Summary of Abnormal Red Blood Cell Morphologies and Disease States

  • Before we start with the abnormal morphologies, let’s talk about normal morphology of Red Blood Cells.
  • Normal mature RBC are biconcave, round discs that are about 6 – 8 in diameter, which is only slightly smaller than the normal small mature lymphocytes ( about 6 – 10 in diameter).
  • The term used to indicate red blood cells of normal size and shape is normocytic. The term used to indicate a normal color or central pallor (i.e., normal hemoglobin content) is normochromic
Normocytic and Normochromic RBC

Normocytic and Normochromic RBC


Hypochromic: Erythrocytes that demonstrate a central pale area that becomes larger and paler as the hemoglobin content diminishes.

  • Iron Deficiency
  • Sideroblastic Anaemia
  • Thalassaemia
Hypochromic RBC

Hypochromic RBC


Anisochromic: indicates the presence of both normochromic and Hypochromic

Anisochromic (Normochromic plus Hypochromic)

Anisochromic (Normochromic plus Hypochromic)


Polychromasia: Changeable terms used to indicate the increased presence of non-nucleated immature erythrocytes (Polychromatophilic erythrocytes) that contain residual RNA which gives a blue-gray tint to the red cells. These cells, which remain after ejection of the nucleus from the orthochromatic erythroblast are slightly larger than mature erythrocytes. After exposure to a supravital stain, the cytoplasm organelles of these cells clump into an easily recognized blue-staining reticulum and the cells is called a reticulocytes.

Polychromasia

Polychromasia


Anisocytosis:  is a “generic” term used to indicate variation in shape of erythrocytes (e.g. oval, pear-shaped, teardrop-shaped, saddle-shaped, helmet-shaped, sickle-shaped, and irregularly shaped).

Anisocytosis

Anisocytosis


Microcytosis: abnormally small erythrocytes (i.e., less than 6 in diameter). compare with the size for small lymphocyte.

  • Found with Hypochromic
Microcytosis

Microcytosis


Macrocytosis: abnormally large erythrocytes (i.e., less than 8 in diameter).

  • Megaloblastic Anaemia
  • High reticulocytes count
  • Liver disease
  • Myelodysplastic syndrome
Macrocytosis

Macrocytosis


Target Cells (Codocytes): erythrocytes that are thinner than normal which show a peripheral rim of hemoglobin with a dark central hemoglobin-containing area. A pale unstained ring containing less hemoglobin separates the central and peripheral zones and gives the cell a target appearance.

  • Liver Disease
  • Hemoglobinopathies
  • Thalassaemia
  • Sideroblastic anemia
Target Cells

Target Cells


Spherocytes: are nearly spherical erythrocytes which are nearly spherical erythrocytes which usually have a diameter smaller than normal. They lack the central pale area due to their spherical shape.

  • Hemolytic anemia
  • Post transfusion
  • Hereditary sphercocytosis
Spherocytes

Spherocytes


Tear-Drop Cells:

  • Severe Anaemia
  • Myloproliferative disorders
Teardrop cells (dacrocytes)

Teardrop cells (dacrocytes)


Elliptocytes and Ovalocytes: are interchangeable terms used to indicate ovalshaped erythrocytes.

  • Hereditary elliptocytosis
  • Iron-deficiency anaemia
  • Thalassaemia
Elliptocytes

Elliptocytes


Stomatocytes:

  • Acute alcoholism
  • Malignancies
Stomatocytes

Stomatocytes


Helmet Cells:

  • G6PD deficiency
  • Pulmonary emboli
Helmet Cells

Helmet Cells

Helmet Cells (Keratocytes)

Helmet Cells (Keratocytes)


Schistocytes: are fragmented red cell segments that are the result of some hemolytic process. These segments can be a variety of shapes but helmet cells and triangularly-shaped cells are particularly characteristic.

  • Disseminated intra-vascular coagulopathy (DIC)
  • Thrombotic Thrombocytopenia purpura (TTP)
  • Hemolytic uremic syndrome (HUS)
Schistocytes

Schistocytes


Sickle cells (drepanocyes): are interchangeable terms used to indicate sickle-like forms of erythrocytes (crescent-shaped, irregular spines, filaments, holly-leaf appearance) noted when RBC containing HbS are subjected to reduction in oxygen tension or pH.

  • Sickle cell anaemia
  • Sickle thalassaemia
Sickle Cells

Sickle Cells


Acanthocytes (Spur Cell):

  • Congenital abetalipoproteinemia
  • Vitamin E deficiency
  • Alcohol intoxication
  • Post-splenectomy
Acanthocytes

Acanthocytes


Burr Cells:

  • Liver disease
  • Renal disease
  • Severe burns
  • Bleeding gastric ulcers
  • Maybe artifact
Echinocyte (Burr Cell)

Echinocyte (Burr Cell)

Acanthocyte vs Echinocyte

Acanthocyte vs Echinocyte


Howell-Jelly: are intracellular particles which are smooth, round remnants of nuclear chromatin (DNA. Usually, only one per cell is seen but, occasionally, there may be more than one

  • Megaloblastic anaemia
  • Mylodysplastic
Howell-Jolly Bodies

Howell-Jolly Bodies


Heinz Bodies

Heinz Bodies

Heinz Bodies


Cabot Rings

Cabot Rings

Cabot Rings

A - Cabot ring B - Howell-Jolly body

A – Cabot ring
B – Howell-Jolly body


Basophilic Stippling: is the term used to indicate the presence of irregular basophilic granules in the cytoplasm of erythrocytes. The granules are composed of unstable RNA and may be fine of coarse.

  • Lead Poisoning
  • Thalassaemia
  • Significant anaemia
  • Dyserythropoiesis
Basophilic Stippling

Basophilic Stippling


Hemoglobin C crystals:  are hexagonal crystals that may be found in individuals with HbC syndromes. The crystals may intracellular or extra-cellular.

Hemoglobin C crystals

Hemoglobin C crystals


Pappenheimer Bodies:  are intracellular inorganic iron-containing granules that may be ob-served on Wright’s stained peripheral blood smears.

Pappenheimer Bodies

Pappenheimer Bodies


Rouleaux formation: describes an aggregation of erythrocytes that are aligned one upon the other, resembling stacks of coins

  • High level of circulating acute-phase proteins.
  • with High ESR rate.
  • autoimmune conditions
  • myeloma
Rouleaux formation

Rouleaux formation


Agglutination of red cells:  is caused by agglutinins and resembles Rouleaux but is more irregular with round clumps rather than linear Rouleaux

Agglutination of red cells

Agglutination of red cells


Summary of red blood cellsmorphology

Summary of red blood cellsmorphology

Share This Post

Related Articles

Leave a Reply

You must be Logged in to post comment.

© 2017 Medical Laboratories. All rights reserved. Site Admin · Entries RSS · Comments RSS
Powered by WordPress · Powered by Medical Labs