Patho[Lab Ppt Trans]_2-2_RBC Morphology (1)

8/4/2019 Patho[Lab Ppt Trans]_2-2_RBC Morphology (1)

1/24

R B C

MORPHOLOGYAug. 2011


2/24

0 Anemia- defined as a reduction in the total quantityof red cells or hemoglobin (Hb) in the circulation.

0 RBC provide a mode of transport of Hb to deliveroxygen to the tissues and carbon dioxide from the

tissues.


3/24

ERYTHROCYTE MATURATION

1. Proerythroblast (14-19 m): Nucleus is large with

fine chromatin and nucleoli; cytoplasm is scant and

basophilic.

2. Basophilic erythroblast (12-17 m): Slightly smaller

nucleus with slight chromatin condensation; increasedcytoplasm and intensely blue (RNA abundance); no

granules and no nucleoli present.

3. Polychromatophilic erythroblast (12-15 m):

Moderately condensed chromatin; lighter, grayish

cytoplasm. The color of the cytoplasm is due to coloring

by both acidic and basic components of the stain.Basophilia is from staining of ribosomes and acidophilia

from hemoglobin. The nucleus is condensed and

intensely basophilic with coarse heterochromatin granules

giving a characteristic checkerboard appearance.

4. Orthochromatophilic erythroblast (8-12 m): Dark,

opaque nucleus; gray-red cytoplasm (trace blue). The

nucleus has become pyknotic and there is abundant

acidophilic hemoglobin.

5. Reticulocyte (7-10 m)Nucleus has been extruded;

cytoplasm is reddish-pale blue. RNA is still present.

6. Erythrocyte (7-8 m): No nucleus; orange-red

cytoplasm; RNA is lost


4/24

0 RBC morphology- determined through peripheral blood smear ( in the thinpart, atfeathery edge )

0 Why at the feathery edge of the smear?1. Distribution- cells not in this edge are stacked (patong-patong)2. Cell contents (nucleus, cytoplasm) are clearly seen3. passage of light through thin partmorphology can be determined4. WBC are numerous at the THICK part because they are bigger .

Indications for requesting for RBC morphology:1. For diagnosis of malaria hospitals have specific tests for malaria but still use

the smear to confirm

2. To detect anemia- any defect in RBC will produce anemia3. To confirm sickle cell anemia; to concretize the diagnosis of the type of anemia

Other specimens tested for RBC/for diagnosis of anemia:1. Bone marrow aspirate2. Urine- identification ofhematuria in patients w/ renal problems, doc looks for

dysmorphic RBCs

Anemia-Pallor: pale conjunctiva, decreased capillary refill (at nail beds), pale skin (ifperson is dark-skin, check the mucosa)

0*CBC only used for RBC count(amount/quantity), not the form of RBCs


5/24

DEFINITION OF TERMS

0 CRENATION- the RBC are with shrunken or irregularborders,tiny smooth projection(ruffles) in their membrane.

This results from loss of intracorpuscular water through

osmosis and not a significant diagnostic indicator of any

disease state can be drugs, dehydration, etc.

0 ACANTHOCYTES-similar to crenated RBC; however the

projections are irregularly spaced and at the apex of theprojections are sharp points. Seen in px with metabolic

dysfunction (dec. lipoprotein absorption in GIT )


6/24

0BURR CELLS similar to elongated crenated rbc and

often assume irregular shapes such as that of

quarter moon. Seen in px with bleeding gastric

ulcers and renal insufficiency.

0TARGET CELLS dark-staining periphery and

darker central area with a lighting between the 2

dark areas.Seen in px with hemoglobinopathies such

as thalassemia and liver disease.


7/24

0PYKNOCYTES observed during the 1sttrimester of life

in the newborns.Have similar appearance tospherocytes with small spinal projections.Seen in px

with G-6-PD dificiency.

0 SICKLE CELL mature RBCs that have become

crescent-shaped.


8/24

0ELLIPTOCYTES are mature RBCs that assume an

elliptical or oval shape. Seen in px with hereditaryelliptocytosis, some forms of anemia. Believed to be

a defect in the integrity of corpuscular membrane.

0 SCHISTOCYTES fragments of RBC still in the

peripheral circulation. Formed in the spleen and

intravascular fibrin clot. Indication ofhemolysis.


9/24

0 SPHEROCYTES smaller than normocytes and

contains abnormally large amount of Hb. Seen in

px with hereditary spherocytosis.

0MICROCYTES smaller RBC in diameter.0 ( 6.0 um or less)

0MACROCYTES ave. diameter of9.0 um in

diameter or greater.


10/24

0 The red blood cells here are normal, happy RBC's. Theyhave a zone ofcentral pallor about 1/3 the size of the

RBC. The RBC's demonstrate minimal variation in size(anisocytosis) and shape (poikilocytosis). A few smallfuzzy blue platelets are seen. In the center of the field are aband neutrophil on the left and a segmented neutrophil onthe right.


