Chapter 4 RED BLOOD CELLS STUDIES Ra w Materials Needed for the Red Cell Production (Erythropolesls) |. Metals: a) Iron ~for hemoglobin synthesis b) Copper — helps catalyze the formation of h ¢) Cobalt - element in Vitamin 612 thus essen| d) Zinc ~ part of the structure of the enzyme carbonic of CO2 = CO2 4 H2)--Carbonic acid and stored in the form of ferritin jemoglobin tial for the maturation of cells anhydrase (RBC transpon Vitamins: a) Cyanocobalamin ~ needed in nucleotide for the maturation of blood cells. _b) Folate Acid/ Pteroyiglutamic acid - promotes methylation of deoxy-uridylate to form deoxythymidilate (ane of the nucleotides necessary for ONA synthesis, Thiamine ~ forms a compound in the cells called thiamine pyrophosphate which is part of a decarboxylase that removes carbon dioxide from pyruvate and other substances. Pantothenic acid - used in the body hich catalyzes the acetylation of many substances. doxine - acts a5 Co-enzyme/ Co-factor in hemoglobin synthesis. the conversion of ribose nucleotide into deoxyribose to form a special chemical called Co-enzyme A lysine, glutamic, valine, ete.) ropoietin, androgen, etc.) opulation of mature erythrocyte and their precursor in blood and bone ther sites. It functions as a unit. Q~ 120 days, it must have a: dent upon the binding of of apoptosis e membrane of the1. equilibrium of production 2, usage 3, destruction Fas — families of Death Receptors, located on the mernbrare of all erphiaid wrogenienss (Harophilic Normoblast). Fost member of the Tumor Necrosis Gene , acquired during the late phase of enphecad differentiation (Orthochromic Normoblast and Polychromataptilic cells) When they are absent or very low level of EPO, the Fast erythroid precursors crovetone Fas marked immature erythroid precursor specifically the Basophilic normoblast (Prorubricyte) Initiating the process of apoptosis, In this process, high levels of EPO are required for protection of innmature erythrotian. e abundant Fast. present In mature erythroblast. Evaluation of Production Sites imaging - a technique used in nuclear medicine to identify sites of erythropoie and Iron 52 --- radioisotope of Iron rechnitium 99m Sulfur Colloid) = most widely used radioisotope in Bing, 4 Erythropolesis (Red Cell Production) }) or M : E Ratlo (3: 1) ~ a useful substitute for the unavailable data on the of erythroid celts in marrow, which is meaningful only when granulocyte jormal. en ~ measures the breakdown products of hemoglobin. n Turnover Rate)- measures the rate of clearance of transferring bound from the plasma and plasma iron content. IS: lesis - red cells that are produced in the bone marrow reaches the ‘hes its maturity. Erythropolesis raised in proportional to the degree of anemia when erythropoiesis is tive erythropoiesis or abnormality preventing a normal marrow useful piece of information in the analysts pf anemia n (14 to 21 days) - The iron incorporated into hemoglobin which lation after the first day of the study, indicates Effective eighty percent of the injected radioactive iron utilized in the circulation within a minimum of ten days. Maximum red cell $ than seventy percent indicate diminished Red Cell Lifedemonstrating effective erythropolesis (RPI= >3) onic blood loss anemia in the bone marrow does not esis - red blood cells produce fh of nucleated red cell precursor in the n and its fife span. Implies deat! Of injected radioactive iron tion into circulating red cells onstrating Ineffective erythropolesis ondary to maturation disorders (ASMD) (from rubriblast to rubricyte) rubriblast (4 cell division, divides within 12 hours to make eter ( 18 - 25um) ing as a band around the nucleus ht, unstained) area —or_ perinuclear halo near condensed areas of chromatin, inactive, stained color) pears more open by light microscopy and does wular.joplasm: Intensely basophilic with chromophobic area and appears more abund: n rubriblast; Non-granular fant jucleus: N: C== 6:1Relatively large, round or slightly oval. Nuclear chromatin strands thickened, stain less red, +: parachromatin is sparse but distinct. Jeoli; are usually visible if