitted via ______________

Causes ___________________ anemia

Commonly identified at __________________ edge of blood smears

Seen in __________, __________, __________, __________, and ______________

Babesia spp.

Formerly known as: ____________________________

Disease = Feline Infectious __________________ Anemia

May be, coccoid, rod-shaped, or ringlike structures, but usually appear as short, dark purple ________on the __________________ of RBCs

Organisms usually detach from the RBC when placed in _________________________.

Cyclic ____________________, organisms may be numerous, scarce or not found in a given blood sample – examine blood at different _____________of the day

May be transmitted by ______________

Mycoplasma haemofelis

Mycoplasma haemofelis

Mycoplasma haemocanis Formerly known as ___________________________

Rare; Usually only occurs in ________________________ or immunosuppressed dogs.

Organism appears as a chain or small cocci or rods that stretch across _____________ of RBC.

Chains may appear “_____________________.”

Mycoplasma haemocanis

Cytauxzoon felis

Small, ring or _______________-shaped bodies in red cells

Causes a ______________ disease in cats

Transmission is by ____________

Rare cause of _________________ anemia

No known _________________

Cytauxzoon felis