ABNORMAL MORPHOLOGY (Hb content) MCH MCHC Central Pallor size Cause Associated Ds. HYPOCHROMIA <27 pg <31 % ↑ Impairment in Hb synthesis (Thin rim of Hb) HYPERCHROMIA >32 pg >36 % ↓ No true hyperchromia Surface: volume ratio is reduced making it seem Hb is ↑ w/ Microcytosis (Hypochromic, Microcytic) IDA Sideroblastic anemia Thalassemia w/ Normocytosis -defect in Iron release from macrophages Rheumatoid arthritis Chronic infx Inflammation Microspherocytosis in burn px Sickle red cells ANISOCHROMIA Presence of both HYPOCHROMIC and NORMOCHROMIC cells Denotes: Effectivity of treatment Severity of disease Abnormal Morphology Size (ANISOCYTOSIS) MACROCYTOSIS >8.5 – 9 µm >100 fL Vit B9 & B12 deficiency Chronic alcoholism Hemolytic anemia w/ reticulocytosis Leukemia Lymphomas HDN – hemolytic ds of the Newborn Liver disease MICROCYTOSIS RBC SIZE MCV Causes <6 µm <80 fL Iron stores are very ↓ or completely depleted IDA Thalassemia Sideroblastic anemia Poikilocytosis 1. Poikilocytosis 2° to defect in RBC DEVELOPMENT Poikilocyte Oval Macrocytes Other Name Macrocytes Defect/Cause Maturation of RBC Vit B9 & B12 deficiency MCV: >125 fL Asso. Diseases Megaloblastic anemia 2. Poikilocytosis 2° to defect in RBC MEMBRANE Poikilocyte Other Name - Defect/Cause Appearance ↑BUN in serum Elliptocytes Ovalocytes Cytoskeletal protein band 4.1 (P. protein) Echinocytes Echinos – Urchin or Sea urchin *artifact Old blood samples -↓ATP, ↑pH Unevenly spaced, POINTED, irregularly-sized spicules Egg-shaped Oval/sausageshaped Rod-shaped Pencil forms Crenated RBCs Evenly spaced, BLUNT, uniformsized spicules Spherocytes - Hereditary: Spectrin deficiency Round cells- lacks central pallor Normocytic or microcytic Codocytes Kodon Bell cells; Target cells; Mexican hat cells; Dart board cells ↑cholesterol & ↑phospholipids in RBC membrane Central area of Hb w/ colorless ring at periphery Burr cells Reversible Invitro – reverse Invivo irreverse Acanthocytes irreversible Stomatocytes Acantho – thorn/spike Spur cells Stoma – smiling mouth ↑ Surface:Volume ratio (↑OFT) Pathologic: found in all throughout examination area Lipid metabolism Always- acquired Unevenly spaced, SLIGHTLY POINTED, club-shaped spicules Damage to Na+ K+ Elongated, slit-like area in central pumps located in pallor RBC membrane Na:K ratio Maybe retained to spleen – shape & deformability Asso. Diseases Acquired IDA Megaloblastic anemia Thalassemia Hereditary MAHA – microangiopathic hemolytic anemia Immune-hemolytic anemias Physical or chemical injury to cells Thalassemia Hemoglobinoathies SS, CC, DD and EE Obstructive liver disease IDA Abetalipoproteinemia Pyruvate kinase deficiency Alcoholic cirrhosis w/ hemolytic anemia Postsplenectomy Lipid malabsorption Lipid metabolism disorders Acquired Alcoholism Cirrhosis Obstructive liver disease RH null disease 3. Poikilocytosis 2° to defect in TRAUMA Poikilocyte Other Name Defect/Cause Appearance Microspherocytes Pyro – fire Pyropoikilocytes (severe burns) Severe burns Thermal damage to RBC membrane (spectrin) -contains HEINZ bodies -inclusions cannot pass through small sinuses of spleen thus remain behind (stretched) -a schistocyte >1 horn-like projections -RBCs pass through intravascular fibrin clot -vacuole RBCs pass through fibrin clots Smaller than spherocytes Dacrocytes Dakry – tear Teardrop cell Keratocytes Keras – horn Schistocytes Schistos – cloven Schizo – half Schizocytes Teardrop Asso. Diseases >1 horn-like projections Forming a Blister Semilunar bodies Crescent cells Half-moon cells Always ACQUIRED Ghost cells – membrane