MLS 332 Unit 2 Part 3 Erythrocyte Abnormalities

Microcytic RBC

small RBC

<80 fL

smaller than a small lymphocyte 

–Mean Corpuscular Volume (MCV)

•80-100 fL

•Correlates to size of the RBCs on a blood smear

• How big does the cell look on the size

–Mean corpuscular hemoglobin (MCH)

•28-34 pg - weight

• average amount of hemoglobin in a RBC

–Mean corpuscular hemoglobin concentration (MCHC)

•32-36 g/dL

•Correlates to hemoglobination on a blood smear

• Measures the concentration of hemoglobin in a given volume of packed red blood cells.

Poikilocytes

Change in Shape of RBC

Anisocytosis 

–Variation in sizes of RBCs

–Correlates with RDW

• Red blood cell Distribution Width

*Do the Cells look uniform

Normocytic RBC

normal size

(80-100 fL)

The same size as a small lymphocyte 

Macrocytic RBC

large RBC

(>100 fL)

Bigger than small lymphocyte 

Hypochromic RBC

pale RBC (more white than pink)

The central pallor is the white part greater than one-third of the cell diameter.

Normochromic RBC

normal color (1/3 central pallor and 2/3 red part )

Spherocytic RBC

darker than usual (little or no central pallor)

Loss of cell membrane so a smaller surface area to the same amount of volume from a normal RBC 

Acanthocyte Alternative Name

spur cell

Acanthocyte Description

Red cells with spicules of varying length irregularly distributed over the surface; no central pallor

Acanthocyte Mechanism of Formation

Excess distribution of cholesterol in outer layer of membrane

Acanthocyte Associated Diseases

Abetalipoproteinemia, alcoholic liver disease, disorders of lipid metabolism, post-splenectomy - need to know yellow

Codocyte Alternative Name

target cell

Codocyte Description

Thin and bell-shaped; on stained blood smears, appears as a target with a central bull's-eye, surrounded by a white zone and outer ring of hemoglobin

Codocyte Mechanism of Formation

Increased surface area-to-volume ratio

Codocyte Associated Diseases

Hemoglobinopathies, thalassemias, obstructive liver disease, iron deficiency anemia, splenectomy, renal disease, LCAT deficiency

Dacryocyte Alternative Name

Teardrop

Dacryocyte Description

Round cell with a single, elongated or pointed extremity; may be microcytic and/or hypochromic

Dacryocyte Mechanism of Formation

Result of prolonged squeezing through a small space (e.g., spleen or fibrous bone marrow) - is stretched out to far

Dacryocyte Associated Diseases

Myelophthisic anemias, primary myelofibrosis (PMF), thalassemias, iron deficiency anemia

Drepanocyte Alternative Name

sickle cell - Is inherited and comes from the polymerization of Hemoglobin S

Drepanocyte Description

Contain polymerized hemoglobin showing various shapes; sickle-, crescent-, or boat-shaped

Drepanocyte Mechanism of Formation

Polymerization of hemoglobin S into rods stretches the cell and increased fragility

Drepanocyte Associated Diseases

Sickle cell disorders (Sickle Cell Anemia) is only inherited and needs to have hemoglobin S

Echinocyte Alternative Name

spur cell

Echinocyte Description

Spiculated red cells with short, equally-spaced projections over the entire surface

Echinocyte Mechanism of Formation

Increased area of the outer layer of membrane in comparison to the inner layer

Echinocyte Associated Diseases

Liver disease, uremia, pyruvate kinase deficiency, peptic ulcers, stomach cancers, heparin therapy

Elliptocyte Alternative Name

cigar cell

Elliptocyte Description

Elongated ellipsoid cell with parallel sides, and some have an area of central pallor, and some don’t, and hemoglobin at both ends

Elliptocyte Mechanism of Formation

Unknown; thought to be alterations in the membrane skeleton

Elliptocyte Associated Diseases

Hereditary elliptocytosis, iron deficiency anemia, thalassemia, anemia of chronic disease

Oval Macrocyte Description

Slightly elongated macrocytic RBC; width is not continuous

• Has to be bigger in size

• Has to be oval shaped

Oval Macrocyte Mechanism of Formation

Abnormal maturation and nuclear/cytoplasmic in the bone marrow asynchrony of developing bone marrow cells

Oval Macrocyte Associated Disease

Megaloblastic anemias

Schistocyte (fragment) Description

pieces of red cells; variety of shapes including triangles, commas

Schistocyte (fragment) Mechanism of Formation

mechanical damage to RBC

*The fragment is torn off and sealed back together

Schistocyte (fragment) Associated Diseases

Hemolytic anemias, intravascular hemolysis, and severe burns

Schistocyte (bite cell) Description

RBC with one or two “bites” taken from it

Schistocyte (bite cell) Mechanism of Formation

splenic pitting - because macrophages take a bite out

Schistocyte (bite cell) Associated Disease

G6PD deficiency so the red cell will build oxidized hemoglobin so a clump forms and macrophages bit the oxidized part out 

