hematology signed
TRANSCRIPT
RBC Morphology
I. RBC SizeII. Hemoglobin ContentIII. RBC shape
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RBC Morphology RBC SizeNormal size is 6-8 u in diameter (NORMOCYTIC RBC/ NORMAL RBC)*******************************************ANISOCYTOSIS
→variation in RBC size●Normocytic ●Microcytic : < 6 u●Macrocytic : > 8 u; appear as large, mature RBC●Megalocytic : > 10u -12u
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Clinical Significance (MACROCYTIC)
●Caused by increase erythropoietin stimulation, increase synthesis of hgb●Due to Vit. B12 and folic acid deficiency●Cirrhosis●Hemolytic anemia●Pernicious anemia
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Clinical Significance (MiCROCYTE)●Caused by impaired globulin synthesis●Decreased hgb synthesis●Mitochondrial abnormality, affecting synthesis of heme●Deficiency of iron and other building materials●Failure of cell division or polyploidy (kaya malaki)
Clinical Significance (Megalocyte)
●Due to Vit B12 and folic acid deficiency●Failure of cell division or polyploidy (the reason why it's big)●Megaloblastic anemia
RBC Morphology HGB content
Normal: Central pallor occupies about 1/3 the size of the RBC (NORMOCHROMIC)*******************************************ANISOCHROMATASIA
→variation in staining property of hgb●Hypochromic : increased central pallor●Hyperchromic: no central pallor●Anulocyte : only periphery unstains hgb
RBC Morphology HGB content
●Hyperchromic/Hyperchromasia/Hyperchromia
→entire cells stain deep pink and lacks central pallor
→Clin.Sig. (does not represent true situation, suggestive of:)
● Megalocytes of pernicious anemia● Blood poisoning● Acute leukemias
RBC Morphology HGB content●Polychromatophilia/Polychromasia→ cytoplasm of non nucleated RBCs have a grayish
blue tint →Basophilic material gives a diffuse homogenous blue
color →property of rreticulocytes when stained with
Wright's →Clin. Sig.:
● Associated with rapid RBC regeneration and increase bone marrow activity
● Reticulocytosis● Pernicous anemia● Leukemia● malaria
RBC Morphology HGB content● Target cells
→other names are
– Leptocyte
– Platycyte
– Mexican hat
– Bull's eye
– Codocyte
● RBCs show hgb conc. At the outer rim and center
● A pale circular zone separates the 2 areas
● Clin.Sig.– Hemoglobinopathies– Liver disorders– Iron deficiencies– Hgb C dse– After splenectomy
RBC Morphology HGB content
● Anulocyte →Thin Rbc that are poorly hemoglobinized and
exhibit a thin peripheral ring stained hgb
● Clin.Sig.
– Hemoglobinopathies
Inclusion Bodies →a normal RBC has no inclusion bodies
→RBC must be anucleated
● ARTIFACTS
→refractile areas and crenation in the RBCs
→clinical sig.
– Water in wright's stain
– Poor staining technique
– Insufficient drying of slide prior to staining
Inclusion Bodies● BASOPHILIC STIPPLING
→coarse granulation resulting from RNA aggregates
→clinical sig.
– Non specific anemias
– Lead intoxication
Inclusion Bodies● CABOT RINGS
→thread like, round, oval, or figure of 8 loops
→due to residual nuclear membrane
→clinical sig.
– Pernicous anemia
– Lead intoxication
Inclusion Bodies● HEINZ BODIES→dark staining, round areas resulting from precipitated denatured hgb
→bind to the red cell membrane and alter its rigidity , resulting in premature destruction in the spleen
→the spleen also removes membrane bound Heinz bodies from red cells resulting in “blister “ or “bite” cells
→clinical sig.
– G-6-PO4 defficiency
– Heinz body anemias
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Inclusion Bodies● HOWELL JOLLY BODIES
→eccentric, small, round, non refractile purple masses consisting of DNA nuclear remnant
→clinical sig.
