RBC Morphology

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Acanthocyte. A type of red blood cell characterized by its spiky surface. It is sporadically seen with severe liver disease or post-splenectomy. Also seen with rare disorder of abetalipoproteinemia.

What is anisocytosis?

Variation in size of RBC’s

What is this?

Babesiosis. Similar to ring forms of malaria

What are these cells exhibiting?

Basophilic stippling. Small aggregates of RNA are seen as small blue dots in the RBC. Fine stippling may be a feature of reticulocytes, whereas coarse stippling can appear with toxic marrow damage, myelodysplasia, and thalassemias.

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Elliptocytes. They are elongated, elliptical cells. They are non-specific when occasionally seen. Large presence of them can be seen in a rare disorder of hereditary elliptocytosis.

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Heinz body. Precipitated hemoglobin is seen as a perimembranous blue dot only after supravital staining. Seen with some hemoglobinopathies.

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Howell-Jolly body. Small, round deeply basophilic nuclear remnant. Seen when spleen is absent.

What are these cells exhibiting

Hypochromia. Cells with decreased MCH. Typical of iron deficiency.

What are these cells exhibiting?

Macrocytosis. These are cells with increased MCV, typical of megaloblastic anemias.

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Malaria. Plasmodium infection seen as “ring forms”, stippling, and gametocytes, depending upon the species.

What is this red cell exhibiting?

Microcytosis. Cells with decreased MCV, typical of iron deficiency anemia and thalassemias.

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Pappenheimer body. These exhibit multiple, tiny iron containing granular blue dots. They are seen when spleen is absent and with iron overload.

What is poikilocytosis?

Variation in shape of RBC’s

What is this cell exhibiting?

Polychromatophilia (polychromasia). This is the bluish tint seen in young RBC’s with high RNA content.

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Reticulocytes. Young RBC with increased RNA content that can be precipitated by supravital staining for identification and enumeration. Often stained with methylene blue.

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Roleaux. This is the linear aggregation of RBC’s that resembles a stack of coins. Seen when surface charge is reduced with increased serum protein, particularly increased fibrinogen or globulin.

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Sideroblast. This is a non-nucleated RBC with stainable iron.

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Spherocyte. Small, round dense cell without central pallor. Suggestive of extravascular (splenic) hemolysis in previously normal persons. With hereditary spherocytosis there is increased osmotic fragility.

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Schistocyte. Fragmented, irregularly shaped red cell, seen with intravascular hemolysis such as microangiopathic hemolytic anemias (DIC, TTP). A variant called a “helmet cell” appears cut in half.

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Drepanocytes (Sickle cells). Curved, banana-shaped cell with pointed ends found in sickle cell disease from aggregation of hemoglobin S.

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Stomatocyte. Cell with slit-like central pallor. Occasional stomatocytes are non-specific or an artefact. Many are seen with rare hereditary stomatocytosis.

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Target cells. Cells with central and peripheral staining with intervening pallor due to increased redundancy of RBC membrane. Seen with liver disease, in some thalassemias, and with hemoglobin C.

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Dacrocytes (tear drop cells). Cells pinched at one end, prominent in myelofibrosis and myelophthisic conditions.