abnormal erythrocytes
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Abnormal ErythrocytesDr Jamil Mourad
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HypochromiaCorresponds to a very thin rim of Hgb and alarger center pale area.
These red cells are often microcytic and areseen in
iron deficiency,
thalassemias
sideroblastic anemia
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Microcytosis
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Macrocytosis>9 micrometers in diameter
Differential diagnosis includes
liver disease
alcoholism
aplastic anemia
myelodysplasia
Megaloblastic anemias (B12 and folatedeficiencies) have macro-ovalocytes (largeoval cells).
Reticulocytes are large immature red cellswith polychromatophilia.
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Schistocytesfragmented cells
Schistocytes are caused by
mechanical disruption of cells in themicrovasculature by fibrin strands or bymechanical prosthetic heart valves.
Differential diagnosis includes
TTP/HUS (Thrombotic Thrombocytopenic
Purpura - Hemolytic Uremic Syndrome) DIC
HELLP Syndrome ( H- hemolysis EL- elevated liverenzymes (liver function) LP- low platelets counts )
malignant hypertension
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Acanthocytesspeculated cells with irregular projections ofvarying length
These are often seen with liver disease.
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Crenated/Burr Cellscells with short, evenly spaced cytoplasmicprojections
Crenated cells may be
an artifact of slide preparation
or found in
renal failure
uremia
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Heinz bodies:inclusions seen only on staining with violetcrystal
Heinz bodies represent denatured Hgb
found in glucose-6-phosphatedehydrogenase after oxidative stress
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Bite Cellscells with a smooth semicircle extracted
Bite Cells are due to:
spleen phagocytes that have removed Heinzbodies consisting of denatured Hgb.
They are found in
hemolytic anemia due to glucose-6-phosphate dehydrogenase deficiency.
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Spherocytesround, dense cells with an absent centralpallor
Spherocytes are seen in
immune hemolytic anemia
hereditary spherocytosis.
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Sickle Cellssickle-shaped cells
Sickle cells are due to polymerization of Hgb S
This occurs from the substitution of a valinefor glutamic acid as the sixth amino acid of thebeta globin chain,
which produces a hemoglobin tetramer(alpha2/beta S2) that ispoorly soluble whendeoxygenated.
They are found in
sickle cell disease
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Target Cellscells with extra hemoglobin in the centersurrounded by a rim of pallor; bulls eyeappearance
Target cells are due to an increase in the ratioof cell membrane surface area to Hgb volume
within the cell.
They have a central spot of Hgb surroundedby a ring of pallor from the redundancy inthe cell membrane.
They are found in
liver disease,
post splenectomy,
in hemoglobinopathies.
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Teardropcells/dacryocytes
teardrop-shaped cells
These are found in
myelofibrosis
myelophthisic states of bone marrow
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Ovalocytes/Elliptocytes/ Cigarcellselliptical cells
Ovalocytes are due to abnormal membranecytoskeleton found in
hereditary elliptocytoisis.
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Polychromatophiliablue hue of cytoplasm
This is due to the presence of RNA andribosomes in reticulocytes.
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Howell-Jolly bodiessmall, single, purple cytoplasmic inclusions
These represent nuclear remnant DNA andare found after
Splenectomy
with functional asplenism
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Basophilic StipplingDark-purple inclusions, usually multiple
Basophilic stippling arises from precipitatedRNA found in
lead poisoning
thalassemia
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Nucleated red cells:These are not normally found in theperipheral blood.
They appear in
hypoxemia
myelofibrosis
Other myelophthisic conditions
sever hemolysis
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ParasitesA variety of parasites, including malaria,trepanozoma, and babesiosis, may be seenwith red blood cells
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Rouleauxred cell aggregates resembling a stack ofcoins
Rouleaux is due to the loss of normalelectrostatic charge-repelling red cells due tocoating with abnormal paraprotein,
Which is present in multiple myeloma.
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