RBC inclusions Flashcards
Also known as punctate, characterized by irregular, dark blue to purple granules evenly distributed within an RBC
Basophilic stippling
Content found in basophilic stippling
Aggregated RNA
Stains used to visualize basophilic stippling
Wright stain (deep blue to purple), supravital stain
Associated with lead poisoning (plumbism/saturnism), arsenic poisoning, pyrimidine-5’-nucleotidase deficiency, anemias with impaired hemoglobin synthesis (thalassemia), refractory anemias, alcoholism, megaloblastic anemias
Basophillic stippling
Type of stippling observed in plumbism, disorders with impaired hemoglobin synthesis, megaloblastic anemia, and severe anemia.
Coarse stippling
Characterized by dark blue irregular granules in Prussian blue iron staining and pale blue clusters in Wright staining
Siderotic granules (Pappenheimer bodies)
Content of siderotic granules
Intracytoplasmic collections of iron
Stains used to visualize siderotic granules
Perl’s reagent through Prussian blue reaction
Conditions associated with siderotic granules
Sideroblastic anemias (dimorphic peripheral blood picture), thalassemia, hemochromatosis or hemosiderosis
Stains to visualize Pappenheimer bodies
New Methylene Blue, Wright stain
Howell-Jolly bodies: typical size, shape, and color
<1 μm, round, blue to purple
Composition of Howell-Jolly bodies
Nuclear chromatin (DNA)
Stains for Howell-Jolly bodies
Wright stain, New Methylene Blue, Feulgen reaction
Conditions associated with Howell-Jolly bodies
Megaloblastic anemias, after splenectomy, thalassemia
Cabot rings: appearance and composition
Threadlike purple-blue loops or rings, remnants of the mitotic spindle
Stains for Cabot rings
Wright stain, Supravital stain
Conditions associated with Cabot rings
Megaloblastic anemias, refractory anemia, lead poisoning
Positive Feulgen reaction indicate in RBC inclusion?
Presence of DNA (Histochemical stain reaction for DNA)
Howell-Jolly bodies
Location and appearance of Heinz bodies in RBCs
Eccentric, large, round, blue to purple materials along the inner RBC membrane
Composition of Heinz bodies
Denatured and precipitated hemoglobin
Stains used to visualize Heinz bodies
Supravital stains (e.g., BCB, NMB, Methyl violet, Crystal violet)
Why are Heinz bodies not visible on Wright stain?
They can dissolve during the staining process
Conditions associated with Heinz bodies
G-6-PD deficiency, drug-induced hemolytic anemias (DIHA), unstable hemoglobin disease
Examples of unstable hemoglobin variants associated with Heinz bodies
Hb Köln, Hb Casper/Southampton, Hb Genova, Hb Gun Hill, Hb M-Saskatoon, Hb Bristol, Hb Torino, Hb Seattle
Favism: related condition and population susceptibility
Sensitivity to fava beans; occurs mainly in people of Mediterranean origin and in the Chinese with G-6-PD deficiency
Result of favism in G-6-PD deficiency
Severe hemolytic episode
Small, multiple, evenly distributed granular greenish-blue bodies in RBCs
Hb H inclusion bodies
Composition of Hb H inclusion bodies
Precipitated Hb H (4 β-globin chains, denatured β-globin chains)
Stains for visualizing Hb H inclusion bodies
Supravital stains (e.g., BCB, NMB)
Appearance of RBCs with Hb H inclusion bodies
Pitted golf ball appearance
Condition associated with Hb H inclusion bodies
Hb H Disease (a subtype of alpha thalassemia)
Examples of protozoan parasites found in RBCs
Malaria, Babesia spp.
Associated feature of malaria-infected RBCs
Schuffner’s dots (eosinophilic stippling)
Stains used for protozoan parasites in RBCs
Wright stain, Giemsa stain
Grades for polychromatophilia, helmet cells, dacryocytes, acanthocytes, schistocytes, and spherocytes
1+ = 1 to 5 per field, 2+ = 6 to 10 per field, 3+ = greater than 10 per field
Grades for poikilocytosis, ovalocytes, elliptocytes, burr cells, bizarre-shaped RBCs, target cells, and stomatocytes
1+ = 3 to 10 per field, 2+ = 11 to 20 per field, 3+ = greater than 20 per field
Another name for rouleaux
Pseudoagglutination
Appearance of rouleaux under the microscope
Stacks of coins
Cause of rouleaux formation
Serum protein abnormality (increased globulin or fibrinogen)
Condition where rouleaux is commonly observed
Multiple Myeloma (Plasma cell myeloma)
Why should the thick part of the blood film be avoided for rouleaux observation?
Red blood cells overlap in the thick part, causing misinterpretation
Grades for rouleaux formation
1+ = aggregates of 3 to 4 RBCs, 2+ = aggregates of 5 to 10 RBCs, 3+ = many aggregates with few free RBCs
Effect of heavier cells on ESR
Faster fall in ESR
How should sickle cells, basophilic stippling, Pappenheimer bodies, and Howell-Jolly bodies be graded?
Positive only
Normal appearance or slight variation in erythrocytes: erythrocyte morphology grading
0
Few abnormal erythrocytes: erythrocyte morphology grading
1+
Moderately increased abnormal erythrocytes: erythrocyte morphology grading
2+
Many abnormal erythrocytes in each microscopic field: erythrocyte morphology grading
3+
Marked increase in abnormal erythrocytes throughout each microscopic field: erythrocyte morphology grading
4+