11/24

0 The RBC's here are smaller than normal and have anincreased zone of central pallor. This is indicative of a

hypochromic (less hemoglobin in each RBC) microcytic(smaller size of each RBC) anemia. There is also increasedanisocytosis (variation in size) and poikilocytosis(variation in shape).


12/24

0 The RBC's here have stacked together in long chains. This isknown as "rouleaux formation" and it happens with

increased serum proteins, particularly fibrinogen andglobulins. Such long chains of RBC's sediment more readily.This is the mechanism for the sedimentation rate, whichincreases non-specifically with inflammation andincreased "acute phase" serum proteins.


13/24

0 The most common cause for a hypochromic microcyticanemia is iron deficiency. The most common nutritional

deficiency is lack of dietary iron. Thus, iron deficiencyanemia is common. Persons most at risk are children andwomen in reproductive years (from menstrual blood lossand from pregnancy).


14/24

0 Here is a hypersegmented neutrophil that is present withmegaloblastic anemias. There are 8 lobes instead of the

usual 3 or 4. Such anemias can be due to folate or to B12deficiency. The size of the RBC's is also increased(macrocytosis, which is hard to appreciate in a bloodsmear).


15/24

0 There are numerous fragmented RBC'sseen here. Some ofthe irregular shapes appear as "helmet" cells. Such

fragmented RBC's are known as "schistocytes" and they areindicative of a microangiopathic hemolytic anemia(MAHA) or other cause for intravascular hemolysis. Thisfinding is typical for disseminated intravascularcoagulopathy (DIC)


16/24

Spherocytes

0 This peripheral blood smear demonstrates many larger bluish

reticulocytes as well as smaller RBC's lacking central pallor--spherocytes. This patient had an autoimmune hemolytic anemia.Antibody coated the RBC's, and portions of the RBC's were removed,decreasing cell size. Many RBC's were removed entirely, resulting inanemia and a bone marrow response with increased erythropoiesis andelevated reticulocyte count (20%). The patient developed an indirecthyperbilirubinemia as well.


17/24

Tear drop cells

0 This peripheral blood smear demonstrates tear drop cells.These characteristically shaped RBC's can be seen inpatients with myelofibrosis and those who underwentradiation


18/24

0 The RBC in the center of the field contains several Howell-

Jolly bodies, or inclusions of nuclear chromatin remnants.There is also a nucleated RBC just beneath this RBC.Abnormal and aged RBC's are typically removed by thespleen. The appearance of increased poikilocytosis,anisocytosis, and RBC inclusions suggests that a spleen isnot present.


19/24

Spherocytes

0 The size of many of these RBC's is quite small, with lack of

the central zone of pallor. These RBC's are spherocytes. Inhereditary spherocytosis, there is a lack of spectrin, a keyRBC cytoskeletal membrane protein. This producesmembrane instability that forces the cell to the smallestvolume--a sphere. In the laboratory, this is shown byincreased osmotic fragility. The spherocytes do not

survive as long as normal RBC's.

No central pallor


20/24

0The nucleated RBC in the center containsbasophilic stippling of the cytoplasm. This

suggests a toxic injury to the bone marrow, suchas with lead poisoning. Such stippling may alsoappear with severe anemia, such as a megaloblasticanemia.


21/24

0 This peripheral blood smear demonstrates markedpoikilocytosis (abnormally shaped RBC's) as well as some

anisocytosis (variation in RBC size), though many are small(microcytes). This patient had beta-thalassemia, ahereditary disorder of beta globin chain synthesis that leadsto ineffective erythropoiesis and a microcytic anemia. Someof the RBC's resemble jigsaw puzzle pieces.

Poikilocytosis


22/24

0 This is sickle cell anemia in sickle cell crisis. The abnormalhemoglobin SS is prone to crystallization when oxygen

tension is low, and the RBC's change shape to long, thinsickle forms that sludge in capillaries, further decreasingblood flow and oxygen tension. Persons with sickle cell trait(Hemoglobin AS) are much less likely to have this happen.


23/24

0 In the center of the field is a rectangular RBC that isindicative ofHemoglobin SCdisease. Both hemoglobin S

and hemoglobin C are present. The RBC's may sickle, butnot as commonly as with Hemoglobin SS disease. Thehemoglobin C leads to the formation of "target" cells--RBC's that have a central reddish dot.

HbSC

HbC


24/24

0

Malaria is a parasitic disease caused by the genusPlasmodium, of which there are four species that affectman. Shown here are "ring forms" of Plasmodiumvivax in red blood cells. This disorder can producehemolysis and anemia.

Documents

Patho[Lab Ppt Trans]_2-2_RBC Morphology (1)