Practical of Clinical Hematology. RBC’s Morphology. Lab 2. RBCs Abnormal morphology. Peripheral Blood Morphology. Abnormal erythrocyte morphology. Is found in pathological states that may be abnormalities in Red cell distribution. Size (anisocytosis).
Peripheral Blood Morphology
Stacking of RBCs due to increased plasma proteins coating RBCs (resembling a stack of coins)
Found in:- Hyperfibrinogenaemia- Hyperglobulinaemia
Antibody-mediated Irregular clumping , temperature dependent
Found in:- Cold agglutinins- Warm autoimmune hemolysis
Normal size of RBC (8 μm) with a range of 7 to 9 μm.
The nucleus of a small lymphocyte (± 8 µm) is a useful guide to the size of a red blood cell).
Most erythrocytes presented in the picture are microcytes (compare with the small lymphocyte). The degree of hemoglobinization is sufficient. Normal platelets and single ovalocytes are present.
1. microcyte 2. normocyte
leading to Microcytosis
Any situation with reticulocytosis – for example bleeding, hemolysis or response to heamatinic factor replacement
Red cell with a “target” or bull’s-eye appearance. The cell appears with a central bull’s eye that is surrounded by a clear ring and then an outer red ring.
Red cells are more spherical. Lack the central area of pallor on a stained blood film.
Red cells with a central linear slit or stoma. Seen as mouth-shaped form in peripheral smear.
Found in:- Alcohol excess- Alcoholic liver disease- Hereditary stomatocytosis
The red cells are oval or elliptical in shape. Long axis is twice the short axis.
Found in:- Hereditary elliptocytosis- Megaloblastic anemia- Iron deficiency - Thalassaemia- Myelofibrosis
Have accentric hallow area. Resemble a women's handbag and may be called pocket-book cell.
Microangiopathic hemolytic anemia
Part of the cell fuses back leaving two or three horn-like projections. The keratocyte is a fragile cell and remains in circulation for only a few hours.
Found in:- Uraemia- Severe burns- EDTA artifact- Liver disease
Also called helmet cells
Sickle shaped red cells
Hb-S disease and trait
Red cell with 30 or more, short blunt projections which are regularly distributed on their surface
Usually artifactual— the result of slow drying under humid conditions.
Sometimes are non - artifactual, indicating uremia or pyruvatekinase deficiency.
Cells retain the central pallor.
Red blood cells with irregularly spaced projections, these projections very in width but usually contain a rounded end
Found in:- Liver disease - Post splenectomy- Anorexia nervosa and starvation
Small round cytoplasmic red cell inclusion with same staining characteristics as nuclei
These are iron containing granules in red blood cells that are seen because the iron is aggregated with mitochondria and ribosomes. They appear as faint violet or magenta specks, often in small clusters, due to staining of the associated protein.
They are associated with severe anemias and thalassemias. Pappenheimer bodies can be increased in hemolytic anemia, infections and post-splenectomy.
Considerable numbers of small basophilic inclusions in red cells.
Found in:- Thalassaemia- Megaloblastic anemia- Hemolytic anemia - Liver disease- Heavy metal poisoning.
Represent denatured hemoglobin (methemoglobin - Fe+++) within a cell.
With a supravital stain like crystal violet, Heinz bodies appear as round blue precipitates.
Presence of Heinz bodies indicates red cell injury and is usually associated with G6PD-deficiency.
Heinz Body Preparation. RBC are incubated supravitally in new Methylene blue to identify precipitates of oxidatively denatured hemoglobin.
Reddish-blue threadlike rings in RBCs of severe anemia's. These are remnants of the nuclear membrane or remnants of microtubules and appear as a ring or figure 8 pattern.
A - Cabot ringB - Howell-Jolly body
Depiction of red blood cell morphologies that may appear on a peripheral smear, showing:
Burr + Spur Cells