MLAB 1415: Hematology Keri Brophy-Martinez Anemia Part Four

Agglutination Irregular clumps of RBCs from antigen-antibody reactions See in cold hemagglutinin disease and paroxysmal nocturnal hemoglobinuria(PNH) Reported as “RBC agglutination noted” 2

Agglutination Use of saline will not disperse clumps; however, warming specimen helps to break clumps up. MCHC usually falsely elevated. 3

Rouleaux Appears as a stack of coins Use of saline disperses formation of stacks Correlates well with elevated sedimentation rate. 4

Rouleaux Caused by increased or abnormal plasma proteins Result of protein deposits on the erythrocyte membrane Seen in patients with multiple myeloma, Waldenstrom's macroglobulinemia, and chronic inflammatory disease. 5

RBC Inclusions 6

Howell-Jolly Bodies Are nuclear remnants containing DNA. Are 1-2um in size and appear singly around periphery of red cell membrane. Develop during periods of accelerated or abnormal erythropoiesis. 7

Howell-Jolly Bodies Spleen usually removes them; however, during times of erythroid stress, spleen cannot keep up with formation of inclusions. Seen following splenectomy, in thalassemia, hemolytic anemias, and in megaloblastic anemias. 8

Basophilic Stippling Contain aggregated ribosomes Stippling may be the result of the RBCs drying on the blood smear. May be seen in lead poisoning, defective or accelerated heme synthesis and thalassemia. 9

Basophilic Stippling May be classified as three forms: ◦ Diffuse or fine - looks like fine blue dusting. ◦ Coarse - dots are larger and more easily defined. ◦ Punctate - coalescing of smaller forms. Very prominent and easily defined.

Siderotic Granules and Pappenheimer Bodies Siderotic granules are small, irregular, magenta inclusions seen along the periphery of the cell membrane. Appear in clusters. Prussian blue stain required for confirmation

Siderotic Granules and Pappenheimer Bodies Causes of: ◦ Sideroblastic anemias ◦ Any condition leading to hemochromatosis. ◦ Hemoglobinopathies ◦ Post-splenectomy patients.

Heinz Bodies Formed as result of denaturation or precipitation of hemoglobin. Are large inclusions that are rigid and severely distort cell. Supravital stains used to visualize ◦ I.E. Crystal violet, brillant cresyl blue Causes of: ◦ Alpha thalassemias ◦ Glucose-6-phosphate deficiency (G6PD) ◦ Any of unstable hemoglobin syndromes. ◦ Red cell injury from chemicals.

Cabot Rings Found in heavily stippled cells Appear in figure- eight configuration Causes of: ◦ Megaloblastic anemias ◦ Homozygous thalassemias ◦ Post-splenectomy.

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Sideroblasts/Siderocytes Sideroblasts ◦ Nucleated erythrocyte that has stainable iron granules Siderocytes ◦ Non-nucleated erythrocyte containing iron granules Must use Prussian blue stain to identify S iderocyte

References Harmening, D. M. (2009). Clinical Hematology and Fundamentals of Hemostasis. Philadelphia: F.A Davis. McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology. Upper Saddle River: Pearson Education, Inc. disorders/ disorders/ cope/stomatocyte.htm cope/stomatocyte.htm

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