Red Cell Morphology Grading Chart

• 1+ = 1-5 per field

• 2+ = 6-10 per field

• 3+ = >10 per field

polychromatophilia

• 1+ = 1-5 per field

• 2+ = 6-10 per field

• 3+ = >10 per field

Helmet cells (helmet-shaped schistocytes)

• 1+ = 1-5 per field

• 2+ = 6-10 per field

• 3+ = >10 per field

dacryocytes / tearrdrop cell

• 1+ = 1-5 per field

• 2+ = 6-10 per field

• 3+ = >10 per field

acanthocytes / thorn / spurr cell

• 1+ = 1-5 per field

• 2+ = 6-10 per field

• 3+ = >10 per field

schistocytes / fragment RBCs

• 1+ = 1-5 per field

• 2+ = 6-10 per field

• 3+ = >10 per field

spherocytes

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

poikilocytosis

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

ovalocytes

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

elliptocytes

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

burr cell / echinocyte

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

bizarre shaped RBCs

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

target cells / codocytes / mexican hat cell / greek helmet cell / leptocytes , bull’s eye cell / platycyte

• 1+ = 3-10 per field

• 2+ = 11-20 per field

• 3+ = >20 per field

stomatocyte / mouth cell

• 1+ = aggregates of 3-4 RBCs

• 2+ = aggregates of 5-10 RBCs

• 3+ = many aggregates w/ only few RBCs

rouleaux formation (pseudoagglutination / stacking of coins RBC aggregates)

serum protein abnormality (increased globulin or fibrinogen)

cause/s of rouleaux formation

Multiple myeloma → now Plasma Cell myeloma

rouleaux formation may be observed in

thick part; overlapping

rouleaux formation may be wrongly reported if examined at the ___ of the smear; because RBCs are ____

whenever present = POSITIVE

sickle cells

whenever present = POSITIVE

basophilic stippling

whenever present = POSITIVE

pappenheimer bodies

whenever present = POSITIVE

Howell-Jolly bodies

0

normal appearance or slight variation in erythrocytes

1+

only a small population of erythrocytes displays a particular abnormality

1+

equivalent descriptive term = slightly increased or few

2+

more than occasional numbers of abnormal erythrocytes can be seen in microscopic field

2+

equivalent descriptive term = moderately increased

3+

severe increase in abnormal erythrocytes in each microscopic field

3+

equivalent descriptive term = many

4+

most severe state of erythrocytic abnormality—abnormality prevalent throughout each microscopic field

4+

equivalent descriptive term = marked or marked increase