RBC Morphology

I. RBC SizeII. Hemoglobin ContentIII. RBC shape

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RBC Morphology RBC SizeNormal size is 6-8 u in diameter (NORMOCYTIC RBC/ NORMAL RBC)*******************************************ANISOCYTOSIS

→variation in RBC size●Normocytic ●Microcytic : < 6 u●Macrocytic : > 8 u; appear as large, mature RBC●Megalocytic : > 10u -12u

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Clinical Significance (MACROCYTIC)

●Caused by increase erythropoietin stimulation, increase synthesis of hgb●Due to Vit. B12 and folic acid deficiency●Cirrhosis●Hemolytic anemia●Pernicious anemia

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Clinical Significance (MiCROCYTE)●Caused by impaired globulin synthesis●Decreased hgb synthesis●Mitochondrial abnormality, affecting synthesis of heme●Deficiency of iron and other building materials●Failure of cell division or polyploidy (kaya malaki)

Clinical Significance (Megalocyte)

●Due to Vit B12 and folic acid deficiency●Failure of cell division or polyploidy (the reason why it's big)●Megaloblastic anemia

RBC Morphology HGB content

Normal: Central pallor occupies about 1/3 the size of the RBC (NORMOCHROMIC)*******************************************ANISOCHROMATASIA

→variation in staining property of hgb●Hypochromic : increased central pallor●Hyperchromic: no central pallor●Anulocyte : only periphery unstains hgb

RBC Morphology HGB content

●Hyperchromic/Hyperchromasia/Hyperchromia

→entire cells stain deep pink and lacks central pallor

→Clin.Sig. (does not represent true situation, suggestive of:)

● Megalocytes of pernicious anemia● Blood poisoning● Acute leukemias

RBC Morphology HGB content●Polychromatophilia/Polychromasia→ cytoplasm of non nucleated RBCs have a grayish

blue tint →Basophilic material gives a diffuse homogenous blue

color →property of rreticulocytes when stained with

Wright's →Clin. Sig.:

● Associated with rapid RBC regeneration and increase bone marrow activity

● Reticulocytosis● Pernicous anemia● Leukemia● malaria

RBC Morphology HGB content● Target cells

→other names are

– Leptocyte

– Platycyte

– Mexican hat

– Bull's eye

– Codocyte

● RBCs show hgb conc. At the outer rim and center

● A pale circular zone separates the 2 areas

● Clin.Sig.– Hemoglobinopathies– Liver disorders– Iron deficiencies– Hgb C dse– After splenectomy

RBC Morphology HGB content

● Anulocyte →Thin Rbc that are poorly hemoglobinized and

exhibit a thin peripheral ring stained hgb

● Clin.Sig.

– Hemoglobinopathies

Inclusion Bodies →a normal RBC has no inclusion bodies

→RBC must be anucleated

● ARTIFACTS

→refractile areas and crenation in the RBCs

→clinical sig.

– Water in wright's stain

– Poor staining technique

– Insufficient drying of slide prior to staining

Inclusion Bodies● BASOPHILIC STIPPLING

→coarse granulation resulting from RNA aggregates

→clinical sig.

– Non specific anemias

– Lead intoxication

Inclusion Bodies● CABOT RINGS

→thread like, round, oval, or figure of 8 loops

→due to residual nuclear membrane

→clinical sig.

– Pernicous anemia

– Lead intoxication

Inclusion Bodies● HEINZ BODIES→dark staining, round areas resulting from precipitated denatured hgb

→bind to the red cell membrane and alter its rigidity , resulting in premature destruction in the spleen

→the spleen also removes membrane bound Heinz bodies from red cells resulting in “blister “ or “bite” cells

→clinical sig.

– G-6-PO4 defficiency

– Heinz body anemias

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Inclusion Bodies● HOWELL JOLLY BODIES

→eccentric, small, round, non refractile purple masses consisting of DNA nuclear remnant

→clinical sig.

