POIKILOCYTOSIS prt. 2 Flashcards
The hallmark of hemolytic anemia secondary to red cell fragmentation is the_______, which takes several forms.
schistocyte
When a red cell attempts to pass between fibrin strands, altered vessels, or damaged heart valve prostheses, it may be cleaved and fragmented and become a_______
The erythrocyte trying to squeeze through an opening half its diameter becomes stretched and develops a blister because of the shear stress of the flowing blood.
When this cell passes through the spleen, it is fragmented into two pieces, and the membrane is less deformable. Fragmented red cells do not survive long in the circulation.
schistocyte
Schistocytes (Greek word schistos, “_____”) or schizocytes (Greek schizo, “_____”’) result from membrane damage; they are not hereditary.
cloven
split
Schistocytes include helmet, triangular, and a variety of small, irregular shapes with a few pointed extremities.
The finding of_____ and _____ is strongly suggestive of a microangio-pathic hemolytic anemia or traumatic hemolytic anemia
helmet and fragmented cells
occur in patients with severe burns, renal graft rejection, glomerulonephritis, vasculitis, thrombotic thrombocytopenic purpura, and diffuse intravascular coagulation
Schistocytes
accompanying march hemoglobinuria most likely are attributable to mechanical damage to the cells in the feet of individuals on long walking expeditions.
Schistocytes
schistocyte with one or more hornlike projections has been identified as a______ (Greek_______, “horn”)
keratocyte
keras
These cells may or may not have a normal volume and usually no area of central pallor.
A________ is the result of an erythrocyte being caught on a fibrin strand, which could cut the cell in two.
As the sides of the erythro cyte are pushed against the fibrin strand, they tend to fuse together.
When this cell escapes from the fibrin strand, it may have a vacuole-like area in the fused portion (this is known as a blister cell).
This vacuole ruptures to form the_______
— a damaged red cell with horns.
keratocyte
do not remain in circulation for more than a few hours, as they are fragile
They are a rare and interesting phenomenon.
Some morphologists report helmet cells, which actually look like a helmet, as ______
Keratocytes
pear shaped with a blunt pointed projection and
may be normal size, small, or large; “teardrops”
dacryocytes
have been so labeled because of their shape (Greek dakry, “tear”)
Dacryocytes (teardrops)
They may also be pear shaped with a blunt pointed projection and may be normal size, small, or large.
Dacryocytes (teardrops)
If a red cell contains a rigid inclusion, such as a Heinz body, the portion with the inclusion cannot pass through small openings of splenic sinuses and thus remains behind.
As the red cell squeezes through the small opening, it is stretched beyond its ability to regain its original shape.
Thus, a teardrop or pear shape is created.
Dacryocytes
typically are observed in myelofibrosis with myeloid metaplasia because of the large size of the spleen.
Other conditions with ______ include myelophthisic anemia, pernicious anemia, B-thalas-semia, drug-induced Heinz body formation, tuberculosis, and tumor metastasized to the marrow.
Teardrop cells
Dacrocytes
Red cells containing ___________________ squeeze through the splenic sinuses, hence will have its original shape STRETCHED (causing teardrop-shaped cells)
Heinz bodies
occur in severe burns as
small, round cells that may be smaller than platelets; they
are the result of thermal damage to the cell membrane.
Microspherocytes
Another name for microspherocytes
microspherules
Microspherocytes in rare hereditary HA occur at what temperature?
45 degrees C
Normocytes (normal RBCs) fragment at what temperature?
49 degrees C
T or F: MCV of those with rare hereditary HA designated pyropoikilocytosis have EXTREMELY LOW MCV
T
a large, pale-pink staining ghost of a red cell—the membrane
remaining after the contents have been released; as large as leukocytes
Semilunarbodies
Other names for semilunar bodies
half-moon cell/crescent cell
T or F: Semilunar bodies are ALWAYS acquired
T
Semilunar bodies are frequently seen in: (conditions)
Malaria & conditions causing overt hemolysis
Three types of poikilocytes characteristic of three abnormal hemoglobins (abnormal hemoglobin content)
- drepanocytes (from Hb S)
- Hb CC crystals
- Hb SC crystals
Three types of poikilocytes characteristic of three abnormal hemoglobins (abnormal hemoglobin content)
- drepanocytes (from Hb S)
- Hb CC crystals
- Hb SC crystals
cells that have been changed from the normal disc shape by the long
rod-shaped polymers of the inherited abnormal Hb S
Drepanocytes
Drepanocytes are also known as
sickle cells
A red cell does not appear sickled until it has lost its _________
and has been fully _____________.
nucleus; hemoglobinized
___________ are thin
and elongated with pointed ends and are well filled with
Hb. They may be curved or straight or have S, V, or L shapes.
