48271934 7 Morphologic Evaluation of Erythrocytes

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MORPHOLOGIC

EVALUATION OF

ERYTHROCYTES DISTRIBUTION

MORPHOLOGY



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



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



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









♦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



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





♦

KERATOCYTES− Also known asBLISTER CELL• Presence of vacuole-

like area− Schizocytes w/ 1 or

more projections− Caught up on a

FIBRIN STRAND



♦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



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



♦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



♦HGB H INCLUSION− Small, greenish-blue inclusion− Due to failure to synthesize alpha

globin chain− Stains w/ 1% BCB



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

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48271934 7 Morphologic Evaluation of Erythrocytes