Abnormal Morphology of Red Blood Cells

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Questions and Answers

Which of the following conditions can cause both round macrocytosis and an increase in central pallor?

  • Folate deficiency
  • Iron deficiency anemia
  • Reticulocytosis (correct)
  • Ethanol abuse

A patient presents with microcytosis and hypochromia. Which of the following conditions is most likely responsible for these findings?

  • Hereditary spherocytosis
  • Reticulocytosis
  • Ethanol abuse
  • Iron deficiency anemia (correct)

Which of these conditions is associated with a lower-than-normal MCV?

  • Iron deficiency anemia
  • Thalassemia
  • Sideroblastic anemia
  • All of the above (correct)

Which of the following conditions is associated with spherocytes, lacking central pallor, and can be caused by alcohol withdrawal?

<p>Zieve's syndrome (C)</p> Signup and view all the answers

How is the size of a normal red blood cell typically described in relation to a lymphocyte?

<p>Slightly smaller than the lymphocyte nucleus (A)</p> Signup and view all the answers

A patient presents with target cells, which are characterized by an increased staining area in the central pallor. What could be a possible explanation for this finding?

<p>Deficiency in the production of alpha-globin chains (C)</p> Signup and view all the answers

What is the term used to describe the presence of both microcytes and macrocytes in the same field of view?

<p>Anisocytosis (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature of macrocytosis?

<p>Increased central pallor (D)</p> Signup and view all the answers

Under what conditions do microcytes typically have a normal central pallor?

<p>When iron deficiency anemia is mild (E)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to cause oval macrocytes?

<p>Ethanol abuse (B)</p> Signup and view all the answers

A patient with a high reticulocyte count is likely to exhibit which of the following morphological changes in their red blood cells?

<p>Round macrocytosis and a blue-gray stain (B)</p> Signup and view all the answers

Which of these is a potential cause of abnormal red blood cell morphology, leading to the presence of microcytes?

<p>Inadequate production of hemoglobin (A)</p> Signup and view all the answers

What is the average diameter of a normal red blood cell?

<p>7.2 microns (C)</p> Signup and view all the answers

Which of these conditions are most likely to cause an increase in MCV?

<p>Folate deficiency (C)</p> Signup and view all the answers

What term describes red blood cells that are larger than normal?

<p>Macrocytes (A)</p> Signup and view all the answers

What is the typical range of MCV for microcytes?

<p>less than 80 cubic microns (D)</p> Signup and view all the answers

Which of the following conditions is NOT associated with the presence of nucleated red blood cells in a peripheral smear?

<p>Severe burns (C)</p> Signup and view all the answers

Which of the following conditions is MOST LIKELY to be associated with the appearance of acanthocytes on a peripheral blood smear?

<p>Liver disease (A)</p> Signup and view all the answers

What is the predominant morphological characteristic of Howell-Jolly bodies?

<p>Small, round cytoplasmic inclusions within red blood cells (C)</p> Signup and view all the answers

Which of the following conditions is MOST LIKELY associated with the presence of siderotic granules (Pappenheimer bodies) within red blood cells?

<p>Lead poisoning (B)</p> Signup and view all the answers

Which of the following conditions can lead to the observation of red blood cells with an irregular clumped appearance, specifically due to cold agglutinins?

<p>Cold agglutinins (A)</p> Signup and view all the answers

What is the characteristic morphology of keratocytes, and what are the conditions associated with their presence?

<p>Irregularly spaced projections on red blood cells; found in liver disease and starvation (A)</p> Signup and view all the answers

Which of the following conditions is NOT associated with red blood cells with an abnormal shape, as seen in sickle cell anemia, acanthocytosis, or roueleaux formation?

<p>Megaloblastic anemia (C)</p> Signup and view all the answers

Which of the following conditions is most likely to present with red blood cell morphology resembling a stack of coins?

<p>Hyperfibrinogenaemia (D)</p> Signup and view all the answers

Which of the following is NOT a condition associated with basophilic stippling?

<p>Iron deficiency anemia (D)</p> Signup and view all the answers

Which of the following statements about Heinz bodies is TRUE?

<p>Their presence indicates red cell injury. (C)</p> Signup and view all the answers

What is the likely cause of the red cell changes seen in the image on the left?

<p>Iron deficiency anemia (A)</p> Signup and view all the answers

Which of the following is TRUE about Cabot rings?

<p>They are remnants of the nuclear membrane. (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of avian malaria?

<p>It is a common cause of hemolytic anemia in humans. (A)</p> Signup and view all the answers

Which condition is NOT commonly associated with ovalocytes or elliptocytes?

