Quiz sobre Stomatocytes e Acanthocytes

Evaluation of Red Cell Morphology & Introduction to Platelets & White Cell Morphology

• This chapter covers the evaluation of red blood cell (RBC), platelet, and white blood cell (WBC) morphology.
• Objectives: The objectives include discussions about hematology stains, identifying normal RBC morphology, defining anisocytosis and poikilocytosis, and correlating RBC indices with morphology.
• Peripheral Blood Smear: A peripheral blood smear is used to detect abnormalities in blood cells. The purpose is to detect or confirm abnormalities and provide information for a differential diagnosis.
• Hematology Stains: Wright's stain, a nonvital polychrome stain, is commonly used Peripheral blood smears. It contains methylene blue (basic dye), eosin (acidic dye), and methanol fixative. Staining only begins when a phosphate buffer (with a pH between 6.4 and 6.8) is added.
• Nonvital Monochrome Stain: Perl's test (Prussian blue stain) is an example, used to visualize iron granules in red blood cells (RBCs).
• Supravital Monochrome Stain: Used to stain specific parts of living cells, without fixation. New methylene blue and neutral red are used to stain specific cellular components.
• Examination of Blood Smear: Various stages are used in the examination of a blood smear. This includes a low power scan (10x), high power scan (40x), and oil immersion examination (100x). Each stage has unique objectives.

Hematology Stain Types

• Nonvital (dead cell) polychrome stain (Romanowsky):
• Most common stain used for routine peripheral blood smears.
• Nonvital monochrome stain:
• Stains specific cellular components. Prussian blue (Perl's Test) is an example.
• Supravital (living cell) monochrome stain:
• Used to stain cellular components without fixing.

Examination of Blood Smear Stages

• Low Power Scan (10x): Determine staining quality, blood cell distribution, and locate areas with clumps or abnormal cells. Identify the optimal area for examination and enumeration.
• High Power Scan (40x): Determine WBC estimate, counting WBCs in 10 fields—averaged to per mm³.
• Oil Immersion Examination (100x): Perform 100 WBC differential count. Evaluate RBCs, including anisocytosis, poikilocytosis, hypochromia, polychromasia, and inclusions. Perform platelet estimates.

Assessment Question

• A 19-year-old male patient presented with joint pain, fever, fatigue, and cough. Laboratory results included: WBC 21.0 x 10⁹/L, RBC 3.23 x 10¹²/L, Hb 9.6 g/dL, and PLT 252 x 10⁹/L. A differential count indicated: 17 band neutrophils; 75 segmented neutrophils; 5 lymphocytes; 2 monocytes; 1 eosinophil; and 26 NRBCs.

Normal Red Blood Cells (RBCs)

• RBC dimensions: 6-8 µm x 1.5-2 µm.
• Volume: 80-100 fL.
• Central pallor: 2-3µm.
• Size variation in normal patients: ~5%.
• Appearance on Wright-stained film: reddish-orange, biconcave disc shape.

Assessment of Red Cell Abnormality

• When checking for abnormal RBC morphology, consider whether the abnormality is seen in every field. Assess size (anisocytosis) and shape (poikilocytosis).
• Consider the red blood cell indices and RDW.
• Take into account the percentage of abnormal cells in 10 fields of vision.

Variations in Red Cell Distribution & Agglutination

• Normal distribution: cells are dispersed.
• Agglutination: In the patient's plasma with cold agglutinins occurs, as well as in cold hemoglobinuria, etc., RBCs appear in stacks. Saline does not disperse.

Variations in RBC Size, Anisocytosis and Macrocytes

• Size: ≥9 µm.
• MCV: >100 fL
• Mechanism of macrocytosis: Impaired DNA synthesis, accelerated erythropoiesis, and increased membrane cholesterol & lecithin.
• Evaluation points: shape (round vs. oval), pallor, and presence of inclusions.

Variations in RBC Size, Microcytes and Ovalocytosis

• Size: <7µm; MCV=<80fL
• Mechanism: Impaired Hb synthesis (ineffective iron utilization, decreased or defctive globin synthesis).
• Characteristics: Shape (round or oval), pallor, presence of inclusions.

Variations in RBC Shape, Polychromasia, Poikilocytosis

• Evaluation of red blood cell shape and inclusions, and how these help determine the presence of abnormal conditions.

Variations in RBC Shape, Sickle Cells (Drepanocytes)

• Rigid, inflexible cells formed by Hb polymerization.
• Varying shapes, most are reversible.
• Irreversible cells are 10% with a pointed projection.
• Not seen in heterozygote subjects.
• Are seen in HbS disease or HbC, Harlem disease, or thalassemias.

Variations in RBC Shape, Fragmented Cells (Schistocytes, Helmet Cells, Keratocytes)

• Mechanism: Alterations in normal fluid circulation (vasculitis, prosthetic heart valves), intrinsic defects of RBCs (spherocytes, antibody-mediated RBC destruction).
• Types include schistocytes, helmet cells, and keratocytes.

Variations in RBC Shape, Acanthocytes (Thorn Cells, Spur Cells)

• Normal or reduced size, 3-12 spiky projections.
• Increase in cholesterol and decreased phospholipid ratio.
• Found in certain conditions, including congenital abetalipoproteinemia and LCAT deficiency.

Variations in RBC Shape, Tear Drop Cells (Dacrocytes)

• Pear-shaped cells.
• Mechanism of formation is unclear. Associated with certain illnesses, like multiple myeloma, idiopathic myelofibrosis, myeloid metaplasia, IDA, and thalassemia.