present ‘bricyte ( Polychromatophilic Normoblast/ Intermediate Normoblast) Not present in normal blood of adults but may appear in blood of newborn infants 10 - 15 um mn diameter Blue-gray to pink-gray due to the presence of hemoglobin production in cell (RNA stains blue; Hemoglobin is red). Slightly increased in relative amount, Non- N:C-4:1 Round, smaller than previous stage and more condensed. The chromatin pattern is coarse and clumped Stains a deeper blue-purple ( Orthochromic or Acidophilic or Late Normoblast) @ of nucleated red cells in a normal marrow — 12 um in diameter inker than previous stage to orange red (complete development of on-granular. C-1:2 eus ( a homogeneous blue-black mass with no structure) This is the rence between the rubricyte and the metarubricyte }.um in diameter (Approximately the same size or slightly larger than ells). ‘a slight pinkish gray. Contains a fine basophilic reticulum of RNA stains with supravital stain ‘or extruded normally in the bone marrow meter ( Ave. 7.2 um) ; ink, salmon pink in color. The mature red blood cells ina cell with a paler staining center occupying ‘one-third ofbasophilic cells that reveals ribosome ina granulofilamentous arrangement das any non-nucleated erythrocyte that contains 2 or More particles of blue-stain, julofilamentous material after NMB staining* s as: a) polychromatophilic macrocytes b) proerythrocytes ¢) granulofilocyte d) diffuse basophilic erythrocyte both in the bone marrow and peripheral into erythrocyte in 2-4 days a ir energy principally theough mitochondrial oxidative blood phosphorylation rather 5 % (Conventional Unit) %_ 15x 10 tothe negative 3 05-15% Relative Value 25-75x10°/t (S.1. Units) development iber of reticulocyte in circulation e from the BM into the circulation sed reticulocytes sticulum network (24 hours) an erythropoietic index activity of a BM or indexImmature Reticulocyte Fraction—- index reported by automated cell counter scellular parasite ( malaria & babesia) ods of Reticulocyte Count jethod Meyer & Tureen Method - BCB aylene Blue Method —- MBN hod -- MBN or BCB od — 0.5 % alcoholic solution of BCB- New Methylene Blue Method New Methylene Blue Stain Powder. Sodium Chloride. and filter before use. qual amount of blood and stain. o stand for several minutes. count 1000 RBC and (relative value) d- methanol, carbol gentian violet & MBN. nd Janus Green lution of BCB ; \Icoholic alcohol 100 ml after 24 hours. Keep in a tightly stopperedn thinly and evenly ona glass sides and air-dry, stient’s blood upon a layer of dried stain or place ‘and stain) on a glass “ dry. od cells ( 100 to 200 per field) simultaneous, erythrocytes containing reticulum — networ, slide and make a smear, ige of sixty (60) or more reticulocyte counts per day or thioflavin T bound to the RNA and allows e response to therapy. ind two wedge smear. e microscopic eyepiece reticulocyte counting as in standard reticulocyte e in square A or Cin successive RBC’s andic Increased Reticulocyte Count in: uute & Chronic Hemorrhage lemolytic Anemia er treatment of deficiency anemia (IDA , Megaloblastic anemia) ents with uremia ( mild hemolysis & decrease RBC survival) ic Decreased Reticulocyte Count fective hemoglobin synthesis ( |.€. Thalassemia, PA, Sideroblastic) lacement of normal marrow cells by cancer or tumor cell llure of the bone marrow to produce erythrocyte (aplastic anemia) ents are necessary to Estimate the Production Rate of Red cells culocyte is converted to absolute number of reticulocyte per unit volume of locyte count = RBC in millions X % Retic etic ct = 4,000,000 X0.05 = 200,000/cumm Reticulocyte Percent (when PCV is used to correct for the presence of RBC count) ct = % reticulocyte X Patient’s PCV Normal value (45) ferred than proportional count regardless of the degree of anemia e count ---is calculated when the hematocrit is abnormally decreased inemia 10 or more RBC should be counted the Normal Hematocrit, preferred to distinguish between the 1 Males (0.45) and for Females (0.42) which is more valid. = x10? ing reticulocyte prevalence to incidence) eticulocytes from the marrow as a