Sickle cells/drepanocytes
T or F: The change in shape of drepanocytes is striking and IRREVERSIBLE secondary to permanent membrane damage by the polymerization of Hb S
T
Typical sickle cells are observed in films from patients with ______________ Hb S disease (Hb SS) but are not often
seen in ___________ Hb S (Hb AS; sickle trait) except under unusual situations when there is low in vivo oxygen tension.
homozygous; heterozygous
Meaning of drepanos
sickle
2 poikilocytes associated with malaria
1) semilunar bodies (poikilocyte secondary to trauma)
2) drepanocytes (poikilocyte secondary to abnormal Hgb content)
Drepanocytes are caused by a ________ mutation on the 6th position of amino acids (glutamic acid is changed to ________)
point (mutation); valine
intracellular crystals that are hexagonal with blunt ends and are darkly stained; these angular crystals form within the cell membrane when Hb C crystallizes
Hemoglobin CC crystals
T or F: Frequently, the cell membrane is not visible, and the crystal appears to be free (Hgb CC crystals). At times, several smaller CC crystals form within the red cell.
T
Hemoglobin CC crystals are seen in homoxygous C (Hgb CC) disease but not in _______________
Hemoglobin C trait (heterozygous)
Hemoglobin CC crystals are seen in homoxygous C (Hgb CC) disease but not in _______________
Hemoglobin C trait (heterozygous)
dark-hued crystals of condensed Hb that distort the red cell membrane
Hemoglobin SC crystals
2 forms of Hgb SC crystals
- straight
with parallel sides - blunt, pointed, protruding end
(“Washington monument” shape).
multiple crystals that
protrude in different directions as finger-like projections from a common crystalline center
Hemoglobin SC crystals
Identify if hemoglobin crystal is SC or CC:
1. crystal PROTRUDING membrane
2. crystal formed WITHIN cell membrane
3. Washington monument
4. Hexagonal and elongated
5. Projecting end blunt
6. both ends blunt
7. parallel sides to crystal
8. parallel sides to projection
- SC
- CC
- SC
- CC
- SC
- CC
- CC
- SC
Erythrocytes with a normal Hb content have a clear central pallor that occupies about one-third of the cell diameter
Normochromic
With decreasing Hgb concentration, there is __________ central pallor, these cells are termed as _________\
Increased; hypochromic
Hypochromia is associated most often with __________
Microcytosis
Examples of hypochromic, microcytic anemias include:
iron deficiency anemia, thalassemia, and sideroblastic anemia
Hypochromia with normocytic cells conditions that result from defective macrophage iron release, which prevents iron from reaching the normoblasts for proper red
cell maturation.
Rheumatoid arthritis, chronic infection, inflammation
the term used to describe the variation in Hb content when both hypochromic and normochromic cells are present.
Anisochromia
Macrocytic cells usually do not have an area of central pallor because of their __________ thickness.
increased
Spherocytes have reduced central concavity and no central pallor because of their _________ thickness.
increased
Sickled red cells do not show normal ______________
central pallor
Hemoglobin is concentrated within a _____________ in the abnormal Hb genotypes CC and SC
crystal
True hyperchromia exists when the __________ is elevated
MCHC
T or F: Erythrocytes normally contain inclusions
F!! NOOOOOOO
Inclusions in developmental organelles:
Howell-Jolly bodies, basophilic stippling, Pappenheimer bodies, polychromatophilic red cells, and Cabot rings
small, round fragments of the
nucleus (resulting from karyorrhexis or nuclear disintegration) of a late nucleated red cell or metarubricyte
Howell-Jolly bodies
Howell-jolly bodies stain _________________ in Wright stain
reddish-blue to blue-black
Howell-jolly bodies may also result from:
- incomplete extrusion of nucleus
- chromosomes that were separated from the spindle during abnormal mitosis
Howell-jolly bodies give a _______ Feulgen reaction
positive
A test for DNA in nuclear chromatin
Feulgen reaction
What inclusions are increased in the blood film after splenectomy?
