HEMATOLOGY 311 nels

MIDTERMS WEEK 8: RBC ANOMALIES

POLYCHROMASIA GRADING
RBC ANOMALIES

I. VARIATION IN HEMOGLOBIN CONTENT

• NORMOCHROMIC CELL
-Refers to erythrocytes with normal amount of
hemoglobin.
-Possesses a central pallor which is about 1/3 of its
diameter.
• HYPOCHROMIC CELL
-Refers to erythrocytes wherein the central light
area of the cell is larger and paler than the normal.
-MCH and MCHC (blood indices are used if we are
going to check this one) are decreased. B. HYPOCHROMASIA
-Often associated with microcytosis (<6-8um)
*Halos maoccupy na buong cell
• HYPERCHROMIC CELL
-Red cells which have an increased Hgb content and
wherein the central light area is smaller than the
normal.
*Halos wala ng central pallor (occupies the whole
cell)

NORMOCHROMIC

-Condition where in the red cells appear pale.

*Halos ioccupy na yung whole cell.
*The picture signifies a low Hgb count
HYPOCHROMIC HYPERCHROMIC
*The distribution is cluttered.
-2 possible causes:
*Decreased Hgb concentration
*Abnormal thinness of the cells:
✓ IDA (Iron Deficiency Anemia): most
II. VARIATION IN STAINING PROPERTY
common type of anemia
A. POLYCHROMATOPHILIA/POLYCHROMASIA/DIFFUSE
✓ Sideroblastic anemia: presence of
BASOPHILIA
siderocytes
✓ Thalassemia: alpha and beta thalassemia

HYPOCHROMASIA GRADING

-This condition wherein the red cells are stained

with various shades of blue with tinges of pink.
-This is due combination of the affinity of Hgb to
acid stain and the affinity of RNA to the basic dye.
-Slightly microcytic (mejo maliliit).
-Indicates reticulocytosis (increased reticulocytes
and are seen on slight bleeding)

Reference: Mrs. Agnes Guzman, RMT

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MIDTERMS WEEK 8: RBC ANOMALIES
C. HYPERCHROMASIA -Myelodysplastic syndrome:
✓ Chronic liver disease
✓ BM failure
✓ Reticulocytosis (increase of reticulocytes)

• Microcyte: cell which is less than 6um in size MCV less

than 80 fl.
-Defect: Abnormal cytoplasmic maturation but normal
-Conditioned wherein the red cell are deeply stained nuclear maturation.
to abnormal thickness of cells (that’s why it’s -Microcytosis is found in:
vivid/matingkad). ✓ Iron deficiency Anemia
-Macrocytosis (larger size f RBC which is >8um) ✓ Inflammation
-Spherocytosis (vivid because of the high Hgb level) ✓ Thalassemia: Alpha and beta thalassemia
-Megaloblastic anemia (deficiency of Vit. B12) ✓ Chronic post hemorrhagic anemia
✓ Hemolytic anemia: could be an internal or external
III. VARIATION IN SIZE bleeding.
A. ANISOCYTOSIS ✓ Sideroblastic Anemia
✓ Hgb E disease: associated with hemoglobinopathies

• Megalocyte: large oval-shaped red cell which is 9-12um.

-Defect: Abnormal nuclear maturation but normal
cytoplasmic maturation.
-Megalocytosis is found in:
✓ Megaloblastic anemias like pernicious anemia
-Condition where in the red cells vary in size both *Seen as large on peripheral blood smears.
macrocytes and microcytes coexist on the same ✓ Anemia
smear. ✓ Vit. B12 deficiency anemia or vit B12 deficiency
✓ Diphyllobothrium latum infection: the fish tape
worms competes with the host for nutrition.

