CHAPTER 10â•… VARIATIONS IN SIZE AND COLOR OF ERYTHROCYTES 95

Anisocytosis is the variation in red blood cell (RBC) diameter (or RBC volume) on a blood
film. This variation correlates with the electronically determined red blood cell distribution
width (RDW). An RDW greater than 14.5% indicates a heterogenous population of RBCs
and a variety of sizes of RBCs should be seen. A low RDW is of no significance.

ANISOCYTOSIS

A B
FIGURE 10–2A╇ Heterogeneous population of FIGURE 10–2B╇ When two distinct populations
erythrocytes, indicating anisocytosis (RDW of RBCs are seen, it is termed a dimorphic
. 14.5%). population (RDW . 14.5%).

Associated with:╇ Anemias, especially iron deficiency, Associated with:╇ Transfusion, myelodysplastic
megaloblastic and hemolytic syndromes, vitamin B12, folate, or iron
deficiencies—early in treatment process
96 SECTION THREEâ•… ERYTHROCYTES

VARIATION IN COLOR OF ERYTHROCYTES

A B
FIGURE 10–3A╇ Hypochromia. The central pallor FIGURE 10–3B╇ Dichromic population of
zone of the erythrocyte must be greater than one- erythrocytes. (Two populations of RBCs are
third of the diameter of the cell before it is classified shown: one normochromic and one hypochromic.)
as hypochromic. (Note: the MCHC, not the MCH,
should be used as a gauge of hypochromia; however,
the MCHC is not always decreased when few Associated with:╇ Transfusions, sideroblastic anemia.
hypochromic cells are seen.)

Associated with:╇ Iron deficiency anemia, thalassemias,

sideroblastic anemia, lead poisoning, some cases of
anemia of chronic inflammation.

C D
FIGURE 10–3C╇ Polychromasia; retained RNA in FIGURE 10–3D╇ Normochromic erythrocytes.
RBCs. (MCHC 32-36 g/dL or 32%-36%.) For comparison
with hypochromic and polychromatic erythrocytes.
Associated with:╇ Acute and chronic hemorrhage,
hemolysis, effective treatment for anemia, neonates.