Lecture Lesson 6: Red Blood Cell Abnormalities PDF

HEMATOLOGY 1 (LECTURE) Macrocytic - Non-nucleated, biconcave disc-like cell - > 100 fL - 6-8 microns in diameter - The cells did not get smaller as they matu...

HEMATOLOGY 1 (LECTURE) Macrocytic - Non-nucleated, biconcave disc-like cell - > 100 fL - 6-8 microns in diameter - The cells did not get smaller as they mature - normocytic and normochromic - Cells did not mature accordingly - Central area of pallor (1/3): gives the cell an - Most likely associated because of nutritional extra surface area deficiency within the RBCs - In order for red cells to survive in the circulation, - Usually associated with liver diseases and they must megaloblastic states o Have a healthy cell membrane that is o Megaloblastic states do not only affect made up of proteins, lipids, and the RBCs. It also affects cells that require carbohydrates B12 or folic acid for DNA metabolism o Be deformable so that they can easily let go of oxygen and enter the vessels COLOR o Have enough hemoglobin inside - Hemoglobin primarily gives color to the red cells o Have a balance in between the - Associated with MCH (mean cell hemoglobin) intracellular and extracellular and MCHC (mean cell hemoglobin environment of the red cell concentration) o Have enough nutrients that will supply - Anisochromia – any variation in red cell color RBCs with energy, particularly glucose affecting its hemoglobin that enters the red cells through Embden-Meyerhof Pathway Normochromic - MCH and MCHC are both normal Nutritional Requirements o MCH: 27-32 pg  CHON and amino acids o MCHC: 32-36%  Vit B12, folic acid, Vit. B6 - Has normal structure of red cell  Fe++  Riboflavin, panthotenic acid, nicotinic acid Hypochromic or Hypochromia - pale red blood cells - Low hemoglobin - Has > 1/3 pallor area SIZE - Microcytic - 6-8 um in diameter - Associated with IDA, thalassemia, anemia of - Volume of the cell is directly proportional to their chronic disease, sideroblastic anemia, and size myelodysplastic anemia - Associated with MCV (mean cell volume) - Anisocytosis – any variation in red cell size Hypochromasia Grading GRADE DESCRIPTION Normocytic 1+ Central pallor is one half of cell diameter 2+ Central pallor is two thirds of cell diameter - 80-100 fL 3+ Central pallor is three fourths of cell diameter - Normal in structure 4+ Thin rim of hemoglobin - There are certain diseases that still shows normal RBCs Hyperchromic or Hyperchromia - Problem is more related to quantity - Does not have pallor area - Examples: - Purely red cell o aplastic anemia – low bone marrow cell - Susceptible to hemolysis production - Does not mean that the red cell has excess o hemolytic anemia – red cells that are hemoglobin not yet lysed; size is still normal o bleeding – there is a decrease of red cells because of bleeding Polychromasia - variation in hemoglobin content showing a slight Microcytic blue tinge (wright stain), gray-blue and larger than normal; residual RNA - < 80 fL - normally present in the blood - Smaller in size - referring to reticulocytes - The decrease production or content of - associated with hemolytic anemia if there is too hemoglobin within the RBCs much polychromatic red cells in the blood - Examples: o Thalassemia – the body doesn’t make enough hemoglobin Polychromasia Grading GRADE % POLYCHROMATIC RED CELLS o iron deficiency anemia Slight 1% o anemia of chronic disease 1+ 3% o sideroblastic anemia – protoporphyrin 2+ 5% IX is absent 3+ 10% 4+ > 11%  HEMATOLOGY 1 (LECTURE) SHAPE o Can be caused by improper drying of - Shape: round and discoid in shape blood smears - Poikilocytosis – any variation in red cell shape o Also called as Burr’s cells in patients with kidney diseases Poikilocytes secondary to Developmental Macrocytosis  Oval Macrocytes o Elongated and the diameter is wide o Markedly increased MCV (>125 fL) o Red cells did not mature properly o Megaloblastic erythropoiesis o No central area of pallor o Megaloblastic anemia o There could be bipolar arrangement of hemoglobin in cases of ovalocytosis o Seen in:  Codocytes  Folic acid deficiency o Also known as target cells or Mexican  Vitamin B12 deficiency hat cell  Pernicious anemia o There is a peripheral rim of hemoglobin  Round Hypochromic Macrocyte surrounded by a clear space in a central o Seen in: hemoglobinized area  Alcoholism o There is an excess surface membrane to  Hypothyroidism volume ratio  Liver disease o Can be associated with an increase  Blue-tinged Macrocyte cholesterol and phospholipids in the cell o Seen in: membrane  Neonate response to anemic o There is an imbalance in the distribution stress of hemoglobin within the RBCs  Response to anemic stress o Target cells are always seen in cases of thalassemia Poikilocytes secondary to Membrane Abormalities o These cells are also present in cases of  Acanthocytes liver diseases and iron deficiency anemia o Also known as thorn cell or spur cell o A spheroid with irregular spikes o Can be form because of abnormal lipids or abnormal ratio of lecithin and sphingomyelin within the red cell membrane o Doesn’t have pallor area (susceptible to lysis) o Can be seen in the presence of hemolytic  Spherocytes anemia, alcoholism, hepatitis, o Hyperchromic red cells malabsorption state, or in the case of o Ball-shaped RBCs abetalipoproteinemia (lack of LDL) o Has low surface area to volume ratio  LDL transports cholesterol from among spherocytes, making them liver to tissues susceptible to hemolysis o Usually seen in patients with spherocytosis, hereditary spherocytosis, hemolytic anemia, autoimmune hemolytic anemia, or burned patients o Sometimes, it is seen in a blood bag that has been stored for quite a long period of time o