1. LABORATORY DIAGNOSIS
RED BLOOD CELLS

4. 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%

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

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

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

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

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

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

14. HEMOGLOBIN CONTENT OF ERYTHROCYTES
Normochromic erythrocytes

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

16. HEMOGLOBIN CONTENT OF ERYTHROCYTES
ASSOCIATED WITH: acute and chronic hemorrhage, hemolysis, effective treatment for anemia, neonates
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
Ovalocytes
ASSOCIATED WITH: Hereditary elliptocytosis or ovalocytosis, thalassemia major, iron deficiency anemia, megaloblastic anemias (macro ovalocytes), myelopthisic anemias

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

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

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

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

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

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

46. 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

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