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LABORATORY DIAGNOSIS RED BLOOD CELLS. PRONORMOBLAST  Size: 12-20 um  Nucleus: round; nucleoli (1-2); fine chromatin  Cytoplasm: dark blue  N/C.

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Presentation on theme: "LABORATORY DIAGNOSIS RED BLOOD CELLS. PRONORMOBLAST  Size: 12-20 um  Nucleus: round; nucleoli (1-2); fine chromatin  Cytoplasm: dark blue  N/C."— Presentation transcript:

1 LABORATORY DIAGNOSIS RED BLOOD CELLS

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4 PRONORMOBLAST  Size: um  Nucleus: round; nucleoli (1-2); fine chromatin  Cytoplasm: dark blue  N/C ratio: 8:1  Reference interval: BM: 1% BM: 1% PB: 0% PB: 0%

5 BASOPHILIC NORMOBLAST Size: um Nucleus: round; nucleoli 0-1; slightly condensed chromatin Cytoplasm: dark blue N/C ratio: 6:1 Reference interval: BM: 1-4% PB: 0%

6 POLYCHROMATIC NORMOBLAST Size: um Nucleus: round; nucleoli 0; quite condensed chromatin Cytoplasm: gray blue N/C ratio: 4:1 Reference interval: BM: 10-20% PB: 0%

7 ORTHOCHROMIC NORMOBLAST  Size : 8-10 um  Nucleus : round ; nucleoli = 0 ; fully condensed chromatin  Cytoplasm : blue to salmon  N/C ratio : 0.5:1  Reference interval : BM : 5-10% PB : 0%

8  Size : um  Nucleus : absent  Cytoplasm : blue to salmon  N/C ratio : NA  Reference interval : BM : 1% PB : 0.5% - 2% POLYCHROMATIC ERYTHROCYTE

9  Size : 7-8 um  Nucleus : absent  Cytoplasm : salmon  N/C ratio : NA  Reference interval : BM : NA PB : Predominant cell type ERYTHROCYTE

10  ASSOCIATED WITH: iron def. anemia, sideroblastic anemia, thalassemia minor, chronic disease (occasionally), lead poisoning, some hemoglobinopathies ERYTHROCYTE: VARIATIONS IN SIZE MICROCYTE

11  Normal erythrocytes are approximately the same size as the nucleus of a small lymphocyte ERYTHROCYTE: VARIATIONS IN SIZE NORMOCYTE

12  ASSOCIATED WITH: liver disease, vitamin B12 deficiency, folate deficiency, neonates ERYTHROCYTE: VARIATIONS IN SIZE MACROCYTES

13  ASSOCIATED WITH: transfusion, myelodysplastic syndromes, vit. B12, folate, or iron deficiencies – early in treatment process DIMORPHIC POPULATION OF ERYTHROCYTES

14  Normochromic erythrocytes HEMOGLOBIN CONTENT OF ERYTHROCYTES

15  ASSOCIATED WITH: iron deficiency anemia, thalassemias, sideroblastic anemia, lead poisoning, some cases of chronic disease HEMOGLOBIN CONTENT OF ERYTHROCYTES Hypochromia

16  ASSOCIATED WITH: acute and chronic hemorrhage, hemolysis, effective treatment for anemia, neonates HEMOGLOBIN CONTENT OF ERYTHROCYTES Polychromasia

17 VARIATIONS IN SHAPE AND COLOR Acanthocyte (Spur Cell) ASSOCIATED WITH: abetalipoproteinemia, severe liver disease, splenectomy, malabsorption, hypothyroidism, vit. E deficiency

18 VARIATIONS IN SHAPE AND COLOR Echinocytes (Burr Cell) ASSOCIATED WITH: uremia, pyruvate kinase def., microangiopathic hemolytic anemia, artifact

19 VARIATIONS IN SHAPE AND COLOR Spherocytes ASSOCIATED WITH: hereditary spherocytosis, some hemolytic anemias, transfused cells, severe burns

20 VARIATIONS IN SHAPE AND COLOR Codocyte (Target cell) ASSOCIATED WITH: hemoglobinopathies, thalassemia, iron deficiency anemia, splenectomy, obstructive liver disease

21 VARIATIONS IN SHAPE AND COLOR Drepanocyte (Sickle cell) ASSOCIATED WITH: Homozygous hemoglobin S disease

22 VARIATIONS IN SHAPE AND COLOR Stomatocyte ASSOCIATED WITH: Hereditary stomatocytosis, alcoholism, liver disease, Rh null phenotype, artifact

23 VARIATIONS IN SHAPE AND COLOR Elliptocytes ASSOCIATED WITH: Hereditary elliptocytosis or ovalocytosis, thalassemia major, iron deficiency anemia, megaloblastic anemias (macro ovalocytes), myelopthisic anemias Ovalocytes

24 VARIATIONS IN SHAPE AND COLOR Schizocyte (Schistocyte) ASSOCIATED WITH: Microangiopathic hemolytic anemia (DIC), severe burns, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, renal graft rejection