– Hemolytic anemia
– Post splenectomy
Number 3s
Inclusion Bodies● HGB C CRYSTALS
→oblong, hexagonal in shape resulting from hgb found in cytoplasm of RBC
→The “washington monument” or octahedral appaerance is typical, with a clear area around the crystal. These crystals may also be shaped like a rod, spherocytic, rhomboid, or hexagon
→clinical sig.
– Hgb C disease : mild hemolytic anemia with splenomegaly that is often aymptomatic but may result in jaundice and abdominal discomfort
– Hgb SC dse
Inclusion Bodies● PARASITES
→most common
→variable appearance depending on the parasite
→clinical sig.
– Plasmodium infection
– Babesia infection
Inclusion Bodies● PAPPENHEIMER BODIES/ SIDEROTIC
GRANULES
→small, blue granules usually appearing in clusters near the periphery of RBC
→consists of non-iron heme
→clinical sig.
– Post splenectomy
– Sideroblastic anemia
– Sickle cell anemia
RBC Morphology RBC shape● ACANTHOCYTES
→Other names
– Thorn cell(acanthol)
– Spur cell
– Spike cell
→spherical, irregularly spaced spinous processes; some have bent tip due to membrane defect
→characterized by a progressive increase in sphingomyelin- lecithin ratio
→clinical sig.
– Abetalipoproteinemia
– Hemolytic anemia
– Neonatal hepatitis
– Liver disorders
RBC Morphology RBC shape● BLISTER CELL
→contains single or multiple vacuoles on markedly thinned areas at the periphery
→characterized by a progressive increase in sphingomyelin- lecithin ratio
→clinical sig.
– Presence results from trauma as cells pass through involved blood vessels
RBC Morphology RBC shape● BURR CELLS
→RBCs have uniformly spaced pointed projections on their outer edges
→clinical sig.
– Uremia
– Acute blood loss
– Cancer of the stomach
– Pyruvate kinase deficiency
RBC Morphology RBC shape
● CRENATED RBCs→also known as Echinocyte (from Gk. Word echinos = sea urchin)
→wrinkled, serrated periphery, uniform projections, uniformly spaced bumps
→blunt spicules
→clinical sig.
– Faulty drying
– Not clinically diagnostic
– Due to dehydration, hypertonic agents,and lytic agents
– Due to exposure to anticoaguants
RBC Morphology RBC shape
● DACROCYTES/ TEARDROP CELLS
→fr. Gk. Word Darkry = tear
→clinical sig.
– Severe anemias
– myelofibrosis
RBC Morphology RBC shape
● ELLIPTOCYES/ OVALOCYTES
→has bipolar aggregates of hgb that cause the cell to be slightly to severely elongated instead of biconcave
→clinical sig.
– Hereditary elliptocytes
– Thalassemia
– Sickle cell anemia
RBC Morphology RBC shape
● KERATOCYTE
→aka Helmet cell
→irregularly contracted , triangular cells
→remnants of ruptured blister cell →clinical sig.
– DIC (disseminated intravascular coagulation)
– Microangiopathic anemia
RBC Morphology RBC shape
● KNIZOCYTE/ TRIANGLE CELLS
● →RBCs looked pinched into a triangular shape
→clinical sig.
– Hemolytic anemia
RBC Morphology RBC shape
● PYKNOCYTES
→distorted, contracted RBC similar to Burr cells
→clinical sig.
– Seen in the first 2-3 months of life
– G-6-PO4 deficiency
– Microangopathic anemia
– Hemolytic anemia
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RBC Morphology RBC shape● SICKLE CELLS
→ aka Drepanocytes, Menisocytes
→Elongated, slightly curved cells with pointed ends
→center of cell contains a dense crystalline area of hgb that fades somewhat towards the periphery
→clinical sig.
