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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