result of an erythropoietin in an anemic subject. iculoc ‘Normal Reticulocyte Birth Rate ‘ birth rate is about 1% of the 5.0 X 10° /cumm .mm / dayPercent to Marrow Reticulocyte Production Index Correction Factor 10 15 2.0 25 $C count = 2,890,000/cu.mm; Retic. ct= 7% count = 0,07 X 2,890,000 == 202,300/uL |= 4 times as many reticulocyte as normal from marrow to circulation = 224/2 4 X 2636 (divided by correction factor ‘45% (constant) = 4% % /2 2X basal fable indicator of rate of erythropoiesis, can ia & marrow response ‘in the absence of anemia stic marrow marrow without concurrent correction srrow should response with elevated result of a failure of the erythroic I but not of a major rrence in anemia of folate fe anemia. dequate response of BMto mechanismErythrokinetic Evaluation- Red Cell Production = Red Cell Destruction May be determined from the following: ‘a, Measurement of red cell life span 'b. Studies of the rate of hemoglobin catabolism Three areas of RBC metabolism that is crucial a. RBC Membrane b, Hemoglobin Structure and Function ‘c. Cellular Energetics jormal Value: Convention Unit St Unit Male: .5.5-6.5 million / cumm 5.5-6.5x10"/L Female — 4.55.5 million / cumm 45-55 x107/L for normal RBC survival and function: r hydrophilic portion, chemically composed of glycolipid, glycoprotein and lrophobic layer containing protein, cholesterol & phospholipid. rophilic layer containing protein ‘Cell Membrane facilitates the interchange of substances with the environment by selective locytosis, exocytosis and locomotion, al signals facilitating cell to cell recognition d groups, histocompatibility loci and receptors that provide for cellular membrane antigen used to identify erythroid cells Inomaly of the erythrocyte membrane associated with the loss of composed of: in designated band 3 that spans the bilayer and is an Glycophorin A (sialic acid) is responsible for the negative various antigens on the membrane surface contribute to membrane integrity*-* massive exchange of HCO3 and hier on 2, Peripheral Protein: (spectrin and actin) - create the framework for the cell ang deter, the shape of the red blood cell. four Skeletal Proteins ‘a. Spectrin b. Protein 4.1. _c-Actin d.. Ankyrin ‘The Junctional complexes contain: | * 1) Protein 4.1 - enhances Interaction of spectrin and actin 2). ‘Actin binding protein e Adducin « " Tropomyosin Protein 4.1 polypeptide chain a) Alpha chain b) Beta chain e 2 sets of spectrin complex bind to the RBC Spectrin -actin ~ band 4.1 complex 'b): Spectrin-ankyrin complex that bind to an integral protein Deficiency leads to abnormal shape of RBC membrane (He Hereditary Elliptocytosis, etc) * cytoskeleton network jereditary Spherocytosis “Bu Upids - 40% ‘ phospholipids 60%; neutral lipids (cholesterol)= 30%; Glycolipids= 10% “Cholesterol is equally distributed between choline and aminophospholipid ‘Two Groups of Phospholipid Choline Phospholipid (phosphatidyl choline and sphingomyeli in) External environment 2 Interaction of these phospholipid with cholesterol play in cholesterol homeostasis in the RBC membrane ‘ ee eet ohare and Phosphatidylserine) a hate Papin pan that is critical to'normal RBC survival in circulation Hise cae on ‘flosnlioad ridkes the red bleed cell ‘appear as a'target © ye. ih Ste oo =e =e isa fen of chroma in the rater solubilization of RBC membrane with diluent SDS, ( Sodium dodecyl brane proteins can be separated by polyacrylamide gel electrophoresis d sulfite) and can be a) RBC membrane protein numbered 1 — 8 can be stained with Blue stain / Silverstain b) 1-4 stained with PAS Coomasie Brilliant Important Membrane Enzyme System Potassium ATPase — controls active transport of sodium and potassium; 3se in sodium without loss of potassium causes the cell to gain water (increase 1e) and subject it to lysis. Increase in potassium causes celll shrinkage tracellular to extracellular ratios of sodium and potassium are 1: 12 and 25:1 ely by as many 300 cationic pumps into sium ATPase- calcium pump moves calcium out of the cell to the plasma concentration gradient. Calcium is involved in the regulation and membrane