– Associated with hgbs in sickle cell anemia (sca)
RBC Morphology RBC shape
● SPHEROCYTES
→spherical, non-biconcave (lack central pallor)
→have dark stained center instead of the normal central pallor
→smaller surface area than the cell size; characterized by increase osmotic fragility
→clinical sig.
– Hemolytic anemia
– HDN
– Hereditary spherocytosis (most common)
RBC Morphology RBC shape
● STOMATOCYTE
→stoma or mouth aka Mouth / Stoma cell
→shows oval or rectangular (slit-like) area of central pallor
→clinical sig.– Liver disease
– Electrolyte imbalance
– Hereditary
stomatocytosis
– artifacts
RBC Morphology RBC shape
● SCHISTOCYTE
→SCHIS - cut
→fragmented RBC; a piece of the RBC is missing causing the reultant RBC to appear; fragmented/ distorted
→clinical sig.
– DIC (disseminated intravascular coagulation)
– Mecahnical trauma (most common)
Miscellaneous● Rouleaux Formation
→RBCs stack together like a roll of coins
→Saline will disperse Rouleaux
→clinical sig.
– Caused by increased CHON (most common)
– Multiple myeloma
– Waldenstrom's macroglobulinemia
Miscellaneous● Agglutination
→Disorderly clumping of RBC →clinical sig.
– RBC antibodies
– autoagglutinins
Miscellaneous● Giant pit
→Round purple bodies
→longer than normal pit but smaller than lymphocyte
→clinical sig.
– none
Qualitative Disorders of Granulocytes● Dohle Bodies
→smear reveals pale blue staining area within the neutrophil cytoplasm
→irregularly shaped blue staining area in the cytoplasm due to free ribosomes or RER
→seen with infections →clinical sig.
– Bacteria infection
Qualitative Disorders of Granulocytes● Pyknotic nucleus
● →smear reveals neutophils with condensed round nuclei or nuclear fragments
→clinical sig.
– Bacterial infection
– Prolonged contact of neutrophils with EDTA
Qualitative Disorders of Granulocytes● Toxic granulation
→smear reveals small dark staining granules within the cytoplasm of neutrophils
→increased number and prominence of the azurophilic (primary) granules
→seen most often with bacterial infections and in association with cytoplasmic vacuolization
→clinical sig.
– Bacteria infection
– Neutrophils induced to increased production of primary granules containing lysozymes
Qualitative Disorders of Granulocytes● Toxic vacuoles
→smear reveals holes in the cytoplasm of neutrophils
→blister cell counterpart sa RBC →clinical sig.
– Bacteria infection
– As bacteria are digested by neutrophils , its vacuoles appear in the cytoplasm
– Due to prolonged EDTA contact
Qualitative Disorders of Granulocytes● Lupus Erythematosus cell
→smear reveals neutrophils that have engulfed homogenous nuclear masses
→as a result, the nucleus of the neutrophils are pushed to the periphery of the cell
→the phagocytized nucleus occupies most of the cytoplasm area
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Qualitative Disorders of Granulocytes● Hypersegmentation
● →polymorphonuclear leaukocyte normally have 3 or 4 lobes but 5/6 or more lobes indicate hypersegmentation
→clinical sig.
– seen most often with megaloblastic anemia , sometimes with myeloproliferative disorders
– ff. Chemotherapy (particularly metho trexate chemotherapy)
Qualitative Disorders of Granulocytes● Smudge cell / Basket Cell
→a ruptured cell remnant , classically associated with fragile lymphocyte, in CLL
Qualitative Disorders of Granulocytes● Pelger-Huet anomaly
→an autosomal dominant condition with neutrophils that are mostly bilobed in the heterozygote (normal fxn ) and unilobate in the homozygote (fatal)
Qualitative Disorders of Granulocytes● May-Hegglin anomaly
→rare disorder with large prominent Dohle like bodies
● Chediak-Higashi syndrome
→rare disorder with large neutrophilic granules representing abnormal lysosomes
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