HEMATOLOGY

POIKILOCYTES SECONDARY TO TRAUMA

❖ excessive physical trauma in the CVS

(cardiovascular)

➢ Abnormalities in the vascular system

● Dacrocytes

● Schistocytes

● Keratocytes

● Semilunar bodies

● Microspherocytes &

● Pyropoikilocytosis

SCHISTOCYTE (SCHIZOCYTES)

➢ Small size

➢ No definite shape

Causes of Red cell fragmentation:

1. Exposure of cells to abnormal conditions like heat

or mechanical trauma

➢ Happens usually at the heart ( those with

artificial heart valve)

2. Contact with fibrin strands or damaged

endothelium (MAHA; DIC)

➢ MAHA: Microangiopathic Hemolytic

Anemia

➢ DIC: Disseminated Intravascular

Coagulation)

● Simultaneous fibrinolysis and

coagulation.

a. Coagulation: Clotting

b. Fibrinolysis: Dissolution of clot

NOTE:

➢ If these two happen at the same time, there will be

formation of fibrin strands, if these strands tear

apart it will result in formation of fragments.

3. Intrinsic defects of the red cell

➢ Abnormalities in composition such as

carbohydrates and phospholipids.

HALLMARK OF HEMOLYTIC ANEMIA

➢ Helmet cells

➢ Triangular cells

➢ Keratocytes

DISEASE OF SCHISTOCYTES IS SEEN

1. prosthetic heart valve

2. microangiopathic hemolytic anemia

3. Disseminated intravascular coagulation

4. Thrombotic thrombocytopenic purpura (TTP)

5. Hemolytic uremic syndrome (HUS): A condition characterized by the triad of hemolytic anemia, acute renal failure, and thrombocytopenia. This syndrome is often triggered by infections, particularly those caused by certain strains of Escherichia coli, leading to severe complications if not treated promptly.

6. clostridial infection

   
   Clostridial infections

   ● Spore forming bacteria

   ● E.g clostridium botulinum

   ➢ Thrombotic thrombocytopenic purpura

   ● Platelets function is abnormal

   ➢ Hemolytic -uremic syndrome

   ● Caused by bacteria

   ● E.g shigella

   KERATOCYTES/HORNED CELL/BITE CELLS/DEGMACYTES

   ➢ with a pair of spicules or 'horns' surrounding a

   gap

   ● Removal of a Heinz body

   - Heinz body: denatured

   hemoglobin

   - Checked in the red pulp of the

   spleen

   - Double check if there is inclusions

   - Splenic spitting will happen

   which will lead to bite cells

   - Culling: whole cell is being killed

   ● Erythrocyte is caught on a fibrin strand.

   ● seen in Hemolytic anemias, G6PD

   deficiency

   - Maintenance of glutathione

SEMILUNAR BODIES

➢ Half-moon/crescent cells; large pale- pink staining

ghost of the RBC

➢ Malaria; other conditions causing overt hemolysis

(release of Hb content)

● Malaria : intraerythroparasite

TEARDROP CELLS/DACROCYTES

➢ Pear-shaped or teardrop-shaped/Racket-shaped

Due to squeezing & fragmentation during splenic

passage

● Abnormality in the composition: the RBC

become fragile

SEEN IN:

➢ Myelofibrosis w/ Myeloid Metaplasia

➢ Presence of inclusions

➢ Hypersplenism

➢ Myelophthisic anemia

➢ Pernicious anemia

➢ B-thalassemia

MICROSPHEROCYTES AND PYROPOIKILOCYTES

➢ MCV 60 fl

➢ Fragments at 45 deg (while a normal RBC

fragments at 49 deg

➢ Severe burns & hereditary pyropoikilocytosis

➢ associated blood group Rh HDN, ABO HDN

OTHER APPEARANCES RELATED WITH HEMOLYSIS

a. BLISTER CELLS

➢ With thinned portion

KNIZOCYTES

➢ Appear like “pinched bottle” ( especially

in the central pallor )

c. PYKNOCYTES

➢ Distorted red cells

Hb H INCLUSIONS

➢ Small greenish-blue inclusion bodies

➢ represent precipitated Hb H

➢ can be seen in early nucleated RBCs in the

bones marrow of patients with Hb H diisease

➢ composed of abnormal hemoglobin that results

from a deficiency in alpha-globin chains.

➢ GLOBIN CHAINS: 4 beta-globin chains