phospholipid structure. jodulated by a cytoplasmic calcium-binding protein called Calmodulin calcium cone rise. Ca-calmodulin combines with and activitates Ca- calcium egress. nergy is needed for: trochemical gradient between plasma and the ation-reduction metabolic pathway);ut of the red cells jum and potassium into and o: ATP to move three sodium jon, ‘sodium pump uses one mole of fo the cell cave shape of red blood cells (maintain the volume , shape ang ina functional state (Fe ++) e Glyceraldehyde 3 ~ he formationof the co- ‘ay he hemoglobin molecule i emoglobin reductas fe that catalyzes themoglobin reductase activity phosphoglycerate (2,3 OPG) that affects the affinity ren release from Hb to tissue oxygenated hemoglobin thus decreasing the ent oxidative denaturation of hemoglobin gthione NADPH to be used by diaphorase in molecule on its reduced state 6PD, DPH) and reduced glutathione (GSH) 92) generated in erythrocyte and to6-Phosphogluconate Ribulose-5-phosphate a |omaor: can be converted to 5. molecules of Glucose-6- co, ai Phosphate If ribose i ee Fe Ribulose-5-Phosphate Glyceraldehyde-3- phosphate 6 NAD’ 2: Phosphodextrose isomerase 3: Phosphofructokinase 8: Phosphoglycerate Mutase 9: Enolase 10: Pyruvate Kinase 11: Glucose-6-Phosphate Dehydrogenase -phosphoglucolactonase 13: 6-Phosphogluconate dehydrogenase 14: Bisphosphoglycerate Mutase 15: 2,3-Bisphosphoglycerate Dehydrogenase D BLOOD CELL lation each day. Aged red cells lose sialic acid | cells or MPS (Mononuclear Phagocytic red by the host. dying cell is removed or the RES cells Hemoglobin is broken down within ime heme oxygenase / heme oxidasef of hemoglobin are cotabolized daily, The iron i 1 to BM for reuse by Rew red blood cells or the ritin and hemosideri- d to amino acid pool, ring Is broken down atone of the methane bridg Buide, Biliverdin is converted tp bilirubin, and to the liver, bilirubin glucuronide Is COUpIeA to py PION May be wy, Oupled to pty + converted t6 wobilinayen nears in the blood attached to hemoglobin and is exhaled, of the blood vessel. Hemoglobin is rel aciated hemoglobin. goes to the liver and processed In the normal way ( burs in the vascular system). " mes depleted, the unbound hemoglobin (dimers) are moglobin, hemosiderin or methemoglotin +. moglobin is present In the blood, it may be oxidized tg ‘ased directly into thy Sto bound to another transport protein hemopexin , leave albumin in the circulation, imparts a brown tinge to d using Schumm’s test 1&1) slobin and methemoglobin are produced by urinary tract ine urine ( bright red)ED CELL COUNT pts position should be noted on the requisition because of the vari J COUNT values due Lo hydrostatic efflue of water and siltrabte the Intravascular space to the dep ation in subastances stitial Huid space and non. pdont int substances like protein, cellular elements and compound associated with lls oF protein will Increase an average of B% decrease on packed cell curs when a patient is lying down because of hemodilution, i¢ patlent’s gets put pf bed, there Is hemoconcentration that occurs thus the valu type of variation occurs with leukocyte counts Itement (xtreme physical exertion or excitement produce counts her than those obtained under basal conditions fore hemocontration can produce erythrocyte counts that are higher than. this may obscure a significant anemia count of the newborn infant is higher than that of adult with an lion / cumm for the following reasons: ntal blood is added ord had been clumped later hemoglobin in the capillary blood than venous blood due to lation resulting in the loss of fluid fter birth reaching its lowest values bi h the normal adult level at age fourter ween the second and count than men, but there Is difference before puberty or inhibitory effect of estrogen on erythropoiesis in lich increases erythropoiesis mil/ul. : ‘ mil/ ul, by the 3" mo, it falls toabout 4.5 ¢ 0.7 mil/ul and slowly ases after age 4 through puberty normally have higher RBC count than those at sea level be oxygen tension, the resulting hypoxia triggers the Increasing erythropoiesis, gonditions, variation of red cell