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  1. Erythrocyte Abnormalities Clinical Pathology, Ms. Canga

  2. Erythrocyte Morphology • Different species have different _________ RBCs with varying degrees of ___________________________. • Dogs have _____________ RBCs (~________ µm in diameter) • Cats, horses, cows, sheep, goats (3-4 µm) • Llamas and camels have ______________________ (oval) RBCs • Deer have _________________-shaped RBCs • Birds, fish, amphibians, and reptiles have ______________________, elliptical RBCs. • Human RBCs are about the same size as those of ______________.

  3. Relative sizes of RBCs

  4. Chicken Llama

  5. Reptile Deer

  6. Normal RBC Morphology Feline blood. Normal erythrocyte morphology. Feline RBCs are smaller than dog erythrocytes, exhibit a slight amount of crenation, and have a minimal area of central pallor

  7. Review • There are 5 ways to classify erythrocytes as normal or abnormal: • 1) ________________________________________________ • 2) ________________________________________________ • 3) ________________________________________________ • 4) ________________________________________________ • 5) ________________________________________________

  8. Arrangement on a Blood Film • How should cells appear on film? • Abnormal formation • _____________________ formation • _________________________________________

  9. Rouleaux Formation • Rouleaux formation • Grouping of RBCs that appear ________________ • Normal in _________________ • Seen with increased _______________ or ___________________ concentration in blood • May appear as an _________________ • Refrigerated blood not allowed to return to room temperature • May be seen if blood has been held too long before preparation of smear

  10. Rouleaux as an Artifact • As you learned in Lab Pro, rouleaux formation may be an artifact. • If it IS an artifact and not a true medical condition in the patient, ____________ may be added to the sample.

  11. Rouleaux Formation

  12. Agglutination/Auto-agglutination • Agglutination is caused by an __________________ that coats the RBC causing bridging or clumping of the cells. • Typically occurs in _________________________ disorders • Agglutination MAY appear as __________________ on occasion • To differentiate between agglutination and rouleaux, saline is added to the sample. • On the next slide, are the EXACT procedures for adding saline to your sample:

  13. Adding Saline to Confirm Rouleaux • When rouleaux is suspected, ____________________ all tubes in question. • Carefully remove ___________ /____________with transfer pipette, leaving the cells undisturbed. Discard/use plasma or serum • Add 2 drops of ________________ to test tube and mix well. • ________________________the tube • Gently re-mix the red cells and perform smear • _________________ will disperse, ______________________________will NOT

  14. Comparison in the Monolayer

  15. Agglutination can Affect WBCs too!

  16. Variation in Color • Called _______________________ • ____________________________ • ____________________________ • Calculated through the ___________ (Remember the formula?) • Classifies cells as ____________________ or _______________________

  17. Polychromasia • Variation in color usually associated with __________ and ____________________ • ________ production begins right before cell loses nucleus • ____________ intensity decreases as metabolic activity ____________________ • ________ increases in intensity as ________ production ______________________.

  18. Polychromasia • Recall that the _______________ the cell in the RBC maturation series, the more dark blue the staining due to increased __________________ activity. • Mature RBCs stain _________ because they have their full complement of ________. • ______ production begins right before cell loses ______________; immature RBCs with some Hb present stain ______________________ because there is still some metabolic activity going on within the cell.

  19. Hypochromasia • ____________ staining intensity of RBCs • Caused by insufficient ________ concentration due to _________ deficiency (Chronic ____________ loss or ______________________) • Cell will appear normally stained around __________________ with a much paler central region. • Hypochromasia is almost always accompanied by _____________________ . (Decreased __________) • Determined by a decreased ______________

  20. Hypochromasia

  21. Hyperchromasia • Increased staining intensity of RBCs • Immature RBCs = larger and darker • Hyperchromasia based on _______ concentration (_______) cannot exist… • Presence of _______________, ___________________, and _____________can interfere with tests and _______________________ increase MCHC • _____________________ often seen • are __________________and __________________but can have normal cell volume. (Cell may be ________________) • May be seen in mismatched _________________________

  22. Hyperchromasia/Spherocytes

  23. Canine blood. Regenerative anemia with spherocytes. Anisocytosis is due to macrocytic cells and spherocytes, which are smaller than normal and lack central pallor. Spherocytes are associated with hemolytic anemias due to immune disease or fragmentation. The polychromatophilic RBC with a rod- shaped area of central pallor (arrow) is a stomatocyte

  24. Poikilocytosis • Variations in the __________________ of RBCs (poikil ~ irregular) • Not a __________________________ • A general term to encompass nondescript variations in ______________ of erythrocytes that are scattered throughout the blood film.