– Hemolytic anemia

– Post splenectomy

Number 3s

Inclusion Bodies● HGB C CRYSTALS

→oblong, hexagonal in shape resulting from hgb found in cytoplasm of RBC

→The “washington monument” or octahedral appaerance is typical, with a clear area around the crystal. These crystals may also be shaped like a rod, spherocytic, rhomboid, or hexagon

→clinical sig.

– Hgb C disease : mild hemolytic anemia with splenomegaly that is often aymptomatic but may result in jaundice and abdominal discomfort

– Hgb SC dse

Inclusion Bodies● PARASITES

→most common

→variable appearance depending on the parasite

→clinical sig.

– Plasmodium infection

– Babesia infection

Inclusion Bodies● PAPPENHEIMER BODIES/ SIDEROTIC

GRANULES

→small, blue granules usually appearing in clusters near the periphery of RBC

→consists of non-iron heme

→clinical sig.

– Post splenectomy

– Sideroblastic anemia

– Sickle cell anemia

RBC Morphology RBC shape● ACANTHOCYTES

→Other names

– Thorn cell(acanthol)

– Spur cell

– Spike cell

→spherical, irregularly spaced spinous processes; some have bent tip due to membrane defect

→characterized by a progressive increase in sphingomyelin- lecithin ratio

→clinical sig.

– Abetalipoproteinemia

– Hemolytic anemia

– Neonatal hepatitis

– Liver disorders

RBC Morphology RBC shape● BLISTER CELL

→contains single or multiple vacuoles on markedly thinned areas at the periphery

→characterized by a progressive increase in sphingomyelin- lecithin ratio

→clinical sig.

– Presence results from trauma as cells pass through involved blood vessels

RBC Morphology RBC shape● BURR CELLS

→RBCs have uniformly spaced pointed projections on their outer edges

→clinical sig.

– Uremia

– Acute blood loss

– Cancer of the stomach

– Pyruvate kinase deficiency

RBC Morphology RBC shape

● CRENATED RBCs→also known as Echinocyte (from Gk. Word echinos = sea urchin)

→wrinkled, serrated periphery, uniform projections, uniformly spaced bumps

→blunt spicules

→clinical sig.

– Faulty drying

– Not clinically diagnostic

– Due to dehydration, hypertonic agents,and lytic agents

– Due to exposure to anticoaguants

RBC Morphology RBC shape

● DACROCYTES/ TEARDROP CELLS

→fr. Gk. Word Darkry = tear

→clinical sig.

– Severe anemias

– myelofibrosis

RBC Morphology RBC shape

● ELLIPTOCYES/ OVALOCYTES

→has bipolar aggregates of hgb that cause the cell to be slightly to severely elongated instead of biconcave

→clinical sig.

– Hereditary elliptocytes

– Thalassemia

– Sickle cell anemia

RBC Morphology RBC shape

● KERATOCYTE

→aka Helmet cell

→irregularly contracted , triangular cells

→remnants of ruptured blister cell →clinical sig.

– DIC (disseminated intravascular coagulation)

– Microangiopathic anemia

RBC Morphology RBC shape

● KNIZOCYTE/ TRIANGLE CELLS

● →RBCs looked pinched into a triangular shape

→clinical sig.

– Hemolytic anemia

RBC Morphology RBC shape

● PYKNOCYTES

→distorted, contracted RBC similar to Burr cells

→clinical sig.

– Seen in the first 2-3 months of life

– G-6-PO4 deficiency

– Microangopathic anemia

– Hemolytic anemia

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RBC Morphology RBC shape● SICKLE CELLS

→ aka Drepanocytes, Menisocytes

→Elongated, slightly curved cells with pointed ends

→center of cell contains a dense crystalline area of hgb that fades somewhat towards the periphery

→clinical sig.