mass and hemoglobin morning and at its lowest in the evening Decreased RBC count Hemorrhage gocythemiaRED BLOOD CELL ANOMALIES op CELL MORPHOLOGY 16 A RED BLO! ee Couses Red call abnormalities O 4 fn tema @ Noma msaieegrne DIC, microanglopathy, @ 3 Frogmente git ver disease oo 7 burns, carding cblastle anemia Hereditary eliptocytosis om 5 hhaemoglobinopathies, ea deop —— MyeloRrbst, pililogte — ettramedullary haemopolesle Liver disease, Stamnes A poliom Basket cell Oxidant: damage-e.g, GOFD deficiency, unstable haemoglobin Howell-Jolly Hyposplenlem, post- ‘oplenectomiy Liver disease, 6 Ke poor eenetony a Basoptilic: Haemoglobinopathy, lead Acanthoayte Liver disease, atippling poisoning, iene nia - salina aemia, renal fallure iia aria. on. Other intra-erythrocytic parasites include Bartondls baciiiformis, babésiosis O on sedincy, Siderotic Dicordered Iron metabolism Micracyte i granules: 6g: slderoblastic anaemia, haemoglobinopathy (Pappenhelmer post-splenectomy bodize) (Use! Sictle cell anaemia ANISOCYTOSIS- variation in size of red blood cells and should be estimated sem: quantitatively as: a) slight b) moderate c) marked © RDW (Red Cell Distribution Width) very useful in the differential diagnosis ¢ microcytic anemia ‘ © is anindex of size variation used to quantitate the amount of anisocyto* seen ona peripheral blood smear © estimates the red blood cell population size derived from the erythroci histogram or (size distribution measurement generated, from a red histogram) f © represents a new parameter that quantifies relative anisocytosis Page 66 'its usefulness in the early detection of IDA ( 7 RDW) and In distinguishing between iron deficiency and B-thalassemia (Normal RDW) size measurement generated from a redcell histogram it is expressed as the ratio of standard deviation (width of histogram) to the MCV a coefficient of variation of red cell size within a given red cell population it is calculated as the coefficient of variation (CV) of the MCV tribution 1D = =X100 N. range =11.5-14.5% Mean Coulter provides two measurement of the relative distribution of red cell age ; a. RDW-CV- calculated as the ratio pf the red blood cell histogram width at one standard deviation divided by MCV ROW-CV = width mcv a RDW-SD - simply the histogram width at the 20% frequency level; uring more than 9 micra in diameter; also known as eeds 100 fl — rare in liver disease without folate deficiency.+ With Mycoplasma pneumonia with high titer of cold agclutinins, the MCV may be artificially high because red cells in doublets or triplets may pass the aperture of the electronic counter. N.- POIKILOCYTOSIS - variation in shape of red blood cells; can be a diagnostic feature of 3 chronic hereditary hemolytic anemia. Red cell deformity may result from: © Increase cytoplasmic viscosity (sickled cells, dehydrated cells) * Intracellular rubbish (Heinz bodies) Membrane rigidity (secondary to ‘oxidant-induced cross-linking of the membrane cytoskeleton «Decrease in the red cell surface to volume ratio Acanthocyte (Greek —acantho -~ thorn or spike) © Redcell with several large irregularly spiculed surface projection «Spur cell, thorn cell , prickle cell . «Few irregularly processes per cell ( 2 to 20 spicules) membrane inju like spicules Acanthocytosis occurs in 2 stages a) Cholesterol loading b) Splenic remodeling or splenic polishing ‘© Altered lipids in cell membrane , decrease LCAT ; changes in the ratio of plasma lipids (lecithin & sphingomyelin) ‘ Seen in alcoholic cirrhosis, abetalipoprotenemla, post-splenectomy, PK deficiency & LCAT deficiency «Marked acanthocytosis can be associated with race Mcleod blood group, lack of Kell antigen precursor ( Kx) 1 ry causing thorn. cell, clutchbag , pocket book, seen in Hb C, Hb SC, 2), Biscuit Cells - Folded red cell, clam thalassemia, liver disorder. 