IV. VARIATION IN SHAPE

A. POIKILOCYTOSIS
-Red cells exhibit variation in shape.
SHAPE CELL DEFECT ASSOCIATED
• Normocyte: 6-8 um in diameter (normal). VARIATION DESCRIPTION DISEASE
-Associated disease: seen in normal condition of acute post 1. DISCOCYTE -Normal cell -Seen in normal
hemorrhagic anemia, hemolytic anemia (increased with a condition Acute
destruction of RBC) and aplastic anemia (the bone marrow biconcave disc post
still produces formed elements but only in a small amount) shape with hemorrhagic
*Pancytopenia produces WBC but only in a small amount increased anemia and
also. This condition leads to leukocytopenia. surface aplastic
*Thrombocytopenia produces platelets but only in a small volume surface. anemia
amount. (normocytic/no
*Anemia is the product of low RBC production. rmochromic
*Patient who has aplastic anemia are prone to infection (low type of anemia.
WBC), bleeding (low platelet), and anemia (low RBC). The only
problem is the
• Macrocyte: larger than normal greater than 8um in size patients who
round in shape mcv >100 FL have aplastic
*MCV pertains on the size of RBC. anemia has
*Manual method (computation of blood indices) pancytopenia).
-Defect: Abnormal nuclear maturation but normal *Polycythemia
cytoplasmic maturation vera: increased
-Associated Disease: Non-Megaloblastic anemia (due to formed
elements
alcoholism)
Reference: Mrs. Agnes Guzman, RMT
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MIDTERMS WEEK 8: RBC ANOMALIES
2. -Small dense -Abnormal - fragmentation
ACANTHOCYTES RBC with few membrane Neuroacanthoc of RBC)
(spur cell) irregularly defect caused ytosis 6. -Could be -ATP deficiency -Usually
spaced by an increase (abetalipoprotei ECHINOCYTES/C pathological or due to artifactual.
projections of sphingomyelin nemia, McLeod RENATED CELLS not. prolonged -Seen in uremia,
varying length. and dec in syndrome) (sea-urchin *If the blood storage of bleeding ulcers,
cells)
-Finger like cholesterol and -Severe liver was stored in anticoagulated gastric
projections phospholipid. disease (spur the test tube for blood carcinoma,
*If there would cell anemia) a long time, Pathologically; hepatitis,
be a *Kung isa lang crenated cells due to abnormal Cirrhosis
deformability or yung can form. lipid content of
problem in the acanthocyte, *Pathologic: the membrane
RBC, the wag na ireport, may be due to
problem may be pag madami, abnormal lipid
caused by the saka pwede. content.
membrane 7. CODOCYTES -Cell w/ central -Defect in -Thalassemia
because this is -Target cell/ area of Hb cholesterol, -Liver disease
where the Mexican Hat surrounded by phospholipid in -Hemolytic
cholesterol, /cells with bull’s colorless area the membrane anemia
eye appearance
phospholipids, and a peripheral -Def in Lecithin -HbSS
and ring. cholesterol acyl -HbCC
carbohydrates transferase -LCAT def.
are found. (LCAT).
3. BISCUIT CELL -Cell assumes a -Cell membrane Hempoglobinopa
(folded RBC) “Pocket book is folded. thies:
roll” -HbSC disease 8. TEARDROP -Cells appear in -Abnormal -HA (hemolytic
appearance or -HbCC disease CELL the shape of a maturation anemia)
biscuit shape. (DACRYOCYTE) teardrop or squeezing and -MA
pear with a fragmentation (megaloblastic
single short or during splenic anemia
long protrusion. passage. -MMM
4. BURR CELL -Cell with - Abnormal -Uremia (myelofibrosis
(echinocyte) irregularly lipid content of -MAHA with myeloid
spaced blunt the membrane (Microangiopath metaplasia)
processes, ic hemolytic -Severe type of
resembles anemia) anemia
crenated RBC. -Liver disease 9. ELLIPTOCYTES -Oval or -Abn membrane Can be found in:
-Has multiple -DIC (ovalocytes) elliptical. due to defective -Healthy person
small (disseminated -Hb appears to spectrin,def in -Megaloblastic
projections that intravascular bBe band protein 4.1 anemia
are evenly coagulation) concentrated *Principal -Hypochromic
spaced over the -TTP at the two ends defect is in the anemia
cell (Thrombotic of the cell cytoskeleton (decrease Hgb
(circumference) thrombocytopen leaving a normal content)
ic purpura) central area of -Hereditary
-PK (Polycystic pallor. ovalocytosis
kidney disease) -Life span is
5. BLISTER CELL -Cell w/ -G6P def. -G6PD def. shortened.
(bite cell) eccentric resulting to -HUS (Hemolytic -Pencil
vacuoles due to accumulation of uremic syndrom form/egg-
the plucked-out Heinz bodies e) shaped, sausage
Heinz body. (products of -MAHA (group of rod shape, cigar
denatured Hgb) condition that is shape, tobacco
associated with shape.
anemia,
hemolysis, and