25 VARIATIONS IN SHAPE AND COLOR Dacryocyte (Tear Drop Cell) ASSOCIATED WITH: Myelofibrosis with myeloid metaplasia, thalassemias, myelophthisic anemias, other causes of extramedullary hematopoiesis

26 VARIATIONS IN SHAPE AND COLOR Rouleaux formation ASSOCIATED WITH: Increased concentrations of globulins and/or paraproteins

27 VARIATIONS IN SHAPE AND COLOR Autoagglutination ASSOCIATED WITH: Antigen/ antibody reactions

28 INCLUSIONS IN ERYTHROCYTES  Color : Dark blue to purple  Shape : round to oval  Size : 1 um  Number per cell : usually 1; maybe multiple  Composition : DNA  Associated with : Splenectomy, hyposplenism, megaloblastic anemia, hemolytic anemia Howell-Jolly bodies

29 INCLUSIONS IN ERYTHROCYTES  Color : Dark blue to purple  Shape : fine or coarse granules  Number per cell : numerous with fairly even distribution  Composition : RNA  Associated with : Lead intoxication, thalassemia, abnormal heme synthesis Basophilic stippling

30 INCLUSIONS IN ERYTHROCYTES  Color : light blue  Shape : fine irregular granules in clusters  Number per cell : usually one clusters; may be multiples. Often at periphery of cell  Composition : Iron  Associated with : Splenectomy, hemolytic anemia, sideroblastic anemia, megaloblastic anemia, hemoglobinopathies Pappenheimer bodies (Siderotic granules)

31 INCLUSIONS IN ERYTHROCYTES  Color : dark blue to purple  Shape : loop, ring, or figure of eight; may look like beads on a string  Number per cell : 1-2  Composition : thought to be remnants of mitotic spindle  Associated with : Myelodysplastic syndrome, megaloblastic anemia Cabot ring

32 INCLUSIONS IN ERYTHROCYTES  Stained with New Methylene Blue  Cell : anuclear immature erythrocytes  Composition : precipitated RNA  Number : ≥2/cell  Color : dark blue  Associated with: erythrocyte maturation Reticulocytes

33 INCLUSIONS IN ERYTHROCYTES  Stained with New Methylene Blue  Cell : mature RBC  Composition : precipitated hgb  Number : single or multiple, generally membrane bound  Color : dark blue to purple  Associated with: Unstable hgb, some hemoglobinopathies, some RBC enzyme deficiencies Heinz bodies

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35 DISEASES AFFECTING ERYTHROCYTES Iron Deficiency Anemia

36 DISEASES AFFECTING ERYTHROCYTES Thalassemia minor PB : microcytosis, slight hypochromia, codocytes, basophilic stippling

37 DISEASES AFFECTING ERYTHROCYTES Thalassemia major PB : numerous nucleated RBC’s, microcytes, hypochromia, codocytes, basophilic stippling, many dacyocytes, many schizocytes, polychromasia

38 DISEASES AFFECTING ERYTHROCYTES Macrocytic anemia (nonmegaloblastic type) PB : round macrocytes (MCV = 112 fl), leukocyte and platelet counts usually normal BM : no megaloblastic changes

39 DISEASES AFFECTING ERYTHROCYTES Megaloblastic anemia PB : pancytopenia, oval macrocytes, Howell-Jolly bodies, nucleated RBC’s, basophilic stippling, hypersegmentation of neutrophils, giant platelets, codocytes, schizocytes, spherocytes, dacrocytes

40 DISEASES AFFECTING ERYTHROCYTES Aplastic anemia PB : pancytopenia, normocytic, normochromic (occasional macrocytes) BM : hypocellular; lymphocytes may predominate

41 DISEASES AFFECTING ERYTHROCYTES PB : spherocytes, schizocytes, polychromasia, nucleated RBC’s Immune Hemolytic Anemia

42 DISEASES AFFECTING ERYTHROCYTES PB : increased number of nucleated erythrocytes, macrocytic/normochromic, polychromasia, spherocytes Hemolytic Disease of the Newborn

43 DISEASES AFFECTING ERYTHROCYTES PB : Spherocytes (variable in number), polychromasia; nucleated erythrocytes possible Hereditary Spherocytosis

44 DISEASES AFFECTING ERYTHROCYTES PB : >25% elliptocytes, usually >60% elliptocytes; indices are normocytic, normochromic Hereditary Elliptocytosis

45 DISEASES AFFECTING ERYTHROCYTES PB : Codocytes, spherocytes, microcytes, polychromasia, intracellular or rod-shaped crystals possible Hemoglobin CC disease

46 DISEASES AFFECTING ERYTHROCYTES PB : Drepanocytes (in crises), codocytes, nucleated rbc’s, schizocytes, Howell-Jolly bodies, basophilic stippling, polychromasia, increased leukocyte count with neutrophilia, increased platelet count Hemoglobin SS disease

47 DISEASES AFFECTING ERYTHROCYTES PB : Few sickle cells, codocytes, intraerythrocytic crystals. Crystalline aggregates of hemoglobin SC may protrude from the erythrocyte membrane Hemoglobin SC disease


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