43) Blister cell few processes per cell irregularly space, usually associated to form keratocyte later ‘ 'e - Bipolar or central distribution of hemoglobin. Crystallized abnormal Hb 4) Bronze Elliptocyt with partial solublization. Most typical finding in sickle cell anemia. echinocyte , moderate number of length, knobby projection ( 10 to 30 spicules, 1s bearing one or few spines, lly shorter than that seen in processes per cell, cell “ 5) Burr cell - sea urchin , thorny apple, irregularly spaced , poi Usually normochromic, reversibly speculated, elongated red cells; acanthocyte. ye volume unless fragmented. Membrane alterati | abnormalities (HUS). Renal transplant, post Icer, inted variable | normocytic. Small cells or fragment: spicules are usual Decreased surface area but sami jon is probably related to plasma chemical splenectomy, uremia, PK deficiency, mi carcinoma, icroangiopathic anemia. Bleeding peptic ul6) Crenated RBC - mulberry, animal cracker, echinocyte, multiple processes per cell (10 to 20 milar length spicules), regularly spaced , usually normochromic ort and blunt , ¢ - bite coll, pitting of red cell inclusion by the spleen (Heinz bod e- camel cell, cigar ~shaped, elliptical cell, narrow oval cell with normal central t ever hypachromic. Seen In Hereditary Elliptocytosis ( 25% to 90%), a few in any myelofibrosis with myeloid metaplasia ,IDA d cell - racket cell, long tailed RBC. 11 - Keratocytes, Horn cells, splitting of red cells by fibrin strands, occluded small sels. Associated in Microangiopathic hemolytic anemia (TTP, HUS, DIC), cardiac is, severe burns. The finding of helmet and fragmented cells is strongly suggestive \ or Traumatic hemolytic anemia. They are as.a_ result of an erythrocyte being, ibrin strand, which could cut the cell in two. tered vessels maged heart valve prosthesis - Also known as damaged red cell with horns, and not remain in circulation for more than a few hours as they are fragile . Jlocyte - deep-staining large oval red cell lacking. a central pallor. Deficiency of {B12 or Folate) required to manufacture DNA. Associated with megaloblastic otherapy with folate antagonist. izocytes , contracted cells, Associated with hemolytic anemia including H. ly contracted red cell. Seen in infantile pyknocytosis and in infants me form of stellated cell with often six processess. isto — cloven or split. Hallmark of hemolytic anemia, secondary repanocyte, sickle-shaped cell pointed at both ends . moglobin during oxygen deprivation. Causes vaso-occlusive SS,SC and SD. characteristic of 3 abnormal HbS: CCerystal_c) Hb SC feature to hypotonic saline solution. Spherical, small, normal! or st viewed in wet preparation. Cell with a decreased Associated with HS, AIHA, HON, March emical injury cells such as burns, snake venom, banked h Hydrocyte, Red cell with slit-like central pallor, n. Concave on one side only. Associated with H. aStomatocytosis tarps hepatobiliary sans, obsiuctve ver diets acute alcoholism, Rh yy fet s elevated with J. MCHC. Arttactual than o WUC TOT Stn « ae ay lar pathophysiologic process. In wet preparation It appears * bowl-shapeds in a, ied smear, it appears as slit-like area of central pallor. stomatospherocyte 62M be bey viewed in wet preparation. d cell drawn-out ir), 19) Tear-drop - = z d cell, FeF t rop ~ (Greek ~ dakry - tear) dacrocte Peer os myelophthisic: (marro,, single - : one blunt: tipped spicule, Associated with Mi A, p-thalassemia, TB an. placement), conditions associated with myelold me tumor metastazied in the BM. aplasia, ised by slow drying. 20) Torocyte — doughnut-shaped artifacts cau: color or Staining in rim of Hemoglobin ans - jated with IDA. Ml, Variation according to Hemoglobin Content / Alteration in au 1) Anulocyte - Pessary cell or Ghost cell. Red cell with Just 2 od large clear central area, Decreased amount of hemoglobin, 2 a > 3um due to decrease hemoglobin pale central are 2) Hypochromic-red cell with a deficiency anemia. associated with IDA and other ic — red cell with seemingly increa .d with H Spherocytosis. 3) Hyperchroml sed hemoglobin content; smaller thar normal, associate | with normal hemoglobin 4) Normochromic— red cell ge Hb and bluish (basophilic substances ith orant molytic anemia. ~ red cell appears mottled wit ute hemorrhage and he 5) Polychromic ; distribution of Hb, seen in act area, Uneven ith central and peripheral condensatcr Mexican hat cell, bull’s eye, leptocyte Increase cholesterol and phospholic: binopathies as Hb C & SC, liver diseas Greek- coden— bell-shaped—red cell wit ear zone in between. Also known as Increase surface membrane. severe IDA, Hemoglo! 