Abnormal Morphology Of Red Blood Cells PDF

ABNORMAL MORPHOLOGY OF RED BLOOD CELLS DR IZATUS SHIMA TAIB SCAN ME PLEASE…  LEARNING OBJECTIVES ◼ Morphology of Normal RBC ◼ Morphology of RBC - size ◼ Morphology of RBC – Hb content (colour) ◼ Types of poikilocytosis ◼ Inclusion bodies  NORMAL RBC ◼ round, elastic,...

ABNORMAL MORPHOLOGY OF RED BLOOD CELLS DR IZATUS SHIMA TAIB SCAN ME PLEASE…  LEARNING OBJECTIVES ◼ Morphology of Normal RBC ◼ Morphology of RBC - size ◼ Morphology of RBC – Hb content (colour) ◼ Types of poikilocytosis ◼ Inclusion bodies  NORMAL RBC ◼ round, elastic, non- nucleated, bi-concave discs ◼ have an area of central pallor (cover 1/3 of cells) - result of the disc-shaped. ◼ Normal mature red blood cells approximately the same size as the nucleus Average diameter of 7.2 of a small lymphocyte microns (range of 6-9 (guideline in determine the RBC size) on a slide. microns) IN DISEASE, ABNORMALITY OF RBC MORPHOLOGY IS DUE TO FOUR (4) MAIN CAUSES: 1. Abnormal erythropoiesis which may be effective or ineffective. 2. Inadequate Hb formation 3. Damage or changes affecting the red cells after leaving the BM 4. Attempts by the BM to compensate for anaemia by increased erythropoiesis.  ABNORMAL MORPHOLOGY OF RBC Abnormalities: 1. In size (anisocytosis). 2. The hemoglobin content (hypochromasia & anisochromasia). 3. In shape (poikilocytosis). 4. The presence of inclusion bodies in erythrocyte. SIZE VARIATION (ANISOCYTOSIS)  SIZE VARIATION (ANISOCYTOSIS) ◼ Microcytes – smaller than normal ◼ Macrocytes - larger than normal ◼ When red cells of normal size, microcytes and macrocytes are present in the same field, the term anisocytosis is used. NORMAL RBC SIZE (NORMOCYTIC) ◼ Size of normal RBC is almost the size of the nucleus of the lymphocyte. A) MICROCYTOSIS RBC Morphology: ◼ Decrease in the RBC size. ◼ (< ± 7µm) in diameter. ◼ MCV of less than 80 cubic microns. Found in: ◼ Iron deficiency anemia. ◼ Thalassemia. ◼ Sideroblastic anemia. TISLA ◼ Lead poisoning. ◼ Anemia of chronic disease. A) MICROCYTOSIS RBC Comment: ◼ Most erythrocytes presented in the picture are microcytes. The degree of hemoglobinization is sufficient. 1. microcyte 2. normocyte  MICROCYTOSIS (NORMAL CENTRAL PALLOR)  MICROCYTOSIS (INCREASED CENTRAL PALLOR) MICROCYTES B) MACROCYTOSIS RBC Morphology: ◼ Increase in the size of a red cell. ◼ > 9µm in diameter. MCV is 100 cubic microns or more. ◼ May be round or oval in shape. Found in: ◼ Folate and B12 deficiencies (oval) ◼ Ethanol (round) ◼ Liver disease (round) FELiR ◼ Reticulocytosis (round) C) ANISOCYTOSIS C) ANISOCYTOSIS HEMOGLOBIN CONTENT VARIATION (RBC COLOR)  HEMOGLOBIN CONTENT VARIATION (RBC COLOR) Erythrocytes, when spread on a glass slide, show varying degrees of central pallor. This central pallor is related to the hemoglobin concentration present in the red cells. A) HYPOCHROMASIA Morphology: Increase in the red cells' central pallor which occupies more than the normal third of the red cell diameter. Found in: IDA Thalassemia Any of the conditions leading to Microcytosis B) HYPERCHROMIC Morphology: Blue-gray stain – consequence uptake of both eosin (by hemoglobin) and basic dyes (by residual ribosomal RNA). Often slightly larger than normal red cells and round in shape - round macrocytosis. Found in: Any situation with reticulocytosis - for example bleeding, hemolysis or response to haemostatic factor replacement. NORMOCHROMIC POIKILOCYTOSIS 1-SPHEROCYTOSIS: Morphology: Red cells are more spherical. Lack the central area of pallor on a stained blood film. Found in: - Hereditary spherocytosis - Immune haemolytic anemia - Zieve's syndrome an acute metabolic condition that can occur during withdrawal from prolonged heavy alcohol use) - Microangiopathic haemolytic anemia 2-TARGET CELLS: Morphology: Red cells have an area of increased staining which appears in the area of central pallor. Found in: - Obstructive liver disease - Severe iron deficiency - Thalassemia - Haemoglobinopathies (S and C) - Post splenectomy 3- OVALOCYTES/ ELLIPTOCYTOSIS: Morphology: oval/ elliptical in