RED BLOOD CELLS IN

PERIPHERAL BLOOD SMEAR

AOR
HEMATOPOIESIS
HEMATOPOIESIS
PRONORMOBLAST
 BASOPHILIC
NORMOBLAST
POLYCHROMATIC
NORMOBLAST
ORTHOCHROMATIC
NORMOBLAST
RETICULOCYTE
 RBC: PERIPHERAL BLOOD SMEAR

•Size
•Shape
•Hemoglobin Content
•Inclusion
•Immaturity
SIZE
SHAPE
Cells lose the biconcave disc shape Loss of membrane function due to  Hereditary spherocytosis
and assume a spheroidal shape Na pump defect leading to Na  Autoimmune hemolytic anemia
retention increasing osmolarity &
attracting more water into cells
Regular, thorny projections all  Depletion of ATP  Very anemic patients
around the periphery of the cells  Exposure to hypertonic  Uremia
solution  Cirrhosis
 Artifact in air drying  Chronic renal failure
Irregularly speculated red Increased ratio of cholesterol  Abetalipoproteinemia
cells in which the ends of the to lecithin  Hemolytic anemia
spicules are bulbous and  Pyruvate kinase
rounded deficiency
Fragmented red cells Trapping of the RBC between
violently opposed mechanical
surfaces like
1. Fibrin
2. Altered blood vessel walls
3. Prosthetic heart valves
 Disseminated intravascular
coagulation
 Thrombotic
thrombocytopenic purpura
 Microangiopathic hemolytic
anemia
Rod or cigar shaped Polarization of  Thalassemia
hemoglobin  Iron deficiency
 Hereditary
elliptocytosis
* egg like or oval shaped Polarization of  Megaloblastic bone
cell; wider than hemoglobin marrow
elliptocytes  Myelodysplasia
* Mature red cells that  Sickle cell anemia
assume an oval shape
 Show a peripheral rim of  Thalassemia
hemoglobin with a dark,  Obstructive liver disease
central , hemoglobin  Hb SC disease
containing area  Post splenectomy
Erythrocytes with a  Occurs as an artifact  Hereditary
central stoma or mouth of slow drying Stomatocytosis
which appear as an  Increased  Acute alcoholism
unstained central permeability to  Liver disease
biconcave area sodium
 SICKLE CELLS
Crescent shape cell that Polymerization of  Sickle cell anemia
lacks zone of central deoxygenated  Sickle cell disease
pallor hemoglobin
 TEAR DROP (DACROCYTE)
RBCs with single elongated Squeezing and fragmentation
point or tail of cells during splenic
passage/ marrow lacunae
exit
 Myeloid metaplasia
 Thalassemia
 Megaloblastic anemia
 Hypersplenism
 Myelofibrosis
INCLUSIONS
BASOPHILIC
STIPPLING

Fine or coarse gray black  Fine granules represent  Lead poisoning

granules in red cells polychromasia  Thalassemia
(reticulocytes)  Heavy metals
 Coarse granules  Increased reticulocytosis
represents impaired
erythropoiesis
HOWELL-
JOLLY
BODIES

 Coarse round densely  Remnants of nuclear  Megaloblastic anemia

stained 1-2 um granules chromatin within the red  Severe hemolytic process
eccentrically located on cell containing DNA  Thalassemia
the periphery of  Accelerated
membrane erythropoiesis
CABOT
RINGS

 Red violet structures  Remnants of  Pernicious anemia

appearing as rings, microtubules of  Lead poisoning
incomplete rings or mitotic spindle
figure of eight
SIDEROCYTES

Non nucleated red cells  Excessive iron overloading in  Hemolytic anemia

containing bright blue non mitochondria of normoblast  Thalassemia
hemoglobin iron granules  Defective heme synthesis
ROULEAUX
FORMATION

Alignment of RBCs one upon the  Elevated fibrinogen or globulins

another so they resemble stack of  Paraproteinemia (Monoclonal
coins gammopathy)
AGGLUTINATION

Irregular round clumps  Cold agglutinins

HEMOGLOBIN
CONTENT
MATURITY
RETICULOCYTE