Reference: Mrs. Agnes Guzman, RMT

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MIDTERMS WEEK 8: RBC ANOMALIES
10. SPHEROCYTE -Small round -Primary: -Chronic 13. -Characterized Abnormal Stomatocytosis
dense cell Spectrin Def lymphocytic STOMATOCYTE by an elongated potassium ratio. is found in:
which lacks the -Secondary: leukemia (mouth cell) or slit-like -Alcoholic
central pallor defective -Immune area of central cirrhosis
area usually interaction of hemolytic pallor -Hereditary
microcytic and spectrin wl anemia due to -Caused by stomatocytosis
sphere shaped. other skeletal ABO osmotic hepatobiliary
-Cells become proteins. incompatibility. changes due to disease
smaller and - Hereditary cation -Rh null
denser r with spherocytosis imbalance syndrome
increase Hb -Immune (Na,K).
content and hemolytic -Also known as
become less anemia hydrocyte
deformable with -Extensive -Called mouth
age. burns (along cell because of
-Shortened with the slit-like
survival time schistocytes area,
because they -Could either be
can be acquired or
sequestered in hereditary PATHOLOGICAL CHANGES IN RBC
the spleen and
destroyed.
-3.4 in diameter
when cut.
11. SICKLE CELLS -Crescent -Found in sickle
(drepanocytes)/ shape cell due anemia and
Menisocyte to abnormal sickle cell trait.
aggregation of
HbS which gives
a tendency for
the cell to
assume a sickle
shape.
-Has no central
pallor.
-Sickle cells are Notes:
thin and Anisocytosis: variations in size (micro and macro).
elongated with *are interpreted through the computation of blood indices as
pointed ends long as we have the CBC.
and are well Low Hgb content: hypochromic cell
filled with Hb Membrane abnormalities: spherocytes
that’s why is Hemoglobinopathies: target cells (codocytes), sickle cells
has no central (menisocyte/drepanocyte).
pallor.
-They may be IV. VARIATION DUE TO THE PRESENCE OF INCLUSION
curved or BODIES
straight or have -Our RBC DOES NOT HAVE ANY INCLUSION BODIES
S, V or L shaped.
A. DIFFUSE BASOPHILIA
12. -Irregularly, -Cell -MAHA (always
SCHISTOCYTES
Supravital Stain: Dark blue granules and filaments in
contracted cell; fragmentation incorporated
(schizocyte) cytoplasm
fragmented cell due to trauma with
Wright Stain: Bluish tinge throughout cytoplasm
-Helmet or caused by schistocytes)
Composition of inclusion: RNA
triangular form. physical and -TTP
Associated disease and condition: Hemolytic anemia
-Called mechanical -DIC
fragmentocytes -HUS After treatment for iron, vitamin B12 or folate def.
agents.
bc of the -UREMIA
traumas of RBC.
Reference: Mrs. Agnes Guzman, RMT
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MIDTERMS WEEK 8: RBC ANOMALIES
B. BASOPHILIC STIPPLING COI: Denatured hemoglobin
*Are composed of denature hgb
*Mejo madami ang inclusion
ADC: Glucose-6-phosphate dehydrogenase
deficiency
-Unstable hemoglobin
-Oxidant drugs/chemicals

E. PAPPENHEIMER BODIES
SS: Dark blue-purple, fine or coarse punctuate
granules distributed throughout cytoplasm.
WS: Same with SS
COI: Precipitated RNA (the violet granules on the
picture)
*The inclusion bodies are spread out on the RBC.
ADC: Lead poisoning (is ALWAYS associated with
basophilic stippling).
Can also be seen in:
-Thalassemia SS: Irregular clusters of small, light to dark blue
-Hemoglobinopathies granules often near periphery of the cell.
-Megaloblastic anemia WS: same with SS
-Myelodysplastic syndrome COI: Iron
*Inclusion is ferric iron
C. HOWELL-JOLLY BODY *Stain used for identification is Prussian blue if you
want to confirm it, use iron stain.
ADC:
-Sideroblastic anemia
-Hemoglobinopathies
-Thalassemia
-Megaloblastic anemia
-Myelodysplastic syndrome
-Hyposplenism
SS: Dark blue-purple dense, round granule; usually -Post-splenectomy
one per cell; occasionally multiple.
WS: Same with SS F. CABOT RINGS
COI: DNA (nuclear fragment)
*Inclusion is on the periphery.
ADC: Hyposplenism Post-splenectomy
-Megaloblastic anemia Hemolytic anemia
-Thalassemia
-Myelodysplastic syndrome
SS:
D. HEINZ BODIES Rings or figure of eights
WS: Blue rings or figure of eights
COI: Remnant of mitotic spindle
ADC: Megaloblastic anemia
-Myelodysplastic syndromes

G. HEMOGLOBIN H INCLUSIONS

SS: Round, dark blue-purple granule attached to

inner RBC membrane
WS: not visible

Reference: Mrs. Agnes Guzman, RMT

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MIDTERMS WEEK 8: RBC ANOMALIES
SS: Fine, evenly dispersed, dark blue granules;
Imparts “golf ball” appearance to RBCs
WS: not visible
COI: Precipitate of b-globin chains of
hemoglobin
ADC: Hb H disease

MISCELLANEOUS VARIATIONS
1. Rouleaux formation

-Stacks of coins
-Pathologic: Increased proteins
-Non-pathologic: Due to improper staining

2. Partially hemolyzed
-RBC
-Improper extraction and staining

3. Acid stain of erythrocytes

-Red cell is colored RED

4. Alkaline stain of erythrocytes

-If buffer solution is too alkaline, red cell are colored dirty
gray.
-pH is not 6.4 (not preferable)

5. Design Formation of RBC

-Caused by fat or oil on the slide ahead of the spreader during
the smear preparation.
-One of the factors is the use of an old slide (new slide is
good).

Reference: Mrs. Agnes Guzman, RMT