RBC Disorders

Part-1

Acanthocyte is seen in:

Abetalipoproteinemia

Severe Liver Disease

Echinocyte Cell is seen in:

Uremia, Artifact
(Alkaline, Glass Effect)

Echinocyte Cell is also called:

Burr Cell

Elliptocyte is seen in:

Hereditary Elliptocytosis, Iron Deficiency, Thalassemia

Macroovalocyte is seen in:

Megaloblastic Anemia

Helmet (Keratocyte) is seen in:

Hemolytic Processes

Schistocyte (RBC Fragment) is seen in:

DIC

Hemolytic Processes

Sickle Cell (Drepanocyte)

Hb SS

Spherocyte is seen in:

Hereditary Spherocytosis

(Elevated MCHC, ABO, HDN)

Other Hemolytic Processes

Stomatocyte (Mouth Cell) is seen in:

Hereditary Stomatocytosis

Liver Disease

Target Cell (Codocyte) is seen in:

Liver Disease

Hb C

Thalassemias

Other Hemoglobinopathies

Teardrop Cell (Dacryocyte) is seen in:

Extramedullary Hematopoeisis

Thalassemias

Pernicious Anemia

HDN means:

Hemolytic Disease of the Newborn

DIC means:

Disseminated Intravascular Coagulation

Howell-Jolly Body is composed of:

DNA

Basophilic Stippling is composed of:

RNA

Pappenheimer Bodies Siderotic Granules (Siderocyte) is composed of:

Iron

Heinz Body is composed of:

Denatured Precipitated Hemoglobin

Cabot Ring is composed of:

Remnants of Mitotic Spindle

Parasites is composed of:

Malaria

Babesia

Trypanosomes

Howell-Jolly Body is stained with:

Wright New Methylene Blue

Basophilic Stippling is stained with:

Wright New Methylene Blue

Pappenheimer Bodies Siderotic Granules (Siderocyte) is stained with:

Wright Confirm with Prussian Blue

Heinz Bodies is stained with:

Supravital Stain

(Brilliant Cresyl Blue or New Methylene Blue)

Not seen with Wright stain

Cabot Ring is stained with:

Wright

Parasites is stained with:

Wright

What stain is used for Cabot Rings and Parasites?

Wright

Indications of Howell-Jolly Body

Disturbed Erythropoeisis

Hemolytic Anemias

Megaloblastic Anemias

Post-Splenectomy

Indications of Basophilic Stippling

Thalassemia

Lead Poisoning

Indications of Pappenheimer Bodies Siderotic Granules (siderocyte):

Sideroblastic Anemia

Hemoglobinopathies

Indications of Heinz Body:

G6PD Deficiency

Thalassemia

Unstable Hemoglobins

Indications of Cabot Ring:

Megaloblastic Anemia

Indications of Parasites:

Parasitic Infection

What is Anisocytosis?

Increased number of red cells with size variations

Normal RBCs:

7-8um (seen when MCV is 80-100fL)

What are Macrocytes?

Larger than normal RBCs

MCV is >100fL

Associated with impaired DNA synthesis

What are Microcytes?

Smaller than normal RBCs

MCV is <80fL

Associated with defective hemoglobin formation

Four ways to detect Anisocytosis:

Using the nucleus of a small lymphocyte in a peripheral blood smear (PBS)

Using the MCV value

Using the RDW value

Using the RBC histogram

What is the 1st way to detect Anisocytosis?

Using the nucleus of a small lymphocyte in a peripheral blood smear (PBS)

1. Macrocytes: RBCs larger than the nucleus of the small lymphocyte

2. Microcytes: RBCs smaller than the nucleus of the small lymphocyte

What is the 2nd way to detect Anisocytosis?

Using the MCV value

1. Average volume of individual RBCs

2. Formula: MCV = (Hematocrit/RBC count) 10

3. Cases: 

   1. Low MCV : Microcytes 

   2. Normal MCV : Normocyte 

   3. High MCV : Macrocyte 

What is the Reference Range of using the MCV Value?

80-100fL

What is the 3rd way to detect Anisocytosis?

Using the RDW value

• Measures the degree of anisocytosis

• Red Cell Distribution Width

• Reference range:

  • Adults: 11.5% to 14.5%

  • Newborns: .14.2% to 19.9%

What is the Reference Range for RDW Value?

• Adults: 11.5% to 14.5%

• Newborns: .14.2% to 19.9% 

Intravascular Hemolysis is also known as?

Fragmentation Hemolysis

Lab Findings of Intravascular Hemolysis in Urine

Increased Urobilinogen

Hemoglobinuria

Prussian Blue reaction

Lab Findings of Intravascular Hemolysis in Serum

Increased Total Bilirubin

Increased B1

Normal B2

Decreased Haptoglobin

Decreased Hemopexin

Lab Findings of Intravascular Hemolysis in Peripheral Blood Smear

Schistocytes

Extravascular Hemolysis is also known as?

Macrophage-mediated hemolysis

Lab Findings of Extravascular Hemolysis in Urine

Increased Urobilinogen

Lab Findings of Extravascular Hemolysis in Serum

Increased Total Bilirubin

Increased B1

Normal B2

Lab Findings of Extravascular Hemolysis in Peripheral Blood Smear

Spherocytes

Normal Hemolysis

RBCs live approximately 120 days

Intravascular hemolysis only happens when:

• RBCs are mechanically damaged 

• Complement-mediated lysis occurs 

• Severe membrane defects are present

Three Erythrocyte Indices

Mean Cell Volume (MCV)

Mean Cell Hemoglobin (MCH)

Mean Cell Hemoglobin Concentration (MCHC)

What is MCV?

Mean Cell Volume
Average volume of an individual RBC

What is MCH?

Mean Cell Hemoglobin

Average weight or amount of hemoglobin in an individual RBC

What is MCHC?

Mean Cell Hemoglobin Concentration

Average amount or mean concentration of hemoglobin in the average RBCs

Formula for MCV

MCV = (Hematocrit / RBC count) x10

Formula for MCH

MCH = (Hemoglobin / RBC count) x10

Formula for MCHC

MCHC = (Hemoglobin / Hematocrit) x10

Reference Range for MCV

80-100 femtoliters

Reference Range for MCH

26-32 picograms

Reference Range for MCHC

31 to 37 g/dL or %

Decreased MCV means

microcytic

Normal MCV means

normocytic

Increased MCV

Macrocytic

Decreased MCHC means

hypochromic

Normal MCHC means

normochromic

Increased MCHC means

hyperchromic

What causes false increased hemoglobin?

Normal MCV, Increased MCH

What is the Rule of Three

Used for checking validity of test results

Works only on normocytic, normochromic specimens

• RBC count x3 = Hemoglobin

• Hemoglobin x3 = Hematocrit

Condition if Normal RDW and Decreased MCV

Anemia of Chronic Disease (ACD)

Condition if Anisocytosis and Decreased MCV

Iron Deficiency Anemia (IDA)

Condition if Normal RDW and Normal MCV

G6PD Deficiency

Condition if Increased RDW and Normal MCV

Sickle Cell Anemia

Condition if Increased MCV and Normal RDW

Liver Disease

Condition if Increased MCV and Increased RDW

Megaloblastic Anemia