“ERYTHROCYTES: NORMAL & ABNORMAL”

NAME : NUR FATHIYAH BINTI MOHD.ID : 012012111311.LECTURER’S NAME :MDM SHUHADADATE OF SUBMISSION : 03 DECEMBER 2013

DIPLOMA IN MEDICAL LABORATORY TECHNOLOGY

HAEMATOLOGY DIAGNOSTIC II (SBD 0153)

NORMAL MORPHOLOGY OF ERYTHROCYTESNORMOCYTIC (NORMAL SIZE) biconcave shape , no nucleus SIZE

7.2 X 2.1 µm

NORMOCHROMIC Hemoglobin content in rbc. Normal colour : pinkish red

(wright / leishman staining). Pale central area -1/3 of total

surface

ABNORMAL

MORPHOLOGY OF

ERYTHROCYTES

normocytic

marcocytic

microcytic

MACROCYTIC MCV < 90 fl Defect in nuclear maturation / stimulated erythrocytes.Disorder : Folate and vitamin B12 deficiency , reticulocytosis.

microcytic

Low in hemoglobin synthesis. MCV > 80 fl Disorder : iron deficiency anaemia , thalassemia and hemoglobinopathies , malabsorption syndrome.

Shape variation

Sickle cell (drepanocytes)

Target cell (codocytes)

Thorn cell (acanthocytes)

Burr cell (echinocytes)

Stomatocytes

Ovalocytes / elliptocytesSpherocytes

Blister cell

Helmet cell (schizocytes)

Tear drop cell (dacryocytes)

Sickle cell (drepanocytes)

No central pallorUsually forming the

shape of a cresent or banana.

Dense hemoglobin (dark red to light purple)

Disorder : sickle cell anemia

Target cell (codocytes)

Bull’s eye appearance (resembles the target sign)

Due to excess membrane cholesterol or low haemoglobin content

Disorder : liver disease , thalassemia

About the same size as normal RBC

Thorn cell (acanthocytes)

Multiple thorny , spikes.

No central pallor

Rare thorn cell may be seen in a blood smear which may be due to the very old RBC’s

Also known as spur cell

Disorder : cirrhosis , neonatal hepatitis and post-splenectomy

BURR CELL (ECHINOCYTES)

Evenly distributed , uniformly sized spicules

Causes : decrease deformability which leads to increasing cell rigidity and premature destruction.

Disorder : bleeding in gastric ulcers , peptic ulcer and gastric carcinoma.

STOMATOCYTES

Due to underlying RBC membrane defect.

“slit-like” or “mouth-like “ central pallor.

Compact and round shape

Disorder : alcoholism , thalassemia minor , hereditary spherocytosis.

OVALOCYTES / ELLIPTOCYTES

Usually longer and narrower

than normal RBC.

Usually has a central pallor

Disorder : thalassemia , hemolytic anemia , iron deficiency anemia.

SPHEROCYTES

Doughnut

shaped

Due to loss of membrane due to aging , antibody coating or genetic defect.

No central pallor

MCV may be normal of slightly decreased

Disorder : autoimmune hemolytic anemia , transfusion reaction

BLISTER CELL

Vacuoles may

ruptured

Thinner area at periphery / outer membrane of cell membrane.

Disorder : pulmonary emboli in sickle cell anemia , microangiopathic hemolytic anemia

HELMET CELL (SCHIZOCYTES)

Remains after rupturing of blister cell

An army helmet features with short straps.

Disorder : emboli , G6PD deficiency , hemolytic anemia

TEAR DROP CELL (DACRYOCYTES)

Unipolar tapered end with a blunt tip

Increase number of tear drop RBC is a clue to a possible underlying marrow process.

Disorder : thalassemia , severe anemia , megaloblastic anemia , mylefibrosis.

VARIATION IN RED CELL COLORATION

Normal erythrocytes : pinkish red with lighted coloured centre.

Anisochromia : uneven coloration of erythrocytes.

Hypochromia : central pallor exceed 1/3 of the cell membrane.

Hyperchromia : erythrocytes is intensively coloured.Polychromatophilia :

cytoplasm is greyish-orange in colour.

VARIATION IN RED CELL DISTRIBUTION

AGGLUTINATION

ROULEAUX FORMATION

Irregular overlapping aggregate of RBC’s.

Seen in cold antibody syndrome

Reaction of antibodies with antigens on erythrocytes

Caused by concentration of fibrinogen or immunoglobulin

Arrangement of erythrocytes in groups that resembles stacks of coins

Seen in multiple myeloma , inflammation

RBC inclusion

Howell-jolly bodies

Basophilic stippling / punctate basiphilia

Pappenheimer bodies

(siderocytes)

H inclusionHeinz bodiesCabot

ring

Reticulocytes

Malaria parasites

C crystal

Nuclear / cytoplasmic aggregates of stainable substances , usually protein.

condition formed if there is the abnormalitiy invoved virus infection classified according to staining

HOWELL-JOLLY BODIES

Composed of fragments of DNA

May be centrally located or sometimes in the periphery

Caused by acceleration / ineffective erythropoiesis in which chromosome fragments are left in the cytoplasm

Staining : Romanowsy (eosin-metilena blue)

Disorder : splenectomy and in thalassemia , hemolytic anemia

BASOPHILIC STIPPLING / PUNCTATE BASOPHILIA

Composed of ribosomes

Artifactual caused by precipitation of RNA during staining

Very small blue / blue-gray granules distributed throughout the cytoplasm of RBC’s

Staining : romanowsy (eosin-metilena blue

Disorder : defective / accelerated heme synthesis , lead poisoning anf thalassemia

PAPPENHEIMER BODIES (SIDEROCYTE)

Purplish irregular aggregates of granules composed of ferric iron

Caused by excess available iron throughout the body

Staining : prussian blue

Disorder : sideroblastic anemia , thalassemia , asplenism

H INCLUSIONStain with

supravital stain four drops of blood is incubated with 0.5ml of brilliant cresyl blue for 20 minutes at 37°cComposed of precipitated chains of beta-hemoglobin

Blue-green dots can be seen in the red blood cell

Can be seen in HbH disease because of the deposit of the unstable hemoglobin red blood cell,HbH.

HEINZ BODIES

Purple-blue inclusions visible only after supravital stain

Composed of denatures hemoglobin

Seen in alpha thalassemia , G6PD deficiency and unstable hemoglobin syndromes

CABOT RING

Purplish ring-shaped , figure-8 / loop shaped structure composed of nuclear membrane remnants

Rarely seenExact mechanism

unknown

Staining : romanowsky

Disorder : pernicious anemia , lead poisoning , homozygous thalassemia and post-splenectomy

MALARIA PARASITES

Round to oval ring-shaped intracellular parasite in RBC’s

Found in malaria

Usually <2 micrometer in young trphozoites

C CRYSTA

LHexagon shaped / rhomboid shaped crystalline structures in RBC’s. Variable sized RBC

crystalline dark blue-purple inclusions.

Disorder : hemoglobin C , hemoglobin SC

RETICULOCYTESYoung red blood cells

that contains ribonucleic acid and ribosomes

Seen As dark blue granule or filament

Staining : Supravital stains (such as brilliant cresyl blue, as used here) clump RNA and mitochondria and permit easy identification of reticulocytes, as compared to mature RBC