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8.1 RBC Morphology

This document describes the morphologic evaluation of red blood cells (RBCs). It discusses normal RBC distribution, color, size, and shape as well as abnormalities including hypochromia, anisocytosis, poikilocytosis, schistocytes, and inclusions like Howell-Jolly bodies. RBC morphology provides information about various anemias and other hematologic conditions.

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Chelsea Pialago
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100% found this document useful (1 vote)
205 views5 pages

8.1 RBC Morphology

This document describes the morphologic evaluation of red blood cells (RBCs). It discusses normal RBC distribution, color, size, and shape as well as abnormalities including hypochromia, anisocytosis, poikilocytosis, schistocytes, and inclusions like Howell-Jolly bodies. RBC morphology provides information about various anemias and other hematologic conditions.

Uploaded by

Chelsea Pialago
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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MORPHOLOGIC EVALUATION OF RBCs ▪ Hypochromic

o Decreased Hgb content


Normal Distribution in Peripheral Smears
o Central pallor is more than 1/3 of the
▪ Thin portion cell
o Even distribution of RBCs o Usually associated with microcytic
o Red cells should be slightly separated cells
from one another or barely touching
without overlapping
o Should represent at least 1/3 of the
entire film
o Area where RBC morphology must be
examined
▪ Feather end
o Irregular RBC distribution with
artifactual shapes, color, and size
distributions ▪ Hyperchromic
o Do not use this for RBC morph o Increased Hgb content
evaluation o No central pallor
▪ Thick portion o Usually associated with macrocytic
o RBCs overlap or lie on top of one cells
another
o Unsuitable for evaluation

Abnormal Distribution

▪ Rouleaux formation
o Alignment of RBCs upon one another
o “stacks of coins” – linear arrangement
o Cause: elevated plasma fibrinogen or
globulins ▪ Anisochromia
o Characteristic of multiple myeloma o Variation in Hb content
and hyperproteinemia o Presence of both hypochromic and
▪ Agglutination normochromic cells
o Clumping of red cells o Characteristic of sideroblastic anemias
o Common cause: cold agglutinins

Color

Intensity of color and size of the central pallor reflects


the amount of Hgb, as measure by MHC (Mean
Corpuscular Hgb) and MCHC (Mean Corpuscular Hgb
Concentration)

▪ Normochromic
o Normal Hgb content
▪ Polychromatophilia
o Central pallor does not exceed more
o Blue-gray tint to the RBCs that
than one third, 1/3, of the cell
signifies presence of residual RNA
indicating that it is a young red cell
that has been in the blood for 1-2
days
o Young red cells, larger than mature
red cells, lack a central pallor, and
appear basophilic on Wright’s stain
▪ Called reticulocytes when
stained supravitally with
brilliant cresyl blue

▪ Anisocytosis
o Variation in RBC size
o Correlated with RBC Distribution
Width (RDW)
▪ Normal Value: 11.6-14.6%
o Feature of most anemias

Size

Diameter of a normal red cell varies slightly; mean of


7-8 um (resembles the size of the nucleus of a
lymphocyte)
Shape
Average thickness: 2.5 um
A normal red cell is a biconcave disc and has been
Defined by Mean Corpuscular Volume (MCV) named a discocyte
Normal Value: 80-100 fL (Normocytic) Normal RBCs appear as circular, homogenous disks
▪ Microcytic ▪ Poikilocytosis
o Decrease in size of RBC o Variation in RBC shape
o Decreased MCV (<80 fL)
o Normal or decreased Hb content
o Characteristic of Iron Deficiency
Anemia (IDA)

▪ Secondary to membrane abnormalities


o Spherocyte
o Ovalocyte and elliptocyte
o Target cell/codocyte (kodon: bell)
o
▪ Macrocytic o Burr cell and crenated cell/echinocyte
o Diameter that exceeds 8.5-9.0 um (echinos: sea urchin)
o MCV: >100 fL o Acanthocyte (acantho: thorn or spike)
o Megaloblastic anemia, alcoholism, o Stomatocyte (stoma: mouth)
etc. ▪ Secondary to trauma
o Schistocyte (schizo: split)
o Blister cell
o Keratocyte (keras: horn)
o Teardrop cell/dacryocyte (dakry: tear)
▪ Secondary to abnormal hemoglobin
o Sickle cell/drepanocyte (drepane:
sickle)
▪ Elliptocytes and Ovalocytes
o Red cells that have an elliptical or oval
shape; ranges from egg-shaped or
slightly oval to sausage, rod or pencil
forms ▪ Schistocytes
o Seen in normal person’s blood but o Indicate the presence of hemolysis
account for less than 10% of the cells o Results when RBC undergoes
o Most abundant in hereditary fragmentation as it passes through
elliptocytosis altered vessels
o Include helmet keratocytes (horn
cells), triangular shape
o Seen in severe burns, MAHA
(microangiopathic hemolytic anemia)

