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Abnormal Cells
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RED CELL ABNORMALITIES
Red Cell SizeRed Cell Type Morphologic Appearance Defect or Change Associated Conditions
Normocytic Normal sized biconcave disc RBCs, 6-8 um
NA NA
Microcytic Smaller RBCs, less than 6 umMCV <80 fl
Abnormal size due to the failure of hemoglobin synthesis
Iron deficiency anemiaThalassemia
Macrocytic Larger RBCsMCV > 100 fL
Impaired DNA syn.Stress erythropoiesisExcess surface membrane
Megaloblastic anemiaLiver disease Alcoholism
Red Cell Hemoglobin ContentRed Cell Type Morphologic Appearance Defect or Change Associated Conditions
Normochromic Normal in color NA NA
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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsHypochromic Central pallor exceed 1/3 of the
diameter of the cellReduced hemoglobin content (MCHC)
Iron deficiency anemiaThalassemia
Hyperchromic No central pallor Greater than normal MCHC Spherocytosis
Red Cell ShapeRed Cell Type Morphologic Appearance Defect or Change Associated Conditions
Acanthocyte Spheroid with 3-12 irregular spikes
Increased ratio of cholesterol to lecithin
End stage liver diseasePyruvate kinase deficiencyAbetalipoproteinemia
Echinocyte Regular 10-30 scalloped short projections
Depletion of ATPExposure to hypertonic solutionArtifact in drying
UremiaCirrhosisHepatitisChronic renal disease
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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsCodocyte Peripheral rim of hemoglobin
surrounded by clear area and central hemoglobinized area (bull’s eye)
Excess surface membrane to volume ratio
HemoglobinopathiesThalassemiaPost-splenectomy
Dacryocyte Teardrop or pear-shaped with single elongated point or tail
Squeezing and fragmentation during splenic passage
Myeloid metaplasiaHypersplenism
Drepanocyte Crescent shape cell that lacks zone of central pallor
Polymerization of deoxygenated hemoglobin
Sickle cell anemia
Elliptocyte Rod or cigar shaped Polymerization of hemoglobin Hereditary elliptocytosis
Schistocyte Fragments of RBCs varying in size and shape
Extreme fragmentation produced by damage of RBCs by fibrin, altered vessel walls and prosthetic heart valves
Disseminated intravascular coagulation (DIC)Microangiopathic hemolytic anemia
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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsSpherocyte Smaller in diameter than normal
RBC with concentrated hemoglobin contentNo visible central pallor
Lowest surface area to volume rationDefective membrane
Hereditary spherocytosisImmune hemolytic anemia
Stomatocyte Normal sized cell with slit like area in center
Known to have increased permeability to sodium
Hereditary stomatocytosisRh null disease
Red Cell InclusionsRed Cell Type Morphologic Appearance Defect or Change Associated Conditions
Howell-Jolly bodies Coarse round densely stained purple 1-2 um granules eccentrically located on periphery of membraneMay be single or double
Nuclear remnants containing DNA
Megaloblastic anemiaAccelerated erythropiesis
Cabot ring Rings, loops or figure of eight; red to purple
Remnants of microtubules of mitotic spindle
Dyserythropoiesis
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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsHeinz bodies Deep purple irregular shaped
inclusions 2 to 3 umFound on RBC inner surface of membrane
Represent precipitated, denatured hemoglobin due to oxidative injury
Hereditary defects in hexose monophosphate shuntG6PD deficiencyUnstable hemoglobins
Basophilic stippling Round dark blue granules uniformly distributed
Represents impaired erythropoiesis
Lead poisoningPyrimidine-5-nucleotidase deficiency
Pappenheimer bodies Small 2 to 3 um irregular basophilic inclusions that aggregate in small clusters near periphery with Wright’s stain
Unused iron deposites Sideroblastic anemiaDefective erythropoiesis
Ringed sideroblast Nucleated RBC that contains nonheme iron particles arranged in ring form
Excessive iron overload in mitochondria of normoblastsDue to defective heme synthesis
Sideroblastic anemia
5
BM smear, iron stain
Supravital stain
Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsSiderocyte Non-nucleated cell containing
iron granulesSame as above Same as above
Miscellaneous RBC abnormalitiesRed Cell Type Morphologic Appearance Defect or Change Associated Conditions
Autoagglutination Clumping of RBCs Presence of antibody Cold agglutininAutoimmune hemolytic anemia
Rouleaux Alignment of RBCs linear appearing as stack of coins
Caused by increased concentration of globulin
Multiple myelomaWaldenstrom’s macroglobulinemia
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WBC ABNORMALITIES
Abnormalities Associated with GranulocytesDescription Morphologic Appearance Defect or Change Associated Conditions
Alder-Reilly granules Large purple-black coarse cytoplasmic granules
Accumulation of mucopolysaccharides
Alder-Reilly anomalyHunter’s syndrome
Auer rods Pink or red rod shaped cytoplasmic structures
Fused primary granules AMLFound in myeloid and monocytic series only
Chediak-Higashi granules Giant red, blue to grayish round inclusions in cytoplasm
Large cytoplasmic inclusions of fused primary granules that are deficient in enzymes for phagocytosis
Chediak-Higashi syndromeAlbinism
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Description Morphologic Appearance Defect or Change Associated ConditionsHypersegmented neutrophil >5 lobes Abnormal DNA synthesis Megaloblastic anemia
Pelger-Huet Single or bilobed nucleus Decreased segmentation Pelger-Huet anomaly
LE cell Neutrophil with large purple homogenous round inclusion with nucleus wrapped around
Three factors needed to produce LE cell: antinuclear antibodies, cell nuclei, phagocytes with ingested material
Lupus erythematosus
Döhle bodies Single or multiple blue cytoplasmic inclusions in neutrophil
Aggregates of free ribososmes of rough endoplasmic reticulum
Severe infectionsToxic states
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Description Morphologic Appearance Defect or Change Associated ConditionsToxic granules Large purple to black azurophilic
granulesPrimary granules Infections, toxic states
Toxic vacuoles Large empty white areas within cytoplasm
Represent end stage phagocytosis
SepticemiaSevere infectionsToxic states
Abnormalities Associated with Lymphocytes/Plasma cellsDescription Morphologic Appearance Defect or Change Associated Conditions
Basket cell Degenerated nucleus or ruptured cell in form of smudge or basket
Lymphocytes that are fragile and break upon smearing
Chronic lymphocytic leukemiaSmall numbers are artifact
Hairy cell Lymphocyte with hair-like cytoplasmic projections surrounding nucleus
Thought to be of B cell origin Hairy cell leukemia
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Description Morphologic Appearance Defect or Change Associated ConditionsSeźary cell Round lymph cell with nucleus
that is grooved or convolutedRepresents leukemic phase of mycosis fungoidesT-cell characteristics
SeźaryMycosis fungoides
Flame cell Plasma cell with red to pink cytoplasm
Associated with increase in IgA Multiple myeloma of IgA nature
Grape cell Plasma cell that contains small colorless vacuoles
Large protein globules giving the appearance of grapes
Multiple myeloma
SOURCE: SAUNDERS MANUAL OF CLINICAL LABORATORY SCIENCE
LEAH MARCH2009
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