6) Target cell - of Hb with a cl codocyte, platycyte. Associated with thalassemia, (obstructive). ~ red cell that show a crescent or half-moon bodies associate: 7) Achromocyte (Seml-lunar) using overt hemolysis. with malaria and other factor cat 8) Xerocyte - “pudding” of Hb at the periphery. Result of net cation & water loss, associate’ with Familial Xerocytosis, MCV and SMCHC CP No. ANISOCHROMASIA - variation of hemoglobin conte! i H ints of red cells seen i dimorphic RBC histogram that results from: TE bic a) After blood transfusion.on severe IDA patients b) tron or B12 deficiency ¢) Sideroblastic anemia 2 Page 70...|ONS ling - punctate basophilia, blue-berry bagel, deficiency of Pyrimidine 5- tered basophilic inclusion that appears homogenously over the cel ‘of ribosome, aggregated RNA associated in condition that greatly hropoiesis, in toxin, poisoning like In lead and arsenic intoxication . its 2BC may suggest the presence of TBM production and reticulocytsis, ce, angular, opaque, reddish brown In Hb CC ( Bar of Gold) , not seen in Hb C fexagonal crystal usually elongated, both ends are blunt, parallelsides to end, finger-like projections, blunt or ejection, a crystal protruding cell sjecting ends blunt, parallel sides to projections (Washington monument) in thread-like or reddish violet, oval or figure of — 8 inclusion, DNA mitotic t of microtubules or a fragment of nuclear membrane associated with s, lead poisoning, megaloblastic anemia. ophilic rod, up to3um in length, described by Schilling, which of severe anemia. aules seen in the erythrocyte in lead poisoning. pitated Hb H, small greenish blue inclusion with New ar the cell membrane, 1 or 4 Heinz bodies in a cell ong oxidant; S or more Heinz bodies in G6PD ips of four at the cell periphery. cells or shift cells; ucleated red cell,cifarum ‘complication of P. falcifarun ‘al outlines; underlying jouleaux formation das it is rotated B RBC forming- With Ihypochtomasia — correlate with MCH and MCHC ( Hf dat I differs, technologist must rely on his or her best judgement to asiets the > Yes + Repull wedge: Report agglutination prese y2+ 3+, 46 rovleaux mcv Report icrocytasis > Yes 75-79 fl le 70-74 FL Qe 64-69 fL 3 <63fl res Mev Report erocytosis > 101-205 fu a 106 ~ 112 #L 2 112-129 fL 36 ~ 2B0fL a . Report sor > Yes > Anisocytosis Is 6 -10% distinguishable 2 11-15% distinguishable 3+ > 15% distinguishable iso / or Report of microcytes when 6 = 25% appear smaller er of microcytes when 25-50% appear smaller macrocyte when 6-25% appear larger of macrocyte when 25-SO% appear larger MCHC >30% I+ > 30% 2+ 29-30% 3+ 25-29% 4+‘ Large ni be rimber of > Yes 3 Target celis6-10% 2+ NOTE: specie siocyte ate of poi , ve Oratocyte 11.25% 3+ poumlonyee mY Stomatocyte 225% 4* reported 19° Ne bur 5 eet naa te term OMENS Bister cells 1-5% ood Foldedcel’s 6- 10% 3 Macroovatceyte 11-25% g 225% “ NOTE standard Spherocyte? 1-5% = 1¢ Schistocyte* 6-10% Review * Dacrocyte * 11-25% 34 Advanced Acanthocyte"* >25% 4* Review ** poakitocytosis ’ eter of Yer > PET yom shape atered 26 Report small Pentecnss 11 = 15% shape akered 3enumber of pape altered * variants one with a total of socytosis will be used only when variants are present (NOTE; The term poukilocytt i to report At ta s+ 25 above. (68 but each varant Is too small as fities and Inclusion Diagnastic Abnormal a le ng > Yes 3 <5% 6-10% de 3+ a Basophilic Stipptl Howell Jolly body + 11-25% Ho > 25% NOTE: Report Number <5/100 WBC, do nape > Yes > Per 100 WBC standard review >5/100, do advanced b review & correct WBC ct Hemoglobin C crystal ** > Yes ~ Report presence NOTE: sickle cell” —* Std. review Malana ** ** Adv. review Siderocyte + + confirm w/ iron stain + No The presence of inclusion shoutd always be reported, likewise with o spherocytes & schistocyte even if they are rare because they may indicat? a4 hemolytic crisis REPORT : Normocytic, Normochromic Page 74