Hemoglobinopathies, Poikilocytosis, RBC inclusions

Hb SC disease

Double heterozygous condition where an abnormal sickle gene from one parent and abnormal C gene form the other parent is inherited

Echinocytes (Burr cells)

Type of cells seen in:

• Liver disease

• Uremia

• Heparin therapy

• Pyruvate kinase deficiency or as an artifact.

Caused by changes in osmotic pressure

Moth-eaten look

Water or drying artifacts can give what type of appearance to RBCs?

Acanthocytes

Type of cells caused by excessive cholesterol in the membrane

• Associated with:

  • Alcoholic liver disease

  • Post-splenectomy

  • Abetalipoproteinemia

Target cells

Type of cells that show central areas of hemoglobin surrounded by a colorless ring and a peripheral ring of hemoglobin; have an increased surface-to-volume ratio

• Seen in:

  • Liver disease

  • Hemoglobinopathies

  • Thalassemia

  • Iron deficiency anemia

Spherocytes

Disk-shaped cells with a smaller volume than a normal erythrocyte

• Cells have a decreased surface to volume ratio

• Lack of a central pallor area

Pyropoikilocytes

Type of cells frequently seen in burns

Dacrocytes

Pear-shaped cells with one blunt projection

• Seen in megaloblastic anemia, thalassemias, and extramedullary hematopoiesis (myelofibrosis, myelophthisic anemia)

Helmet cells

Type of cells seen in microangiopathic hemolytic anemias (MAHA)

Schistocytes

Damaged RBC; fragments of various sizes and shapes are present, often with pointed projections

• Seen in microangiopathic hemolytic anemia (MAHA)

• Thermal injury

• Renal transplant rejection

• G6PD deficiency

Stomatocytes

Type of cells characterized by an elongated or slit-like area of central pallor

• Seen in liver disease, hereditary stomatocytosis or as artifact

• Caused by osmotic changes due to cation imbalance (Na+, K+)

Elliptocytes

Cigar to egg-shaped erythrocytes associated with defects of the red cell membrane proteins

Nucleated RBCs

RBC inclusion that is usually an orthochromatic normoblast but can appear in any erythropoeitic stage of maturation

• Indicates bone marrow stimulation or increased erythropoiesis

Howell-Jolly Bodies

Small round DNA fragments seen in sickle cell anemia, beta thalassemia major and other severe hemolytic anemias, megaloblastic anemia, alcoholism, and post-splenectomy

Basophilic Stippling

Multiple, tiny, fine and coarse inclusions evenly dispersed thoughout the cell

• It has a “blueberry bagel” appearance

Pappenheimer Bodies

Small, irregular, dark staining, iron granules usually clumped together at periphery of the cell

• Caused by an accumulation of ribosomes, mitochondria, and iron fragments

Cabot rings

Thin- red-violet, single to multiple ring-like structures that may appear in loop of figure-eight shapes

• Seen in megaloblastic anemia, myelodysplastic syndromes, lead poisoning

Heinz bodies

Degraded hemoglobin usually seen in G6PD deficiency