MLAB 1415: Hematology
Keri Brophy-Martinez
Anemia
Part Four
Agglutination
Irregular clumps of RBCs
from antigen-antibody
reactions
 See in cold hemagglutinin
disease and paroxysmal
nocturnal
hemoglobinuria(PNH)
 Reported as “RBC
agglutination noted”

2
Agglutination

Use of saline will not
disperse clumps; however,
warming specimen helps
to break clumps up.

MCHC usually falsely
elevated.
3
Rouleaux
Appears as a stack of coins
 Use of saline disperses
formation of stacks
 Correlates well with
elevated sedimentation
rate.

4
Rouleaux
Caused by increased or
abnormal plasma
proteins
 Result of protein
deposits on the
erythrocyte membrane


Seen in patients with
multiple myeloma,
Waldenstrom's
macroglobulinemia, and
chronic inflammatory
disease.
5
RBC Inclusions
6
Howell-Jolly Bodies
Are nuclear remnants
containing DNA.
 Are 1-2um in size and
appear singly around
periphery of red cell
membrane.
 Develop during periods
of accelerated or
abnormal erythropoiesis.

7
Howell-Jolly Bodies
Spleen usually removes them;
however, during times of
erythroid stress, spleen
cannot keep up with
formation of inclusions.
 Seen following splenectomy,
in thalassemia, hemolytic
anemias, and in megaloblastic
anemias.

8
Basophilic Stippling
Contain aggregated
ribosomes
 Stippling may be the
result of the RBCs drying
on the blood smear.
 May be seen in lead
poisoning, defective or
accelerated heme
synthesis and thalassemia.

9
Basophilic Stippling

May be classified as three
forms:
◦ Diffuse or fine - looks like
fine blue dusting.
◦ Coarse - dots are larger and
more easily defined.
◦ Punctate - coalescing of
smaller forms. Very
prominent and easily
defined.
Siderotic Granules and
Pappenheimer Bodies
Siderotic granules
are small, irregular,
magenta inclusions
seen along the
periphery of the cell
membrane.
 Appear in clusters.
 Prussian blue stain
required for
confirmation

Siderotic Granules and
Pappenheimer Bodies

Causes of:
◦ Sideroblastic anemias
◦ Any condition leading to
hemochromatosis.
◦ Hemoglobinopathies
◦ Post-splenectomy patients.
Heinz Bodies
Formed as result of denaturation or
precipitation of hemoglobin.
 Are large inclusions that are rigid and severely
distort cell.
 Supravital stains used to visualize

◦ I.E. Crystal violet, brillant cresyl blue

Causes of:
◦
◦
◦
◦
Alpha thalassemias
Glucose-6-phosphate deficiency (G6PD)
Any of unstable hemoglobin syndromes.
Red cell injury from chemicals.
Cabot Rings
Found in heavily
stippled cells
 Appear in figureeight configuration


Causes of:
◦ Megaloblastic anemias
◦ Homozygous
thalassemias
◦ Post-splenectomy.
15
Sideroblasts/Siderocytes



Sideroblasts
◦ Nucleated erythrocyte
that has stainable iron
granules
Siderocytes
◦ Non-nucleated
erythrocyte containing
iron granules
Must use Prussian blue
stain to identify
Siderocyte
References
Harmening, D. M. (2009). Clinical Hematology and
Fundamentals of Hemostasis. Philadelphia: F.A Davis.
• McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory
Hematology . Upper Saddle River: Pearson Education,
Inc.
• http://www.ezhemeonc.com/index.php/hematologicaldisorders/
• http://www.wiwe.net/irene/lab/chemheme/heme/micros
cope/stomatocyte.htm
•
References
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http://home.ccr.cancer.gov/oncology/oncogenomics/WE
BHemOncFiles/Review%20of%20Terms.html
http://tiny.cc/85k0b
http://image.bloodline.net/stories/storyReader$1214
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