Schistocyte (keratocyte) Description

"helmet cell"

Schistocyte (keratocyte) Mechanism of Formation

impalement of RBC on fibrin strand

Schistocyte (keratocyte) Associated Diseases

hemolytic anemias and glomerulonephritis

Spherocyte Description

Spherocytic red cells with dense hemoglobin content; complete lack of central pallor

Spherocyte Mechanism of Formation

Decreased surface area-to-volume ratio

Spherocyte Associated Diseases

Hereditary spherocytosis, immune hemolytic anemias, severe burns

Stomatocyte Alternative Name

Mouth Cell - Uniconcave or cupshaped RBC; on stained smear has an oval or slit-shaped central pallor

Stomatocyte Mechanism of Formation

Increased lipid content or area of the inner layer of cell membrane as compared to outer layer

Stomatocyte Associated Diseases

Hereditary stomatocytosis, lead poisoning, often artifact and stumble open it by chance 

Basophilic Stippling Description

Round or irregularly shaped granules of variable number and size, distributed throughout the RBC

• If you need to squint to see it than it not their

Basophilic Stippling Composition

Aggregates of ribosomes(RNA) and mitochondira

Basophilic Stippling Associated Diseases

Lead poisoning, thalassemia, anemias associated with abnormal hemoglobin synthesis (SIDEROBLASTIC ANEMIA)

Cabot Ring Description

Appear as a figure-8, ring, or incomplete ring. (very rare)

Cabot Ring Composition

Remnant microtubules of the mitotic spindle

Cabot Ring Associated Diseases

Severe anemias and dyserythropoiesis

Howell-Jolly Bodies Description

Small, dark purple, round bodies located in the periphery of the cell; usually occur singly

*All Inclusion are in Red

Howell-Jolly Body Composition

DNA inclusion

Howell-Jolly Body Associated Diseases

Post-splenectomy, megaloblastic anemias, functional asplenia, and severe anemia

Heinz Body Description

Bluish-purple round-shaped bodies of varying sizes, usually near cell membrane

(can't see on normal stain)

ONLY VISIBLE ON A SUPRAVITAL STAIN, NOT WRIGHT’S STAIN

Heinz Body Composition

Denatured, precipitated hemoglobin that forms within red blood cells, often associated with oxidative stress

Heinz Bodies Associated Diseases

G6PD-deficiency, unstable hemoglobin disoders, oxidizing drugs/toxins, post-splenectomy 

Pappenheimer Body Description

Grape-like clusters of bluish/purple aggregates, usually found in the periphery of the cell

Pappenheimer Body Composition

Iron and Protein

Pappenheimer Bodies Associated Diseases

Sideroblastic anemia, thalassemia, other severe anemias (sickle cell anemia)

Hemoglobin C Crystal Description

dark red, hexagonal "crystals" within RBCs made out of hemoglobin C 

Hemoglobin C Crystal Mechanism of Action

Intracellular crystallization of hgb C

Hemoglobin C Crystal Associated Diseases

Hemoglobin C disease is Inherited

Agglutination Description

Rosette-like clusters of RBCs throughout the peripheral blood smear

Agglutination Mechanism of Formation

Caused by antigen/antibody interactions between sensitized red blood cells

Agglutination Associated Diseases

Autoimmune Anemias

Rouleaux Description

RBCs stacked together in rows, appearing as a "stack of coins"

Rouleaux Mechanism of Action

Excess plasma proteins cause RBCs to be "sticky"

Rouleaux Associated Diseases

Multiple myeloma or other disorders associated with increased globulins/paraproteins

Babesia Description

ring-like organsims seen BOTH intracellularly and extracellularly

Malaria Description

ring-like organisms found only intracellularly, as well as in different stages 

Polychromasia Description

Immature red blood cells that lack a nucleus but are larger in size than a mature red blood cell and have a purplish color

*the purplish color is picking up residual RNA up Azure B in Wright Stain )

Polychromasia Mechanism of Action

Bone marrow releases red blood cell precursor earlier than is normal

Polychromasia Associated Diseases

Various anemias, normal newborn

Nucleated Red Blood Cell (nRBC) Description

An immature stage of the erythrocyte that still has a nucleus. Normally not found in the peripheral blood of a healthy adult.

Nucleated Red Blood Cell (nRBC) Mechanism of Formation

Bone marrow releases red blood cell precursor earlier than is normal

Nucleated Red Blood Cell (nRBC) Associated Diseases

Various anemias and normal newborn