<p>Hemolytic Anemia (B)</p> Signup and view all the answers

Which of the following conditions is characterized by red blood cells with a central linear slit or stoma, giving the cell a mouth-shaped appearance?

<p>Alcohol Excess (D)</p> Signup and view all the answers

Which cell morphology is most commonly associated with Microangiopathic Haemolytic Anemia (MAHA)?

<p>Schistocytes (A)</p> Signup and view all the answers

Which cell morphology is characterized by red blood cells with uniformly spaced, pointed projections on their surface, also known as Echinocytes?

<p>Burr Cells (D)</p> Signup and view all the answers

A patient presents with a blood smear showing red blood cells with a central hollow area. Which condition is most likely?

<p>Microangiopathic Haemolytic Anemia (A)</p> Signup and view all the answers

Which condition is NOT typically associated with red blood cell fragmentation (Schistocytes)?

<p>Sickle Cell Anemia (D)</p> Signup and view all the answers

Which of the following cell morphologies is often associated with a bone marrow disorder characterized by excessive scar tissue formation?

<p>Tear Drop Cells (D)</p> Signup and view all the answers

Which of the following conditions is characterized by red blood cells with two or three horn-like projections, often described as 'horn cells'?

<p>Uremia (C)</p> Signup and view all the answers

Flashcards

Normal RBC Morphology

Normal red blood cells are round, non-nucleated bi-concave discs with central pallor covering 1/3 of the cell.

Anisocytosis

Variation in the size of red blood cells, indicating the presence of microcytes and macrocytes.

Microcytes

Red blood cells smaller than normal, typically less than 7µm in diameter.

Macrocytes

Red blood cells larger than normal, usually greater than 9µm in diameter.

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Hypochromasia

Decreased hemoglobin content in red blood cells, leading to pale coloration.

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Poikilocytosis

Abnormal shapes of red blood cells, differing from typical biconcave form.

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Inclusion Bodies

Abnormal structures found within red blood cells, indicating various disorders.

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Erythropoiesis

The process of producing red blood cells, which may be ineffective in certain disease states.

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MCV (Mean Corpuscular Volume)

A measure of the average volume of red blood cells; 100 cubic microns or more.

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Hyperchromic

Red blood cells appear more intensely stained from increased ribosomal RNA and hemoglobin.

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Normochromic

Normal coloration of red blood cells with proper hemoglobin concentration.

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Spherocytosis

Red blood cells are spherical and lack central pallor.

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Target Cells

Red blood cells with a distinct area of staining resembling a target.

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Macrocytosis

Presence of abnormally large red blood cells.

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Ovalocytes/Elliptocytosis

Red blood cells that are oval or elliptical in shape, associated with conditions like thalassemia and hereditary elliptical disorders.

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Tear Drop Cells

Red blood cells shaped like a tear drop or pear, often found in myelofibrosis and megaloblastic anemia.

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Blister Cell

Red blood cells with an eccentric hollow area, commonly seen in microangiopathic hemolytic anemia.

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Schistocytosis

Fragmentation of red blood cells associated with conditions like DIC and mechanical hemolytic anemia.

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Stomatocytosis

Red blood cells exhibiting a central linear slit, resembling a mouth, often seen in hereditary conditions.

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Burr (Crenation) Cell

Red blood cells with pointed projections, found in hemolytic anemia and uremia.

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Keratocytes (Horn Cell)

Cells that have two or three horn-like projections due to fusion at the membrane.

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Conditions linked to Ovalocytes

Includes thalassemia major, hereditary ovalocytosis, and sickle cell anemia.

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Basophilic Stippling

Small basophilic inclusions in red cells due to ribosomal RNA aggregation.

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Heinz Bodies

Denatured hemoglobin showing as blue precipitates with crystal violet stain, indicating red cell injury.

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Cabot Rings

Reddish-blue threadlike rings in RBCs, remnants of the nuclear membrane, rare in specific anemias.

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Parasites of Red Cell

Protozoan parasites causing avian malaria, transmitted by mosquitoes, can lead to hemolytic anemia.

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Siderotic Inclusions

Iron-containing granules found in red cells, indicating excess iron in the cells.

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Keratocyte

A fragile red blood cell circulating briefly, linked to conditions like uraemia and liver disease.

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Acanthocytes

Red blood cells with irregular projections, associated with liver disease and anorexia.

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Sickle Cells

Red blood cells that are sickle-shaped, typically found in sickle cell anemia.