– Associated with hgbs in sickle cell anemia (sca)

RBC Morphology RBC shape

● SPHEROCYTES

→spherical, non-biconcave (lack central pallor)

→have dark stained center instead of the normal central pallor

→smaller surface area than the cell size; characterized by increase osmotic fragility

→clinical sig.

– Hemolytic anemia

– HDN

– Hereditary spherocytosis (most common)

RBC Morphology RBC shape

● STOMATOCYTE

→stoma or mouth aka Mouth / Stoma cell

→shows oval or rectangular (slit-like) area of central pallor

→clinical sig.– Liver disease

– Electrolyte imbalance

– Hereditary

stomatocytosis

– artifacts

RBC Morphology RBC shape

● SCHISTOCYTE

→SCHIS - cut

→fragmented RBC; a piece of the RBC is missing causing the reultant RBC to appear; fragmented/ distorted

→clinical sig.

– DIC (disseminated intravascular coagulation)

– Mecahnical trauma (most common)

Miscellaneous● Rouleaux Formation

→RBCs stack together like a roll of coins

→Saline will disperse Rouleaux

→clinical sig.

– Caused by increased CHON (most common)

– Multiple myeloma

– Waldenstrom's macroglobulinemia

Miscellaneous● Agglutination

→Disorderly clumping of RBC →clinical sig.

– RBC antibodies

– autoagglutinins

Miscellaneous● Giant pit

→Round purple bodies

→longer than normal pit but smaller than lymphocyte

→clinical sig.

– none

Qualitative Disorders of Granulocytes● Dohle Bodies

→smear reveals pale blue staining area within the neutrophil cytoplasm

→irregularly shaped blue staining area in the cytoplasm due to free ribosomes or RER

→seen with infections →clinical sig.

– Bacteria infection

Qualitative Disorders of Granulocytes● Pyknotic nucleus

● →smear reveals neutophils with condensed round nuclei or nuclear fragments

→clinical sig.

– Bacterial infection

– Prolonged contact of neutrophils with EDTA

Qualitative Disorders of Granulocytes● Toxic granulation

→smear reveals small dark staining granules within the cytoplasm of neutrophils

→increased number and prominence of the azurophilic (primary) granules

→seen most often with bacterial infections and in association with cytoplasmic vacuolization

→clinical sig.

– Bacteria infection

– Neutrophils induced to increased production of primary granules containing lysozymes

Qualitative Disorders of Granulocytes● Toxic vacuoles

→smear reveals holes in the cytoplasm of neutrophils

→blister cell counterpart sa RBC →clinical sig.

– Bacteria infection

– As bacteria are digested by neutrophils , its vacuoles appear in the cytoplasm

– Due to prolonged EDTA contact

Qualitative Disorders of Granulocytes● Lupus Erythematosus cell

→smear reveals neutrophils that have engulfed homogenous nuclear masses

→as a result, the nucleus of the neutrophils are pushed to the periphery of the cell

→the phagocytized nucleus occupies most of the cytoplasm area

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Qualitative Disorders of Granulocytes● Hypersegmentation

● →polymorphonuclear leaukocyte normally have 3 or 4 lobes but 5/6 or more lobes indicate hypersegmentation

→clinical sig.

– seen most often with megaloblastic anemia , sometimes with myeloproliferative disorders

– ff. Chemotherapy (particularly metho trexate chemotherapy)

Qualitative Disorders of Granulocytes● Smudge cell / Basket Cell

→a ruptured cell remnant , classically associated with fragile lymphocyte, in CLL

Qualitative Disorders of Granulocytes● Pelger-Huet anomaly

→an autosomal dominant condition with neutrophils that are mostly bilobed in the heterozygote (normal fxn ) and unilobate in the homozygote (fatal)

Qualitative Disorders of Granulocytes● May-Hegglin anomaly

→rare disorder with large prominent Dohle like bodies

● Chediak-Higashi syndrome

→rare disorder with large neutrophilic granules representing abnormal lysosomes

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