Questions and Answers
What morphological feature distinguishes acanthocytes from echinocytes?
In which condition would you likely observe dacrocytes?
Which RBC morphology is characterized by fragmented cells?
What is the primary pathology associated with the presence of Howell-Jolly bodies?
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Which cell type is associated with G6PD deficiency?
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What type of RBC inclusions are characterized by denatured hemoglobin?
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Which RBC morphology may indicate hereditary elliptocytosis?
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Target cells are known to be associated with which of the following conditions?
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Which type of red blood cell morphology is associated with myelofibrosis?
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Which RBC inclusion is characterized by the presence of basophilic ribosomal precipitates?
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Which cell type is most likely to appear in conditions of G6PD deficiency?
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What pathology is associated with the presence of acanthocytes?
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Which RBC morphology is characterized by small, spherical shapes without central pallor?
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Target cells are typically associated with which of the following?
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In which condition would you expect to find ringed sideroblasts?
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Which RBC morphology consists of fragmented red blood cells?
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What type of red blood cell morphology is associated with increased surface area-to-volume ratio?
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Which RBC inclusion is characterized by the presence of basophilic granules that contain iron?
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Which type of RBC morphology is closely associated with mechanical hemolysis?
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What is the morphology of RBCs that are 'shed a tear' due to mechanical squeezing in the bone marrow?
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Which condition is most likely to lead to the presence of Heinz Bodies in RBCs?
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What morphological feature characterizes echinocytes in comparison to acanthocytes?
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Elliptocytes are primarily associated with which hereditary condition?
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Basophilic stippling in RBCs is typically associated with which condition?
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Study Notes
Red Blood Cell Morphology
- Acanthocytes (spur cells): Irregular projections; associated with liver disease, abetalipoproteinemia, vitamin E deficiency.
- Echinocytes (burr cells): Smaller, uniform projections; linked to liver disease, end-stage renal disease (ESRD), and pyruvate kinase deficiency.
- Dacrocytes (teardrop cells): Form due to mechanical squeezing in bone marrow; indicative of myelofibrosis.
- Schistocytes (helmet cells): Fragmented red blood cells; common in microangiopathic hemolytic anemias (MAHAs) like DIC, TTP/HUS, and HELLP syndrome.
- Degmacytes (bite cells): Result from the removal of Heinz bodies in G6PD deficiency by splenic macrophages.
- Elliptocytes: Associated with hereditary elliptocytosis; caused by mutations in membrane proteins like spectrin.
- Spherocytes: Small, spherical cells devoid of central pallor; found in hereditary spherocytosis and autoimmune hemolytic anemia, characterized by reduced surface area-to-volume ratio.
- Macro-ovalocytes: Seen in megaloblastic anemia; often accompanied by hypersegmented neutrophils.
- Target cells: Increased surface area-to-volume ratio; associated with conditions like hemoglobin C disease, asplenia, liver disease, and thalassemia.
- Sickle cells: Deformed cells that occur in sickle cell anemia under low oxygen conditions (high altitude, acidosis) or high concentrations of hemoglobin S (dehydration).
Red Blood Cell Inclusions
- Iron Granules: Found in sideroblastic anemias like lead poisoning; visualized as perinuclear mitochondria with excess iron using Prussian blue stain.
- Howell-Jolly Bodies: Basophilic nuclear remnants; generally removed by splenic macrophages, found in functional hyposplenia and asplenia.
- Basophilic Stippling: Ribosomal precipitates present in sideroblastic anemia and thalassemias, not containing iron.
- Pappenheimer Bodies: Basophilic granules containing iron; associated with sideroblastic anemia.
- Heinz Bodies: Denatured, precipitated hemoglobin observed in G6PD deficiency; visualized using supravital stains like crystal violet.
RBC Morphology
- Acanthocytes ("spur cells"): Irregular projections of varying sizes; associated with liver disease, abetalipoproteinemia, and vitamin E deficiency.
- Echinocytes ("burr cells"): Smaller, uniform projections; linked to liver disease, end-stage renal disease (ESRD), and pyruvate kinase deficiency.
- Dacrocytes ("teardrop cells"): Indicative of bone marrow infiltration like myelofibrosis; RBCs appear teardrop-shaped due to mechanical squeezing during egress from the bone marrow.
- Schistocytes ("helmet cells"): Fragmented red blood cells associated with microangiopathic hemolytic anemias (MAHAs) such as DIC and TTP/HUS, as well as mechanical hemolysis (e.g., from heart valve prostheses).
