LABORATORY DIAGNOSIS RED BLOOD CELLS

PRONORMOBLAST Size: 12-20 um Nucleus: round; nucleoli (1-2); fine chromatin Cytoplasm: dark blue N/C ratio: 8:1 Reference interval: BM: 1% PB: 0%

BASOPHILIC NORMOBLAST Size: 10-15 um Nucleus: round; nucleoli 0-1; slightly condensed chromatin Cytoplasm: dark blue N/C ratio: 6:1 Reference interval: BM: 1-4% PB: 0%

POLYCHROMATIC NORMOBLAST Size: 10-12 um Nucleus: round; nucleoli 0; quite condensed chromatin Cytoplasm: gray blue N/C ratio: 4:1 Reference interval: BM: 10-20% PB: 0%

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%

POLYCHROMATIC ERYTHROCYTE Size : 8-8.5 um Nucleus : absent Cytoplasm : blue to salmon N/C ratio : NA Reference interval : BM : 1% PB : 0.5% - 2%

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

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

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

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

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

HEMOGLOBIN CONTENT OF ERYTHROCYTES Normochromic erythrocytes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

DISEASES AFFECTING ERYTHROCYTES Iron Deficiency Anemia

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

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

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

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

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

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

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

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

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

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

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

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