RBC Inclusions, Howell-Jolly Bodies

• Irregular dark purple or black cytoplasmic inclusions.
• Represent nuclear remnants.
• Seen in megaloblastic anemia, thalassemia, hemolytic anemias, splenectomy, and hyposplenia.

RBC Inclusions, Basophilic Stippling

• Multiple tiny, fine, or coarse inclusions in the rRNA and ribosome remnants.
• Seen in conditions like poisoning, burns, chemotherapy, and certain anemias such as thalassemia, megaloblastic anemia, and sideroblastic anemia.

RBC Inclusions, Siderotic Granules (Pappenheimer Bodies)

• Small, irregular clusters along the peripheral part of RBCs.
• Composed of non-heme iron.
• Seen in conditions like sideroblastic anemia, hemochromatosis, hemosiderosis, sickle cell anemia, and following splenectomy.

RBC Inclusions, Heinz Bodies (Unstable Hbs)

• Denatured hemoglobin.
• Appear as small, round, reddish-purple inclusions.
• Seen in G6PD deficiency, thalassemia, and unstable hemoglobin disorders.

RBC Inclusions, Cabot Rings

• Round to ring-shaped inclusions.
• Represent remnants of the mitotic spindle.
• Seen in megaloblastic anemia and thalassemia or it can be seen following splenectomy

RBC Inclusions, Hb H bodies

• Denatured hemoglobin in a-thalassemia major.
• Have golf ball appearance with supravital stain (not visible with Giemsa-Wright stain).

RBC Inclusions, Hb SC

• Hemoglobin SC crystals; fingerlike projection.
• Occur when Hemoglobin SC is present.

RBC Inclusions, Hemoglobin C Crystals

• Condensed, rod-shaped intracellular crystals, present in hemoglobin C or SC disease.

Platelet Morphology

• Size: 2-4µm.
• Shape: Discoid.
• MPV (mean platelet volume): 6.8-10.2 fL
• Platelet granules: Fine blue granules scattered throughout the cytoplasm.
• Morphological changes after splenectomy.

Examination of Platelet Morphology II

• Increased platelet count in myeloproliferative disorders (MPD).
• Platelets of various sizes (anisocytosis).
• Platelets with or showing loss of granules (agranular or hypogranular).

Examination of Platelet Morphology III & IV

• Characteristic morphologies: Bernard-Soulier syndrome (giant platelets), grey platelet syndrome (agranular platelets).
• Platelet clumps: EDTA as a possible cause.

Examination of Platelets & White Blood Cell (WBC) Morphology.

• Normal and abnormal platelet counts

Leucocytes: Normal and Abnormal Morphology

• Morphology of normal cells.
• Eosinophils: 12-16 µm; bilobed nucleus; bright red-orange granules.
• Basophils: 10-15 µm; bilobed nucleus; dark purple granules.
• Monocytes: 12-20 µm; horseshoe or kidney-bean shaped nucleus; gray/blue cytoplasm.
• Lymphocytes: 6-9 µm round nucleus; scant cytoplasm; light purple/bluish granules.

Toxic Granulation

• Dark blue-black cytoplasmic granules in neutrophils.
• Associated with acute infections, drug poisoning, burns, vasculitis, or toxemia of pregnancy.

Dohle Bodies

• Small light blue cytoplasmic inclusions.
• Associated with infections, poisoning, burns, or chemotherapy.

Hypersegmented Neutrophils

• Neutrophils with 5 or more lobes.
• Seen in megaloblastic anemia, inherited anomalies, chronic infections.

Pelger-Huet Anomaly

• Inherited condition, neutrophils nuclei do not segment properly, with two lobes.

Chediak-Higashi Syndrome

• Inherited, rare, fatal disorder in children.
• Neutrophils and other leukocytes contain large, reddish-purple granules.
• Associated with anemia, neutropenia, and thrombocytopenia.

Alder-Reilly Anomaly

• Heavy, densely stained azurophilic granules in neutrophils.

May-Hegglin Anomaly

• Inherited disorder characterized by Dohle body-like inclusions in neutrophils and giant platelets. Associated with thrombocytopenia.

Auer Rods

• Rod-like cytoplasmic inclusions; reddish-purple.
• Seen in acute myeloblastic leukemia (AML).

Vacuolated Neutrophils

• Clear unstained areas in cytoplasm, often associated with active phagocytosis, infections, burns, etc.

Smudge or Basket Cells

• Disintegrating WBCs; condensed, structureless nuclear chromatin.

Hypogranular or Agranular Neutrophils

• Fewer/no granules in neutrophils.
• Seen in some myelodysplastic syndromes (MDS) and myeloid leukemias.

LE Cells

• Neutrophil engulfing a nucleus of another neutrophil.
• Seen in systemic lupus erythematosus (SLE).

Barr Bodies (Drum Stick)

• Small, round chromatin projection attached to a neutrophil nucleus.
• Represents the inactive X-chromosome in females.

Erythrophagocytosis

• Neutrophils and/or monocytes have engulfed red blood cells (RBCs).
• A positive direct antiglobulin test (DAT) often accompanies the condition.
• Common in cases with polyagglutinable blood components

Effect of Storage on Blood Cell Morphology

• Storage can cause granular changes in some leukocytes and effect RBC shape and appearance.

Conclusion

• Information regarding abnormal hemoglobin and variations in red blood cell and platelet morphology.
• Relevant data is gathered for different cells of the blood and their related diseases.

Este quiz explora condiciones medicales relacionadas a células sanguinee, incluyendo stomatocytes e acanthocytes. Respond le perguntas que examina le characteristics e le conditiones associato con iste tipos de cellulas. Amplia tu cognoscentia in hematologia e le implicasiones clinicos de iste phenomena.