RBC ANOMALIES

ERYTHROCYTIC MORPHOLOGY ANISOCYTOSIS:

NORMOCYTES: - Variation in RBC size, indicating a

heterogeneous RBC population
- Normal erythrocytes that are approximately the -
same size as the nucleus of a small -
lymphocyte.

MACROCYTES:

- RBCs greater than 8 um in diameter; MCV

greater than 100 fL
-
POIKILOCYTOSIS:

- General term to describe variation in shape

-

MICROCYTES:

- RBCs less than 6 um in diameter; MCV less

than 80 fL
-

ECHINOCYTES:

- Have evenly spaced round projections; central

pallor area present
-
-
ACANTHOCYTES: TEARDROP CELLS:

- Have unevenly spaced pointed projections; - Pear-shaped cell with one blunt projection
lack a central pallor area -
-
-

SICKLE CELLS:

- Shapes vary but show thin, elongated, pointed

ends and will appear crescent shaped; usually
lack a central pallor area
TARGET CELLS: -
- Show a central area of hemoglobin - Seen in hemoglobinopathies SS, SC, SD, and
surrounded by a colorless ring and a S/ß-thalassemia
peripheral ring of hemoglobin; cells have an -
increased surface-to volume ratio
-
-

SPHEROCYTES: HELMET CELLS:

- Disk-shaped cell with a smaller volume than a - Interior portion of cell is hollow, resembling a
normal erythrocyte; cells have a decreased horn or helmet
surface-to volume ratio -
- Lack a central pallor area
-
- MCHC may be >37%; increased osmotic
fragility
-
-
SCHISTOCYTES: RED CELL DISTRIBUTION WIDTH

- Damaged RBC; fragments of various sizes RDW:

and shapes are present, often with pointed
projections - A calculated index (from the RBC histogram)
- given by hematology analyzers to help identify
anisocytosis
-

RED CELL RED BLOOD CELL SIZE

DISTRIBUTI ↓ N MCV ↑ MCV
ON WIDTH MCV
Normal

Increased

Erythrocyte Inclusions

NUCLEATED RBCs:
STOMATOCYTES: - Usually orthochromic normoblasts but can
appear in any erythrocytic stage of maturation
- Characterized by an elongated or slit-like area
- Indicate bone marrow stimulation or increased
of central pallor
erythropoiesis
-
-
-
-

ELLIPTOCYTES:
HOWELL-JOLLY BODIES:
- Cigar- to egg-shaped erythrocytes
- Associated with defects of the red cell - Small, round DNA fragments (0.5-1.0 um in
membrane proteins diameter) usually one per cell, but can be
- multiple
- Stain dark purple to black with Wright's stain
-
-
BASOPHILIC STIPPLINGS: HEMOGLOBIN SC CRYSTALS:

- Multiple, tiny, fine, or coarse inclusions evenly - 1-2 blunt, fingerlike projections extending from
dispersed throughout the cell; "blueberry the cell membrane
bagel" appearance -
-
-

PAPPENHEIMER BODIES:

- Small, irregular, dark-staining iron granules

usually clumped together at periphery of the
cell
-
-
-

HEINZ BODIES:

- Multiple inclusions ranging in size from 0.3 to

2.0 um
-
-
-
CABOT RINGS:

- Thin, red-violet, single to multiple ring-like

structures that may appear in loop or figure-
eight shapes
-
-

SPOROZOAN PARASITES:

-
-

HEMOGLOBIN C CRYSTALS:

- Condensed, intracellular, rod-shaped crystal

-
ERYTHROCYTE DISTRIBUTIONS MORPHOLOGY GRADING CHART

ROULEAUX: MORPHOLOGY

- Stacking or "coining" pattern of erythrocytes 1. Polychromatophilia

due to abnormal or increased plasma proteins
- May see excessively blue color to smear 2.
macroscopically and microscopically 3. Dacryocytes
-
- 4.
-
5. Schistocytes

6.

GRADING

-
-
-

MORPHOLOGY GRADING CHART

MORPHOLOGY

1. Poikilocytosis

2.

3. Elliptocytes
AGGLUTINATION: 4.
- Characterized by clumping of erythrocytes 5.
with no pattern
- 6.
-
7. Stomatocytes
-
GRADING

-
- .
-

MORPHOLOGY

1. Rouleaux

GRADING

-
-
-

MORPHOLOGY GRADING CHART

MORPHOLOGY

1. Sickle cells

2. Basophilic stippling

3.

4. Howell-Jolly bodies

GRADING

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ERYTHROCYTE HEMOGLOBIN GRADING OF POLYCHROMASIA

NORMOCHROMASIA: POLYCHROMATOPHILIC RBCs:

- 1.

HYPOCHROMASIA: 2.

- Central pallor area is greater than one-third 3.

the diameter of the cell
- 4.
- 5.
-
HYPERCHROMASIA:
GRADING OF HYPOCHROMIA
-
CENTRAL PALLOR:

1. 1+ –

2. 2+ –

3. 3+ –

4. 4+ –

POLYCHROMASIA:

- Variation in hemoglobin content showing a

slight blue tinge when stained with Wright's
stain; residual RNA
-