remaining after RBC has released its contents MMM – Myelofibrosis w/ Myeloid Metaplasia Myelophthisic anemia Pernicious anemia Beta-thalassemia Heinz body formation due to drug ingestion MAHA – microangipathic hemolytic anemia TTP – Thrombotic Thrombocytopenia Purpura March hemoglobinuria Traumatic hemolytic anemia Severe burns Renal graft rejection Glomerulonephritis Malaria Conditions that cause overt hemolysis 4. Poikilocytosis 2° to defect in ABNORMAL Hb Poikilocyte Drepanocytes Other Name Drepane – sickle Sickle cells Defect/Cause Appearance Asso. Diseases Polymerization of HbS (unstable/quick polymerization) Thin, elongated & pointed cells filled w/ Hemoglobin Commonly Hb SS – Homogeneous (Sickle cell disease) Occurs bc of INHERITED HbS Hemoglobin - CC crystals Hemoglobin SC - crystals Rare Hb AS – Heterogeneous (Sickle cell trait) Cell membrane is not visible Hexagonal crystals w/ blunt ends that stain darkly Hemoglobin condenses and distort the RBC membrane Washington Monument Shape Others Hb SC Hb S Beta-thalassemia Hb C – Harlem Hb S - Memphis Commonly Hb CC – Homogeneous (Hb C disease) Rare Hb AC – Heterogeneous (Hb C trait) Hb SC diseaase RED BLOOD CELL INCLUSIONS 1. Developmental ORGANELLES INCLUSION Howell-Jolly Bodies Basophilic Stippling Pappenheimer bodies (Siderotic granules) APPEARANCE Small round fragments of the nucleus Fine or coarse stipplings that appear EVENLY throughout RBC Fine or coarse granules that appear NEAR THE PERIPHERY of RBC REASON OF FORMATION Incomplete nuclear fragmentation Wright stain REDDISH BLUE Metarubricyte defect (ortho) Feulgen reaction DNA – red RNA green Wright Stain Deep blue to Purple Result of karyokinesis Remnants of ribosome STAIN DISEASE COLOR Negative to Pearl’s Prussian Blue Degrade ferritin (ferric) Siderocyte granules – mature RBC Sideroblast – immature RBC Wright stain Darkly stained Positive to Pearl’s Prussian Blue - confirmatory Sickle cell anemia Hemolytic anemia Megaloblastic anemia Congenital absence of spleen Splenic atrophy after multiple infarctions PYRIMIDINE-5’NUCLEOTIDASE DEFICIENCY Thalassemia Megaloblastic anemia Alcoholism Lead & Arsenic intoxication Sideroblastic anemia Thalassemia Hyposplenism After splenectomy Polychromato philic Red Cells Cabot rings Young mature RBC still have RNA ↑ EPO stimulation of the BM Thin, Ring-like Figure of 8 Incomplete rings Remnants of Mitotic spindle and microtubules Wright stain Supravital stain reticulocytes Wright stain Diffusely blue Reddish Violet Lead poisoning Megaloblastic anemia Severe anemias 2. Abnormal Hemoglobin Precipitation INCLUSION Heinz Bodies APPEARANCE Round & refractile inclusions Large-singly Small-many Hemoglobin H Inclusions Pitted golf ball – multiple Heinz bodies Small, greenish-blue inclusion bodies REASON OF STAIN FORMATION Denaturation of Not visible in globin of Hb – Wright stain precipitating of Hb Visible: supravital *pitted in the stains spleen = bite cells Precipitation of Hb H (Hb variant) – unstable Hb prone to oxidation & precipitation Supravital stain Inclusions w/ reticulin DISEASE COLOR Crystal Violet AROMATIC COMPOUND POISONING G-6-PD deficiency Severe anemias Brilliant Cresyl Blue New Methyle ne blue 3. Protozoans Inclusions INCLUSION Malaria Babesia APPEARANCE Sausage, crescent, bananashaped Maltese cross formation Organism M. falciparum M. vivax M. ovale M. malariae Babesia microtii Vector STAIN Female Anopheles mosquito Giemsa (Best) (Wuchereria bancrofti) Acridine Orange Female Anopheles mosquito Giemsa (Wuchereria bancrofti) DISEASE Malaria Babesia