RED CELL ABNORMALITIES

RED CELL ANOMALIES

• Anisocytes
• RBCs w/ color variation
• Poikilocytes
• RBC inclusion bodies

Red cell morphological anomalies are NOT SPECIFIC for a disease

They only serve as clues!

There may be some deviation from what is written in RODAK

Study the pictures from the internet for your FINAL LAB EXAM (sometime in February)

Red Cell Anomalies

I. Anisocytosis
• Variation in cell size
• blood smear exam and/or by reviewing the MCV and RDW
• normal RBCs: 6-8 um in diam.
• Evaluation of normal RBC size: compare w/ the nucleus of a small lymphocyte

Macrocytes – diameter > 8.0 um; MCV > 100 fL

- assoc. with impaired DNA synthesis (occurring in Vit. B 12 or folate deficiency)

Microcytes – diameter < 6.0 um; MCV < 80 fL

- cells are usu. hypochromic but may be normochromic
-defective hemoglobin formation

Normal Blood Smear

RBCS – normal size

MACROCYTES

MACROCYTIC RBCs
Megaloblastic anemia
Vit B12 and Folate deficiency
Nonmegaloblastic anemia

GLOSSITIS
HYPERSEGMENTED NEUTROPHILS
MICROCYTES

MICROCYTIC RBCs
• Thalassemia
• Anemia of chronic inflammation
 • Iron Deficiency Anemia
• Lead Poisoning (Plumbism)
• Sideroblastic Anemia

GLOSSITIS

Red Cell Anomalies

II. Cells with color variation

• normal: RBCs have a central area of pallor approx. 1/3 the diameter
Hypochromic cells
• central pallor >1/3 of diameter
• usually microcytic

Hypochromic Cells

Polychromatophilic RBCs
• larger than normal w/ bluish tinge using Wright’s stain
• large nos. in the bld. smear = assoc. w/ decreased RBC survival or hemorrhage or erythroid
hyperplastic marrow

Polychromatophilic red blood cells

“Hyperchromic” cells – RBCs w/ ”falsely increased Hb content”

Red Cell Anomalies

III. Poikilocytosis
• variation in shape

Spherocytes
• almost spherical in shape
• lacks the central pallor
• MCHC is “high”
• Hereditary Spherocytosis

Stomatocytes
• mouth cell
• elongated RBC w/ a slit-like central pallor
• Rh Null syndrome, alcoholism, Hereditary Stomatocytosis & severe liver dses.

Acanthocytes
• thorn cell, spur cell
• RBCs w/ irregularly spiculated surface
• abetalipoproteinemia
Echinocytes
• crenated RBCs
• w/ regularly spiculated surface
• spicules are rounded at the tip
• Usu. caused by artifactual drying of smear, bile acid abN or due to the effects of barbiturates or
salicylates

Burr cells
• regularly spiculated surface (but the projections of the spicules are more pointed than the
echinocytes’)
• uremia, acute blood loss, cancer of the stomach, and pyruvate kinase deficiency

Ovalocytes

Elliptocytes (cigar cells)

• found in N persons (about 5-10%) but ↑ in cases of Hereditary Elliptocytosis

Dacryocytes
• teardrop cells
• Primary myelofibrosis (PMF)

Schistocytes
• fragmented RBCs
• microangiopathic HA, uremia, severe burns, & DIC

Sickle cells

Drepanocytes
• Polymerization of Hb S
• Sickle Cell Anemias

Target cells
• leptocytes, platycyte, codocyte, Mexican hat cell
• ”bull’s eye” appearance
• Liver dse., certain hemoglobinopathies, thalassemia

Red Cell Anomalies

IV. Red Cell Inclusion Bodies

Baso. stippling (punctate basophilia)
• irregular basophilic gran.
Fine stippling – ↑ prod. of RBCs
Coarse stippling – Lead poisoning or other dses. w/ impaired Hb synthesis
Siderotic gran.
• intraerythrocytic collections of iron (demo. by iron stains)
• using Wright’s stain: → Pappenheimer bodies
• rarely seen in the bld. smear except after splenectomy

Howell-Jolly bodies
• round remnants of nuclear chromatin
• Single HJ: megaloblastic A, hemolytic A, after splenectomy
• Mult. HJ bodies (in a single cell): usu. indicate megaloblastic A or some other form of abN.
erythropoiesis

Cabot rings
• ring-shaped, figure-of-eight
• probably microtubules remaining from mitotic spindle
• evidence of abn. erythropoiesis

Heinz bodies
• irregular refractile gran. (often found at the periphery)

• In N0 indiv. → 1 to 4 per cell

• 5 or more → G-6-PD def.

• not demo. by Wright’s stain; use supravital stains instead (NMB, BCB, methyl violet, crystal
violet)

Hb H inclusions
-precipitate of beta globin chains

Malarial stipplings
• Wright’s stain: Schuffner’s gran. are purplish red

Crystals related to Hb C
- Hb SC
- Hb CC

☞ Rouleaux formation – “stack of coin”

- causes: ↑ plasma fibrinogen/globulins

☞ NRBCs: ↑ nos. are particularly found in HDN and thalassemia major

: may cause falsely ↑ WBC ct.
:FORMULA FOR CORRECTED WBC COUNT:
uncorrected WBC ct. X 100
# NRBCs per 100 WBCs + 100

☞ Certain parasites or bacteria