Erythrocyte Disorders Flashcards
Anemia
A decrease in the O2 carrying capacity of blood caused by a decrease or abnormality in hgb (Congenital, Acquired disorders, Hemorrhage, etc); Anemia is an expression of an underlying disorder (symptom not disease, so the origin of the anemia must be identified for effective treatment)
Anemia Treatment
There is no universal treatment, Blood transfusion may be effective in some anemia’s but may be toxic in others; Some simply require vitamin or mineral supplementation
Anemia Characteristics
Increased respiration and cardiac output in an effort to increase oxygenated blood flow; Tachycardia, shortness of breath
Prolonged anemia may lead to heart failure
Increased hematopoiesis may cause BM hyperplasia also may involve fetal organs
Anemia - Increased oxygen utilization
2,3 BPG concentration elevates so Oxygen is pushed off of hgb more readily (Prolonged 2,3 BPG elevation may be detrimental)
O2 is released prematurely, Distal tissues may become hypoxic, Poor energy production, Fatigue
Normal RBC Characteristics
Size: Normal RBC is 6-8μm in diameter
Shape: Round, biconcave
MCV Changes During Development
Average MCV
Birth: 108fL, macrocytic
6 mo-2 years: 77fL, microcytic
18 years +: 90fL, normocytic
Anisocytosis
Elevated RDW (variation in RBC size), but may have a normal MCV
Microcytosis
Smaller than lymph nucleus, Decreased MCV
Frequently, but not always, accompanied by hypochromia
Macrocytosis
Larger than lymph nucleus
Increased MCV
Hypochromia
Decreased hgb
Increased central pallor
Polychromatophilia
Indicates erythropoiesis
Reticulocytes
Light purple due to residual RNA
Poikilocytes
Acanthocytes Schistocytes Drepanocytes Spherocytes Dacrocytes Echinocytes Ovalocytes Stomatocytes Codocytes
Acanthocytes
Also known as Spur or thorn cells
Multiple unevenly spaced thorn-like or rounded projections, No central pallor
Clinical Conditions: Liver disease, Lipid metabolism disorders, Fat malabsorption, Anything that may cause increased membrane cholesterol
Schistocytes
Fragmented RBCs
Several subtypes including keratocytes (helmet cells)
Variable sized “pieces” of an RBC, May or may not show central pallor
Clinical Conditions: Microangiopathic hemolytic anemia, Uremia, Hemolytic disease of the newborn (HDN), Disseminated intravascular coagulation (DIC)
Drepanocyte
Sickle cells
Thin, elongated, pointed ends, No central pallor, Caused by polymerization of Hgb S
Clinical Conditions: Sickle cell anemia, Hgb SC disease
Spherocytes
Spherical, Densely stained, No central pallor, Sometimes appear smaller than other RBCs
Clinical Conditions: Hereditary spherocytosis, PK deficiency, Severe burns, Immune mediated hemolysis
*Never report spherocytes unless you are finding them in a “good” area of the slide
Dacrocytes
Teardrop cells
Pear shaped, Pointed or elongated at one end
Clinical Conditions: Diseases of the bone marrow, Sign of extramedullary hematopoiesis, Myelophthisic anemia, Most any type of anemia, Disorders causing hypersplenism (Formed as the spleen pits inclusions, Thalassemia)
Echinocytes
Burr cells, Crenated RBCs
Evenly distributed short spikes, Central pallor
Clinical Conditions: Uremia, Liver disease, Stomach cancer
Only sometimes clinically significant (May be an artifact of slide making, Caused by an increased dry time- Cold temperature, Slide too thick)
Correlate your findings with a diagnosis if available; Clinically significant Burr cells are usually randomly distributed, Insignificant Burr cells are usually seen in high numbers
Ovalocytes
Elliptocytes
Oval shape, May be slightly oval to very stretched, Central pallor, Rounded ends
Clinical Conditions: Hereditary ovalocytosis, Several miscellaneous anemia’s, Thalassemia, Iron deficiency, Sickle cell anemia
Stomatocytes
Mouth cells
Slit-like area of central pallor, Uniconcave disc shape
Clinical Conditions: Abnormal membrane ion exchange, Hereditary stomatocytosis, Liver disease, Lead poisoning
Codocytes
Target cells
Target or bull’s-eye appearance, Bell shaped cells, Caused by excessive cell membrane
Clinical Conditions: Thalassemia, Liver disease, Misc.. anemia
Erythrocyte Inclusions
RBCs are non-nucleated and free of any internal structures- presence of an inclusion always indicates a pathological condition
Inclusions: Basophilic stippling, Howell-Jolly bodies, Pappenheimer bodies, Heinz bodies
Basophillic Stippling
Numerous bluish-black inclusions distributed across entire cell composed of aggregated ribosomes (rRNA)
Clinical conditions: Lead poisoning, Thalassemia, Sideroblastic anemia, Misc. anemia’s
Howell-Jolly Bodies
Dark purple spherical inclusion, Residual nuclear DNA, Usually only one per cell
Clinical conditions: Post-splenectomy, Hemolytic anemia, Megaloblastic anemia
Pappenheimer Bodies
Siderotic granules
Aggregated iron, Appear as clusters of small granules, ID can be confirmed using the Prussian blue (iron) stain
Clinical conditions: Post-splenectomy, Sideroblastic anemia, Megaloblastic anemia, Hemoglobinopathies
Heinz Bodies
Small round inclusions near the periphery composed of precipitated hemoglobin, Only visible with supravital stains
Clinical conditions: G6PD deficiency, Results in excessive oxidation of heme (forms precipitates), Hemoglobinopathies, Supravital
Russell Bodies
Large round areas of built-up IG that cannot be released from the Plasma cells, look like a bag of marbles
Distinguished from vacuoles by the appearance of stain within these areas