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Nucleated Red Blood Cells

Early released red blood cells from bone marrow, contain a nucleus, indicating oxygen demand.

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Rouleaux Formation

Stacks of red blood cells resembling coins, seen in hyperfibrinogenemia and hyperglobulinemia.

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Red Cell-Agglutination

Clumps of red blood cells due to cold or warm agglutinins, indicating autoimmune hemolysis.

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Howell-Jolly Bodies

Small cytoplasmic inclusions in red blood cells, found post-splenectomy or in megaloblastic anemia.

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Siderotic Granules

Iron-containing inclusions in erythrocytes, seen in lead poisoning and vitamin B6 deficiency.

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Study Notes

Abnormal Morphology of Red Blood Cells

  • Presentation: The presentation is about abnormal morphology of red blood cells (RBCs).

Learning Objectives

  • Morphology of Normal RBCs: Includes shape, size, and hemoglobin content.
  • Morphology of RBCs - size: Describes the variation in size, including microcytes (smaller) and macrocytes (larger) than normal.
  • Morphology of RBCs - Hb content (color): Discusses alterations in hemoglobin content leading to variations in color, including hypochromasia (reduced hemoglobin) and hyperchromasia (increased hemoglobin).
  • Types of poikilocytosis (shape of RBC): Explores different abnormal shapes besides the normal biconcave disc shape.
  • Inclusion bodies: Covers inclusions (e.g. Howell-Jolly bodies) that can be present within the RBC.

Normal RBCs

  • Structure: Round, elastic, non-nucleated, biconcave discs with a central pallor (covering about 1/3 of the cell).
  • Size: Approximately the same size as the nucleus of a small lymphocyte, with an average diameter of 7.2 microns (range of 6-9 microns).
  • Purpose: Normal mature red blood cells carry oxygen throughout the body.

Disease and Abnormal RBC Morphology

  • Causes of Abnormal Morphology: Four main causes:
    • Abnormal erythropoiesis (effective or ineffective production of RBC).
    • Inadequate hemoglobin (Hb) formation (hypo- or hyperchromic).
    • Damage/changes to RBCs after leaving the bone marrow (e.g., hereditary spherocytosis).
    • Bone marrow attempts to compensate for anemia through increased erythropoiesis.

Abnormal RBC Morphology: Further Detailed Information

  • Size Variations (Anisocytosis):
    • Microcytes: Smaller than normal RBCs.
    • Macrocytes: Larger than normal RBCs.
    • Anisocytosis: Presence of both microcytes and macrocytes within the same field of view.
  • Hemoglobin Content Variations:
    • Hypochromasia: Increased central pallor, less hemoglobin.
    • Hyperchromasia: Decreased central pallor, more hemoglobin.
    • Anisochromasia: A combination of hyper- and hypochromasia.
  • Shape Variations (Poikilocytosis):
    • Various abnormal shapes (e.g., spherocytes, target cells, sickle cells, tear drop cells, blister cells).
  • Inclusion Bodies:
    • Howell-Jolly bodies: Small, round cytoplasmic inclusions appearing similar to nuclei.
    • Siderotic granules (Pappenheimer bodies): Iron containing cytoplasmic inclusions.
    • Basophilic stippling: Small clumps of ribosomal RNA.
    • Heinz bodies: Denatured hemoglobin precipitates.
    • Cabot rings: Reddish-blue threadlike remnants of the nuclear membrane.
    • Parasites (e.g., malaria): Can be identified within red blood cells.

Specialized Classifications of Abnormal RBC Morphology

  • Spherocytosis: Spherical, lack central pallor.
  • Target Cells: Increased staining with an area of central pallor.
  • Ovalocytes/Elliptocytes: Oval or elliptical in shape, respectively.
  • Tear Drop Cells: Shaped like a tear drop or pear.
  • Blister Cells: Eccentric hollow area inside the cell.
  • Schistocytes: Fragmented red blood cells.
  • Stomatocytes: Central linear slit or stoma.
  • Burr/Crenation Cells: Uniformly spaced, pointed projections on surface.
  • Keratocytes (horn cells): Cell fragments with horn-like projections.
  • Acanthocytes: Irregularly spaced projections, mostly rounded ends.
  • Nucleated RBCs: Presence of nuclei in red blood cells, an indication of early release from the bone marrow.
  • Rouleaux Formation: Stacks of RBCs resembling a stack of coins.
  • Red Cell Agglutination: Irregular clumps of red blood cells.
  • Sickle cells: Crescent or sickle-shaped cells.

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