shape. Found in: - Thalassaemia major. - Hereditary ovalocytosis. - Sickle cell anemia - Hereditary elliptocytosis - Megaloblastic anemia - IDA - Thalassaemia - Myelofibrosis (A bone marrow disorder in which excessive scar tissue forms in the bone marrow ) 4- TEAR DROP CELLS: Morphology: Red cells shaped like a tear drop or pear Found in: - Myelofibrosis - Megaloblastic anemia - IDA - Thalassaemia 5- BLISTER CELL: Morphology: Have eccentric hollow area. Found in: Microangiopathic hemolytic anemia 6- SCHISTOCYTOSIS: Morphology: Fragmentation of the red cells. Found in: -Disseminated intravascular coagulation (DIC) - Microangiopathic haemolytic anemia (MAHA) - Mechanical haemolytic anemia 7- STOMATOCYTOSIS: Morphology: Red cells with a central linear slit or stoma. Seen as mouth-shaped form in peripheral smear. Found in: - Alcohol excess - Alcoholic liver disease - Hereditary stomatocytosis - Hereditary spherocytosis 8- BURR (CRENATION ) CELL: Morphology: Red cell with uniformly spaced, pointed projections on their surface (Echinocytes) Found in: - hemolytic anemia - Uremia (A condition where there is abnormally high levels of waste products in the blood due to kidney failure.) - Megaloblastic anemia 9- KERATOCYTES (HORN CELL): Morphology: Part of the cell fuses back leaving two or three horn- like projections. The keratocyte is a fragile cell and remains in circulation for only a few hours. Found in: - Uraemia - Severe burns - EDTA artifact - Liver disease 10- ACANTHOCYTOSIS: Morphology: are red blood cells with irregularly spaced projections, these projections very in width but usually contain a rounded end Found in: - Liver disease - Post splenectomy - Anorexia nervosa and starvation 11- SICKLE CELLS: Morphology: Sickle shaped red cells Found in: Hb-S disease (Sickle cell anemia) 12- NUCLEATED RED BLOOD CELLS These red blood cells are released from the bone marrow early into the bloodstream, due to the need for oxygen. Normal red blood cells do not contain a nucleus on a peripheral smear. 13- ROULEAUX FORMATION: Morphology: Stacks of RBC's resembling a stack of coins. Found in: - Hyperfibrinogenaemia - Hyperglobulinaemia 14- RED CELL-AGGLUTINATION: Morphology: Irregular clumps of red cells Found in: - Cold agglutinins - Warm autoimmune hemolysis INCLUSION BODIES 1- HOWELL-JOLLY BODIES: Morphology: Small round cytoplasmic red cell inclusion with same staining characteristics as nuclei Found in: - Post splenectomy - Megaloblastic anemia 2- SIDEROTIC GRANULES (PAPPENHEIMER BODIES) Morphology: ◼ Anucleate erythrocytes with iron- containing (siderotic) cytoplasmic inclusions. ◼ Nucleated erythroid cell with the same inclusions is termed a sideroblast. ◼ Increased numbers may be seen in connection with abnormalities of heme synthesis. Found in: ◼ in drug intoxication (e.g. chloramphenicol), lead poisoning, vitamin B6 deficiency ◼ in dyserythropoiesis associated with neoplastic transformation (MDS/AML).  Left panel: Siderotic inclusions in a red cell in peripheral blood Right panel: Two sideroblasts, stained for iron with Prussian blue 3- BASOPHILIC STIPPLING: Morphology: Considerable numbers of small basophilic inclusions in red cells. Aggregation of ribosomal RNA in RBC cytoplasm Found in: - Thalassemia - Megaloblastic anemia - Hemolytic anemia - Liver disease - Lead poisoning. 4- HEINZ BODIES: ◼ Represent denatured hemoglobin (methemoglobin - Fe+++) within a cell. ◼ With a supravital stain like crystal violet, Heinz bodies appear as round blue precipitates. ◼ Presence of Heinz bodies indicates red cell injury and is usually associated with G6PD-deficiency. 5- CABOT RINGS: Reddish-blue threadlike rings in RBCs These are remnants of the nuclear membrane and appear as a ring or figure 8 pattern. Very rare finding in patients with Megaloblastic anemia, severe anemia's, lead poisoning, and dyserythropoiesis. 6- PARASITES OF RED CELL: are protozoan parasites which occur in many species of birds and are the cause of avian malaria. Transmitted by mosquitoes, infection with Plasmodium can be a cause of hemolytic anemia