8.1 RBC Morphology
8.1 RBC Morphology
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
▪ 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
▪ 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