Howell-jolly bodies
Seen in sickle cell anemia, other hemolytic anemias, megaloblastic anemia, congenital absence of spleen, splenic atrophy
Howell-jolly bodies
fine or coarse, deep blue to
purple staining inclusion that appears in erythrocytes on a dried Wright-stained film; smaller than Howell-Jolly bodies, are usually irregularly shaped, and appear homogeneously throughout the Fib portion of the erythrocyte.
Basophilic stippling
T or F: Basophilic stipplings do NOT exist in living cells but can be observed in well-made preparations for electron microscopy
T
2 forms of basophilic stippling:
- Fine stippling
- Granular
Basophilic stippling due to increased red cell population, seen with increased polychromatophilia
Fine stippling
Basophilic stippling due to abnormal instability of RNA in the young cells, seen in lead poisoning, thalassemia, megaloblastic anemia, and severe anemia.
Granular stippling
Siderotic granules that are small, irregular, dark-staining granules that appear near the periphery of a young erythrocyte in a film stained with Wright or supravital stain
Pappenheimer bodies
these bodies stain positively in Perls’ PRUSSIAN BLUE indicating their iron content
Pappenheimer
An erythrocyte that is positive for siderotic (iron) granules
in a Prussian blue stain is designated a __________
siderocyte
A normoblast (nucleated erythrocyte) with siderotic
granules is called a _____________.
sideroblast
Pappenheimer: Normally no more than
_____ small iron particles are noted in developing nucleated red cells in bone marrow.
3
Siderotic granules in normal sideroblasts and siderocytes represent dispersed _______ (a storage form of iron) molecules.
ferritin
The ________ is thus responsible for removing excess iron-containing granules from young red cells in
which Hb synthesis is complete.
spleen
On a Wright-stained film it is possible to misidentify Pappenheimer bodies as ______________ when the
iron overload is severe
basophilic stippling
A thin ringlike structure called a _____________ may appear in erythrocytes in megaloblastic anemia
or other severe anemias, in lead poisoning, and in dys-
erythropoiesis, in which erythrocytes are destroyed before being released in the bone marrow
Cabot ring
What are the 2 inclusions associated with or are present in lead poisoning?
Basophilic stipplings, Cabot rings
Inclusions that may be circular
and appear at the cell periphery, or it may form a figure eight, incomplete rings, or other configurations.
Cabot rings
round, refractile inclusions not visible
on a Wright-stained film. They range in size from about 1 to 3 um and are attached to the erythrocyte membrane; if in multiples, may appear as pitted golf ball
Heinz bodies
Heinz bodies are best identified by supravital staining with basic dyes such as:
crystal violet, methylene
blue, or brilliant cresyl blue
_____________ consist of denatured globin derived from destruction of the Hb molecule. These inclusions are not seen in normal individuals (unless the person is acutely poisoned) because they are pitted out by the spleen.
Heinz bodies
Heinz bodies are produced in the blood of normal persons who have been poisoned by:
aromatic nitro-com-
pounds, amino-compounds, and inorganic oxidizing agents used in treatment protocols
Heinz bodies also occur in individuals with a hereditary
deficiency of the enzymes _________ or glutathione as a result of exposure to
drugs or agents containing the above compounds
glucose-6-phosphate dehydrogenase (G6PD)
Heinz bodies also occur in individuals with a hereditary
deficiency of the enzymes _________ or glutathione as a result of exposure to
drugs or agents containing the above compounds
glucose-6-phosphate dehydrogenase (G6PD)
Plasmodium spp. are transmitted to man by _________
Anopheles mosquitoes
4 plasmodium species that cause malaria
- P. vivax
- P. malariae
- P. falciparum
- P. ovale
(VilMa FOntanilla)
Schuffner’s stipplings; 4 maturation stages infects the RBC (become enlarged)
P. vivax (Vilma Santos)
RBC not enlarged; Ziemann’s dots
P. malariae (Manila Zoo)
Small delicate ring forms, gametocytes are banana shaped; Maurer’s dots
P. falciparum (Ferdinand Marcos)
RBC is oval; James dots
P. ovale (Orange Juice)
forms ringlike structures resem¬
bling the ring stages of malarial parasites; round, oval, elongated, amoeboid, or pear-shaped
and are often tiny, ranging in size from 1 to 5 um; appears as tiny rings with minimal blue tufts of cytoplasm and a little dot of chromatin. Reproduction occurs asexually
by a division that results in a tetrad of organisms that somewhat resembles a cross.
Babesia
Red cells infected with Babesia are ___________, and pigment is not present
Not enlarged
