HEMA LEC - Erythrocytic Morphology and Assoc Disease Flashcards
are normal erythrocytes that are approximately the same size as the nucleus of a small lymphocytes.
Normocytes (discocytes)
a. RBCs greater than 8um in diameter;
- Macrocytes
MCV greater than 100 fL
- Macrocytes
Seen in megaloblastic anemias, such as B12/folate deficiency
- Macrocytes
Seen in non-megaloblastic anemia of liver disease or accelerated erythropoiesis; also seen in normal newborns
- Macrocytes
a. RBCs less than 6um in diameter;
Microcytes
MCV less than 80 fL
Microcytes
Seen in iron-deficiency anemia, thalassemias, sideroblastics anemia, and anemia of chronic disease
Microcytes
a. Variation in RBC size, indicating a heterogeneous RBC population (dimorphism)
anisocytosis
heterogeneous RBC population (dimorphism)
(dimorphism)
b. Correlates with RDW (red blood cell distribution width), especially when the RDW exceeds 15.0%
anisocytosis
c. Seen post-transfusion, post-treatment for a deficiency (e.g., iron), presence of two concurrent deficiencies (e.g., iron and vitamin B12), and idiopathic sideroblastic anemia
anisocytosis
a. General term to describe variation in shape
b. Associated with a variety of pathologic conditions
- Poikilocytosis
include crenated, and burr cells (sea urchin cells)
Echinocytes
Have evenly spaced round projections; central pallor area present
Echinocytes
Seen in liver disease, uremia, heparin therapy, pyruvate kinase deficiency, anemia associated with renal insufficiency (burr cells) or as artifact in improper air drying
Echinocytes
Caused by changes in osmotic pressure due to depletion of ATP which supports the cation pump, exposure to hypertonic solution
Echinocytes
Have unevenly space pointed projection; lack a central pallor area
Acanthocytes (spur cells/thorn cells)
Associated with alcoholic liver disease, post-splenectomy, and abetalipoproteinemia, malabsoprtion states, hepatitis of the newborn, severe haemolytic anemia associated with cirrhosis and in metastatic liver disease
Acanthocytes (spur cells/thorn cells)
Caused by excessive cholesterol in the membrane
Acanthocytes (spur cells/thorn cells)
a. Show a central area of hemoglobin surrounded by a colorless ring and a peripheral ring of hemoglobin; cells have an increased surface-to-volume ratio
Target cells (codocytes or Mexican hat cells)
Seen in liver disease, hemoglobinopathies SS SC CC DD EE, thalassemia, iron-deficiency anemia, obstructive liver disease, postsplenectomy states
Target cells (codocytes or Mexican hat cells)
Caused by excessive cholesterol in the membrane or a hemoglobin distribution imbalance
Target cells (codocytes or Mexican hat cells)
thinner variant of codocytes
Leptocyte
Disk-shaped cell with a smaller volume than a normal erythrocytes; cells have decreased surface-to-volume ratio
Lack a central pallor area
c. Associated with defects of the red cell membrane proteins
Spherocytes (ball shaped cells)
MCHC may be >37%; increased osmotic fragility
Spherocytes (ball shaped cells)
Damaged RBC; seen in hereditary spherocytosis (HS), G6PD deficiency, and isoimmune and autoimmune hemolytic anemias, blood banked stored blood for a long time
Spherocytes (ball shaped cells)
are frequently seen in severe thermal injury (burns).
Microspherocytes (
After splenectomy in a patient with HS, spherocytes ____ indicating that the abnormality involves the red blood cell membrane itself rather than splenic damage to the cells.
persist
a. Pear-Shaped cell with one blunt projection
b. Seen in megaloblastic anemias, thalassemia, and extramedullary hematopoiesis (myelofibrosis, myelophthisic anemia)
Teardrops (dacryocytes)
a. Shapes vary but show thin, elongated, pointed ends and will appear crescent shaped; usually lack a central pallor area; described as having a holly leaf appearance
Sickle cells (drepanocytes)
Contain polymers of abnormal hemoglobin S
Sickle cells (drepanocytes)
Seen in hemoglobinopathies SS, SC, SD, and S/B-thalassemia
Sickle cells (drepanocytes)
Cell Shape is caused by cell membrane alterations due to an amino acid substitution
Sickle cells (drepanocytes)
a. Interior portion of cell is hollow, resembling a horn or helmet
c. Seen in microangiopathic hemolytic anemias
Helmet cells (horn cells or keratocytes)
b. Basically a schistocyte with a hornlike projections (Gr. Keras: horn)
Helmet cells (horn cells or keratocytes)
a. Damaged RBC; fragment of various sizes and shapes are present, often with pointed projection
Schistocytes/schizocyte (RBC fragments)
Seen in microangiopathic hemolytic anemias (e.g., DIC, HUS, TTP), thermal injury, renual transplant rejection, and G6PD deficiency
Schistocytes/schizocyte (RBC fragments)
a. Characterized by an elongated or slit-like area of central pallor
Stomatocytes (mouth cells)
Caused by osmotic changes due to cation imbalance (Na+/K+)
Stomatocytes (mouth cells)
Seen in obstructive liver disease, Alcoholism, cirrohosis, hereditary stomatocytosis, RH NULL DISEASE, or as artifact
Stomatocytes (mouth cells)
a. Cigar- to – egg-shaped erythrocytes
Elliptocytes (ovalocytes)
Seen in hereditary elliptocytosis, iron-deficiency anemia (pencil forms), megaloblastic anemia (macro-ovalocytes), thalassemia major
Elliptocytes (ovalocytes)
Associated with defects of the red cells membrane proteins specifically in membrane protein 4.1
Elliptocytes (ovalocytes)
– a transitional variant of Hereditary elliptocytosis.
Hereditary pyropoikilocytosis
has the same appearance as elliptocytes and usually occur at the first 6 months of life.
Pyropoikilocytes
To differentiate from normal red blood cells, it usually lyses at 45-460C while normal red blood cells lyses at 490C
Pyropoikilocytes