Caused by antigen-antibody reaction o Spherocytes are formed because of a deficiency in the RBCs peripheral proteins, particularly spectrin  Echinocytes o Also known as sea-urchin cells o Crenated RBCs o Spikes are evenly distributed and the projections are short o Form when RBCs is exposed to hypertonic solution or the cells do not have enough energy  HEMATOLOGY 1 (LECTURE) o Sometimes encountered when the patient is burned o Keratocytes – schistocyte with horn-like projections  Stomatocytes o Also known as mouth cells or bowl- shaped cells o Caused by an increased permeability of  Dacryocyte cell membrane to sodium o Sometimes shortened as dacrocytes o “crying cell” o Seen in patients who are alcoholic, have o Has tear-drop appearance liver diseases, liver cirrhosis, and in cases o Formed because of the squeezing and of Rh null conditions (persons who don’t fragmentation of RBCs when they pass posses Rh antigens on their red cells) the spleen  Results when cells successfully passed through the spleen o Present when a person has myeloid dysplasia (the marrow keeps on producing abnormal cells)  Elliptocytes o Elongated with narrow diameter o Rod or cigar-shaped cells o The defect is in the peripheral protein of the RBC, particularly deficient in protein band 4.1 o Seen in cases of elliptocytosis, iron Poikilocytes secondary to Abnormal Hb Content deficiency anemia, and thalassemia  Drepanocytes o Also known as sickle cell o Has leaf-like or crescent-shaped cell appearance o Formed because of the polymerization of abnormal hemoglobin S Poikilocytes secondary to Trauma  Schistocytes o Red cells are split o Fragmentations are produced, especially if it is within the blood vessel wall o Results when RBCs bumped into clots, Other Poikilocytes damaged vessels, or prosthesis.  Blister Cell o The presence of these cells is associated o Also known as helmet cells with a condition called o Also formed because of a trauma in the microangiopathic hemolytic anemia red cells (cells are lysed because of the problem o Precursor cells before turning to within the blood vessel) Schistocytes, they will first be blister cell  HEMATOLOGY 1 (LECTURE)  Basophilic Stipplings – evidence of precipitation of ribosomes and RNA due to heavy metal poisoning within the erythropoietic cells o D-ALA is affected because of heavy metal poisoning  D-ALA helps in the formation of heme  If D-ALA is affected, problem in heme synthesis may occur  Degmacyte o Accumulation of ribosomes and RNA o Also known as bite cell within the cell o Looks like a bitten piece of donut  Ribosomes and RNA help in the o Formed because of Heinz bodies caused formation of globin by oxidative stress o Has a donut appearance with blueberry  G6PD deficiency on top o Spleen will try to remove the Heinz o 2 types of basophilic stipplings bodies in the red cells, but it will leave a  Fine: precipitation of too much permanent mark on the cell RNA that is usually associated with polychromasia  Coarse: problems with hemoglobin synthesis, especially in cases of lead poisoning  Cabot Ring – because of improper development of cells, microtubules and mitotic spindle remains in the cell o Fragments of nuclear material  Slight: less than 5%  Moderate: 5-15%  Marked: more than 15% Particular variation:  Occasional: 10%  Heinz Bodies – formed because of oxidative stress o Golf ball-like appearance Formed because of an abnormal development of RBCs o Defect in the pentose-phosphate (improper or incomplete development and maturation) pathway or deficiency with G6PD,  Howell-Jolly bodies – small round fragments of resulting to the increase susceptibility of nucleus, resulting from karyorrhexis (when red cell to oxidative cell nucleus is excluded) o Supravital stain is used to easily recover o Staining techniques is performed to Heinz bodies confirm the remnants of nucleus o Feulgen stain – most specific stain and reaction for Howell-jolly bodies  HEMATOLOGY 1 (LECTURE)  Ringed sideroblast – an immature cells, there is an accumulation of iron deposits o sidero means “iron” o present in cases of lead poisoning and porphyria (porphyrin IX synthesis is not enough) o Prussian blue (Perl’s stain) is used to confirm the presence of iron  Pappenheimer bodies – basophilic inclusions that aggregates in clusters near the periphery  Hemoglobin H inclusion – represents the o Formed because of the accumulation of precipitation of abnormal hemoglobin H ribosomes, mitochondria, and unused o Form of alpha thalassemia accompanied iron by hemolysis o Formed because of abnormalities within the globin chain o Supravital stain is used to easily recover HbH inclusions  Microorganisms o malaria  Hb CC crystals – presence of hexagonal hemoglobin with blunt ends and stained dark o Formed because of the precipitation of hemoglobin C crystals  Hb SC crystals – combination of abnormal hemoglobin S and C  HEMATOLOGY 1 (LECTURE) MORPHOLOGY GRADE Polychromatophilia 1+ = 1-5/field Helmet cell, Dacrocyte 2+ = 6-10/field Spherocyte, Acanthocyte 3+ = >10/field Schistocyte Poikilocytosis 1+ = 3-10/field Codocyte, Burr cell 2+ = 11-20/field Stomatocyte, Ovalocyte 3+= >20/field Elliptocyte Rouleaux 1+ = 3-4 aggregates 2+ = 5-10 aggregates 3+ = numerous aggregates Sickle cells POSITIVE only Basophilic stippling Pappenheimer bodies Howell- Jolly o Babesia  has Maltese cross formation  thick-borne  Sometimes mistaken as malaria  Agglutination o Can still be reported o Because of antibodies (can be cold agglutinins, hemolytic anemia, or pneumonia)  Rouleaux – stack of coins o Can be an evidence of increase protein in the blood o Too much antibody is present o Commonly seen in multiple myeloma o Adding drops of NSS can separate and disperse the RBCs