  25. Poikilocytosis Note: Poikilocytosis, anisocytosis, and polychromasia are present on this slide.

  26. Schistocytes “Helmet Cell” • RBC fragments resulting from shearing of red blood cell by _________________________________. • May be seen with _______________________________________ (DIC) or with ________________________ • Expect to also see ________________________________ on blood film of animals with DIC • Can be caused by excess _______________deposition, malformation of _______________________, or excessive _________________________in the blood • Common name is “__________________________”

  27. Schistocytes

  28. Acanthocytes “Spur Cells” • Have irregular membrane projections of _______________________ length and diameter with __________________________tips • _______________________sized and spaced • May be seen in blood smear of: • Cats with _____________________________________, • Dogs with ___________________diseaseor • ____________________________of the liver • Represent __________________ alteration rather than ________________________ • Commonly called “________________”

  29. Acanthocytes

  30. Echinocytes“Burr Cells” • __________________ change • Resulting from _____________ change in blood, altering cell _____________________ • May appear __________________ or ruffled, with relatively _____________ sized and spaced, short, _________ projections • Associated with ____________ disease, ____________________ or rattlesnake _________________________in dogs • Can be _____________________ if excess of _______ is present

  31. Echinocyte formation

  32. Echinocytes

  33. Echinocytesas“Crenation” • __________________ Change • ______________________ • Slow ________________ of blood film • _____________________EDTA tube • Affects the ________________ of the cells on a blood film

  34. Crenation

  35. Drepanocytes“Sickle Cells” • ________________________ with pointed ends • Result of alteration in __________ due to low ___________ tension • Normal finding in ___________, Angora _________, and some ___________

  36. Drepanocytes

  37. Keratocytes“Helmet cell” • Also called “________________” • Keratocytes are believed to result from ____________________________________ • Can also result from _________________ injury found with ___________ deficiency • Presence of keratocytes has also been associated with ____________________, _________________, ________________________, and various _________________ diseases.

  38. Keratocytes and Pre-keratocytes

  39. Anulocytes“Punched-out cells” • ____________ shaped RBCs that form as a result of a loss of the membrane ____________________. • Cell cannot return to normal shape after passing through a narrow _____________________. • May be seen in any _______________ disease. • Can also occur due to low _______ concentration or as an ____________________.

  40. Anulocytes (Punched-out cells)

  41. Dacryocyte“Teardrop cells” • _________________ shaped RBCs with a single ____________________ or _______________end • May be seen in _________________________ diseases or ____________ and ________________ disorders of dogs. • Can be an ______________ . Check to see if the _______________ are all pointing in the __________ direction.

  42. Dacryocytes “Tear-drop Cells”

  43. Eccentrocyte • Characterized by a shifting of the _______________ to one side of the RBC • ____________ portion of membrane is ragged and poorly _______________________________. • Form under conditions of ___________________ stress • May be seen with ____________________________Anemia

  44. Eccentrocyte

  45. Codocytes (Leptocytes) • Characterized by an increase in membrane _________________ _________ • Include all of the following cells: • __________________________ • __________________________ • __________________________ • __________________________

  46. Target Cells (Bull’s eye Cell) • Resembles a ____________ with a bulls-eye • Have central area of _____________ surrounded by area of pallor • _________________ of cell contains band of _______ • A few may be seen in _____________ smears • May be associated with __________ deficiency, _________, ___________ diseases, and some _______________ disorders.

  47. Target Cells

  48. Folded cells and Stomatocytes • Folded cells have a ______________ _____appearing central pallor • _____________________ have a transverse, raised fold extending across the center of the cell and a clear, _________-like pale region in the center. • Both may be caused by a change in membrane _____________ associate with ______________ disease • Both are considered an ___________________ if the areas of pallor are ________________________ to the feathered edge.

  49. Stomatocyte

  50. Stomatocytes