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Atlas of Clinical Hematology

Atlas of Clinical Hematology

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Published by Maath Khalid

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Published by: Maath Khalid on Mar 14, 2012
Copyright:Attribution Non-commercial

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07/22/2013

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Section
1
THEPERIPHERALSMEAR
 
Evaluation of Red Cells 
I
n evaluating red cells the examiner looks for abnormalities in size andshape, hemoglobin content, inclusions, aggregation, and immature forms.The normal red cell is about 8
m in diameter, slightly less than the nucleusof a small lymphocyte, which is approximately 8.5
m. When the erythro-cyte’s size is normal, it is
normocytic 
; when larger,
macrocytic 
; and when smaller,
microcytic.
The automated cell counters measure size as mean cell volume(MCV); microcytosis corresponds to an MCV 
80 fl, macrocytosis to an MCV 
100 fl. A substantial variation in size is called
anisocytosis 
and registers onthe automated counters as an increased red cell distribution width (RDW).The biconcave erythrocyte is thinner in the middle, creating a central palloron blood smears that is ordinarily less than of the cell’s diameter. Such a
1
 ⁄  
3
cell, possessing the normal amount of hemoglobin, is called
normochromic 
. When the central pallor is greater than normal, indicating decreased hemo-globin content, the erythrocyte is
hypochromic.
Severe hypochromia corre-sponds to a decreased mean cell hemoglobin concentration (MCHC) asmeasured by the automated analyzers. When central pallor is absent fromcells that are separated from contiguous ones, the usual reason is a decreasein cell membrane surface, making the cell denser, less concave in the center,and more spherical, hence a
spherocyte 
. Some macrocytic cells are thicker thannormal and also lack central pallor.The examiner should look for abnormalities in red cell shape (a significant increase in the number of abnormally shaped cells is called
poikilocytosis 
) andscrutinize the interior of the erythrocytes to detect inclusions and the pres-ence of nuclei or a bluish-purple color, indicating immature cells. Finally, theexaminer looks for abnormalities in red cell aggregation—
agglutination 
, orthe clumping of red cells into a rosette configuration, or
rouleaux 
, erythro-cytes aligned in a row like a stack of coins.

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