▪ Spherocytes
o Nearly spherical erythrocytes
o Diameter is smaller than normal; lack
a central pale area
o Found in hereditary spherocytosis ▪ Acanthocytes
(HS) and in some cases of o Irregularly spiculated red cells in
autoimmune hemolytic anemia (AHA) which the ends of the spicules are
bulbous and rounded
o Commonly seen in
abetalipoproteinemia or certain liver
diseases

▪ Target Cells/Codocytes
o RBC with a thin membrane, peripheral
rim of Hb and dark, central, Hb-
containing area
o Frequently seen in Hb C disease,
thalassemia, liver disease
▪ Burr cells/Echinocytes
o Regularly contracted cells with sharp
ends
o May occur as an artifact during film
preparation or as the result of
hyperosmolarity or decreased
adenosine triphosphate

Inclusions

▪ Howell-Jolly Bodies
o Smooth, round remnants of nuclear
chromatin
o Stain reddish-blue to blue-black with
Wright’s stain
▪ Stomatocyte o Appears singly in a cell and is <1 um in
o Elongated, slit-like area of central diameter; however, 2 or more may be
pallor noted in a cell in severe anemias and
o Seen in alcoholism, cirrhosis, alcoholism
obstructive liver disease, Rh null o Megaloblastic anemia, hemolytic
disease anemia, after splenectomy

▪ Dacryocyte/Teardrop Cells
o Pear-shaped with a blunt pointed ▪ Basophilic Stippling
projection o Fine or coarse, deep blue to purple
o Myelofibrosis, thalassemia, etc. staining inclusion that represent
aggregates of ribosomes that appear
during the drying and staining of films
o Smaller than Howell-Jolly bodies
o Usually irregularly shaped

▪ Sickle Cells/Drepanocyte
o RBCs deformed by rod-like structures
of polymerized Hb S
o Thin and elongated RBCs with pointed
ends
▪ Curved, S, V or L shaped o Fine stippling
o Sickle cell anemia ▪ Commonly seen in increased
polychromatophilia
o Coarse stippling
▪ Seen in lead poisoning and in
megaloblastic anemia
▪ Pappenheimer bodies
o Small, irregular, dark-staining granules
located near the periphery
o If it contains iron = SIDEROCYTE
(stained with Prussian blue)
o Hyposplenism, sideroblastic anemia,
thalassemia ▪ Protozoan inclusions
o Malaria
o Babesia

▪ Heinz Bodies
o Round, refractile inclusions not visible ▪ Nucleated Red Cells
on a Wright-stained film; best o Present normally only in the blood of
identified by supravital staining the fetus of very young infants
(crystal violet, methylene blue or o In the healthy adult, they are confined
brilliant cresyl blue; red arrow) to the bone marrow and appear in the
o Represents denatured Hb circulating blood only in disease, in
o Pitted out by spleen = BITE CELL (blue which their presence usually denotes
arrow) an extreme demand made on the
o Seen in G6PD deficiency marrow, extramedullary
hematopoiesis or marrow
replacement
o May be mistaken as lymphocyte
▪ To identify: cytoplasm has the
same color as a normal red
cell; nucleus is also compact &
condensed

▪ Cabot rings
o Thin, ring-like structures; appear at
the cell periphery or it may form a Artifacts
figure of 8
o Stains reddish-blue to violet with ▪ Precipitation of dye granules
Wright’s stain ▪ Refractile artifacts
o Its origin is still unclear but may ▪ Codocytes in some areas but not others
represent a part of the mitotic ▪ Solid cells and elongated cells at the sides and
spindle, remnant of microtubules or a end on film
fragment of the nuclear membrane ▪ All cells crenated in thin portion of film
o Megaloblastic anemia, lead poisoning ▪ Schistocytes may result form wiping
▪ Doughnut appearance
▪ Particles of fat
▪ Detergent

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