Hematology Exam 1: Poikilocytes, Distributions, Inclusions, Parasites, Crystals

Spherocytes

- Ball with no pallor

- Decreased SA/Volume ratio (loss of biconcavity)

- Increase in MCHC

- Etiologies: Hereditary spherocytosis, autoimmune hemolytic anemia, burns \

Ovalocytes

- oval/cigar shaped

- contains central pallor

- decrease in membrane cholesterol and/or spectrin

- cells cannot reform into binconcave erythrocytes

-Etiology: hereditary ovalocytosiselliptocytosis

Target Cells

- Bull's eye shape w dark central pallor

- Sombrero

- increase cholesterol/phospholipids

- decreased Hgb

- Increased SA/Volume ratio

-Etiologies: Hemoglobinopathies, Thalassemia (3-4+ cells), Liver disease (1-2+ cells)

Burr cells

-short/wavy projections

-multitude of diseases

- Uremia (3-4+ cells)

- Look similar to crenated RBCs, however, crenated cells are due to lab (H2O or heparin)

Acanthocytes

- Spherical RBCs with uneven spiny projections

- Increased cholesterol

- Decreased lecithin

- Etiologies: Abetalipoproteinemia (3-4+), Liver disease (2-3+), Retinitis pigmentosa (1-2+)

Schistocytes (1-4+)

-RBC fragments

- Both small and large fragments make up schistocytes

- Shape is due to loss of cell membrane

- Etiologies: Hemolytic, uremia, DIC, Heart valve problem, burns (2-3+)

Tear Drop Cells

- Tear drop shaped

- RBCs pushed through bone marrow fibrosis

- Etiology: Primary myelofibrosis (2-3+)

Sickle Cells

- Shaped like sickle/crescent moon

- Low O2 > HbS polymerizing > sickle cells

- Diagnostic for: HbS

Stomatocytes

- Characterized by slit in central pallor ( concavity in 1 direction)

- Shaped like a bowl

- Defective stomatin & Na+/K+ pumps -> swelling of cell

- Etiologies:

Hereditary Stomatocytosis (3-4+)

Liver Disease (1-2+)

Alcoholism

Rouleaux (1-4+)

- RBCs are stacked like rolls of coins (think grapes)

- increase plasma proteins > sticking at RBCs > neutrlizing of sialic acid > stacking of RBCs

- Etiologies:

Multiple myeloma

Waldenstrom's

Agglutination

- RBCs clump due to antibodies

- Etiologies: Cold agglutinin syndrome

Either: Warm autoimmune hemolytic anemia OR cold autoimmune hemolytic anemia

Basophilic Stippling

- Multiple, course bluish granules

- Hgb synthesis defect > RNA, ribosomes, mitochondria (within blue granules)

- Etiologies:

Lead poisoning (2-3+)

Howell-Jolly Bodies

- 'belly button'

- Larger, round blue/purple spheres

- Residual DNA isnt expelled after RBC maturation

- Etiologies

Hemolytics anemia (2-3+)

Splenectomy (2-3+)

Megaloblastic anemia

Thalassemia

Siderotic granules

- Single/multiple greenish-blue iron granules

-Prussian blue stained iron granules

- Etiology: Sideroblastic anemia

- From impaired Hgb synthesis

Siderocyte

- RBC with NO nucleus w prussian blue stained iron granules

Sideroblast

- RBC with a nucleus w prussian blue stained iron granules

Heinz Bodies

- Round/oval bodies in VITAL STAINS

-NOT SEEN IN WRIGHT'S STAIN

-Etiologies: (3-4+)

G6PD deficiency

unstable Hgb

Thalassemias

Cabot Rings

- Fine red/violet ring structure

- Arg - rich histones w iron (rare occurence)

- Etiologies: megaloblsstic anemias, metal poisoning

Malaria

-Malaria transmitted by mosquitoes

- Trophozoite: IDs for malaria

reddish/purple signet ring

-Schizont: reddish/purple clumps

Gametocyte: shaped like a banana

Babesia

- Transmitted by ticks

- Forms trophozoite, similar to malaria

Hemoglobin C crystals

-Intracellular red rod-shaped crystals

- Beta chain mutation -> OxyHbC -> crystals

*Diagnostic for HbC

Hemoglobin SC Crystals

- Crystals are irregular shaped

- Partially HbS and partially HbC

* Diagnostic for HbSC

- Child of person with traits for HbS and HbC

Water Damage

- Due to lab error

- Stain must be changed

-Appears moth-eaten