- Degmacytes ("bite cells"): Formed in G6PD deficiency; result from macrophagic removal of Heinz bodies, giving RBCs a 'bitten' appearance.
- Elliptocytes: Found in hereditary elliptocytosis; caused by mutations in genes coding for RBC membrane proteins like spectrin, leading to elliptical shape.
- Spherocytes: Seen in hereditary spherocytosis and autoimmune hemolytic anemia; compact spherical shape with no central pallor, resulting in a decreased surface area-to-volume ratio.
- Macro-ovalocytes: Typically associated with megaloblastic anemia; also characterized by hypersegmented neutrophils.
- Target cells: Found in conditions like HbC disease, asplenia, liver disease, and thalassemia; exhibit increased surface area-to-volume ratio, resembling targets.
- Sickle cells: Indicative of sickle cell anemia; sickling occurs under low oxygen conditions, high HbS concentration, or dehydration.
RBC Inclusions
- Iron Granules: Present in sideroblastic anemias (e.g., lead poisoning); perinuclear mitochondria exhibit excess iron and require Prussian blue staining for visualization.
- Howell-Jolly Bodies: Nuclear remnants present in functional hyposplenia and asplenia; typically removed by splenic macrophages, they are basophilic and do not contain iron.
- Basophilic Stippling: Seen in sideroblastic anemia and thalassemias; results from basophilic ribosomal aggregates and lacks iron.
- Pappenheimer Bodies: Associated with sideroblastic anemia; consist of basophilic granules that contain iron, reminiscent of "Pappen-hammer."
- Heinz Bodies: Result from G6PD deficiency; contain denatured hemoglobin and appear as precipitates. Require supravital staining (e.g., crystal violet) for visualization due to their nature.
RBC Morphology
- Acanthocytes ("spur cells"): Associated with liver disease, Abetalipoproteinemia, and Vitamin E deficiency; characterized by asymmetric projections of varying sizes.
- Echinocytes ("burr cells"): Linked to liver disease, end-stage renal disease (ESRD), and pyruvate kinase deficiency; display smaller, more uniform projections compared to acanthocytes.
- Dacrocytes ("teardrop cells"): Indicative of bone marrow infiltration, such as myelofibrosis; resemble teardrops due to mechanical squeezing during RBC release from bone marrow.
- Schistocytes ("helmet cells"): Associated with microangiopathic hemolytic anemias (MAHAs), including DIC, TTP/HUS, and HELLP syndrome, as well as mechanical hemolysis; appear as fragmented RBCs.
- Degmacytes ("bite cells"): Found in G6PD deficiency; formed by the removal of Heinz bodies by splenic macrophages.
- Elliptocytes: Seen in hereditary elliptocytosis; caused by mutations affecting RBC membrane proteins, including spectrin.
- Spherocytes: Associated with hereditary spherocytosis and autoimmune hemolytic anemia; these are small, spherical cells that lack central pallor and have a decreased surface area-to-volume ratio.
- Macro-ovalocytes: Often observed in megaloblastic anemia; characterized by their larger size and oval shape.
- Target cells: Associated with conditions like HbC disease, asplenia, liver disease, and thalassemia; increased surface area-to-volume ratio gives them a target-like appearance.
- Sickle cells: Primarily seen in sickle cell anemia; sickling is triggered by low oxygen conditions, high HbS concentration, or dehydration.
RBC Inclusions
- Iron Granules: Found in sideroblastic anemias (including lead poisoning and myelodysplastic syndromes); characterized by excess iron in perinuclear mitochondria, visible with Prussian blue stain.
- Howell-Jolly Bodies: Indicative of functional hyposplenia (e.g., sickle cell disease) and asplenia; contain basophilic nuclear remnants usually removed by splenic macrophages.
- Basophilic Stippling: Associated with sideroblastic anemia and thalassemias; marked by basophilic ribosomal precipitates without iron content.
- Pappenheimer Bodies: Present in sideroblastic anemia; consist of basophilic granules that contain iron.
- Heinz Bodies: Associated with G6PD deficiency; these are denatured and precipitated hemoglobin visible with a supravital stain like crystal violet, removed by macrophages resulting in bite cells.
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Description
Explore the various types of red blood cell morphology and their associated pathologies. This quiz covers acanthocytes, echinocytes, and other RBC types, along with their clinical significance. Test your knowledge on how these morphological changes relate to different diseases.
