Module 5 Abnormal RBC Morphology Acknowledgments Ministry of Health Guyana Centers for Disease Control and Prevention CDC Global AIDS Program GAP Guyana Centers for Disease Control and Prevention CDC Atlanta American Society for Clinical Pathology ASCP Objectives Distinguish normal and abnormal RBC morphology with respect to the following Size including alterations caused by a heterogeneous or dimorphic RBC population Haemoglobin content RNA concentration polychromasia reticulocytes Shape alterations RBC inclusion bodies Variations in red cell pattern Artifact List synonyms for abnormal RBC morphology Objectives Identify the composition of RBC inclusion bodies including the following stains used to identify Wright s Romanowsky stain Perl s Prussian blue iron stain Supravital stain Correlate abnormal RBC morphology with associated conditions Five RBC morphological features are evaluated on the blood smear Variations in RBC Size Variations in RBC Color Variations in RBC Shape RBC Inclusions Variations in RBC Distribution Pattern Five RBC morphological features are evaluated on the blood smear Variations in RBC Size Variations in RBC Color Variations in RBC Shape RBC Inclusions Variations in RBC Distribution Pattern Normocytic RBCs MCV 82 098 0 fL Homogeneous RBC population RDW 14 0 low uniform size RBC Size Variations Anisocytosis A variety of different sizes Heterogeneous RBC population RDW 14 0 high Variations in RBC Size Microcytosis MCV 82 0 fL Macrocytosis MCV 98 0 fL The red cells shown in A B and C appear B A A Macrocytic and anisocytosis B Microcytic hypochromic C Normocytic C The red cell picture shown demonstrates Anisocytosis with high RDW RBC population is heterogeneous with microcytic and macrocytic red cells aka dimorphic with two RBC populations Five RBC morphological features are evaluated on the blood smear Variations in RBC Size Variations in RBC Color Variations in RBC Shape RBC Inclusions Variations in RBC Distribution Pattern Variations in RBC Size and or Hgb Content Color The red cells shown in A and B exhibit A A Hypochromia B Polychromasia B Five RBC morphological features are evaluated on the blood smear Variations in RBC Size Variations in RBC Color Variations in RBC Shape RBC Inclusions Variations in RBC Distribution Pattern Variations in RBC Shape Poikilocytosis Abnormal RBC Shape Rigid RBCs Normal Discoid Shape Deformable Red Cells End stage Liver disease Schistocytes Spherocytes Damaged red cells Variations in RBC Shape Acanthocytes No pallor Spherocytes No pallor Echinocytes Have a pallor Includes crenated burr cells The red cells at the arrows are Acanthocytes no pallor area a spherocyte with projections Variations in RBC Shape Target Cells Codocytes looks like bull s eye Hemoglobin molecules crystallize C Crystals Changes how molecule binds oxygen which alters the shape of the cell Sickle Cells Drepanocytes Variations in RBC Shape C crystal Hgb C SC crystals Hgb S Hgb C Sickle Cells Hgb S If there is a defect at the molecular level DNA mutates and have altered information so the defects will be multiplied and divided pass on defect to progeny Note the target cells The red cells at the arrows are a Sickle cells that contain Hgb S b C crystals that contain Hgb C c SC crystals that contain Hgb S AND Hgb C c SC crystals bizarre shape Variations in RBC Shape Normocytic Ovalocytes Ovalocytes Elliptocytes Macrocytic Ovalocytes Pencil forms microcytic hypochromic Variations in RBC Shape Teardrops Dacrocytes Stomatocytes Five RBC morphological features are evaluated on the blood smear Variations in RBC Size Variations in RBC Color Variations in RBC Shape RBC Inclusions Variations in RBC Distribution Pattern RBC Inclusions Howell Jolly bodies Nucleated RBC NucRBC Pap body HJB Indicate excess iron Pappenheimer bodies Could indicate lead poisoning have to report because environmental hazard Can lead to mental retardation Basophilic stippling a stippled RBC with punctate dark dots RBC Inclusions Pappenheimer bodies Wright s stain Jun k Pappenheimer bodies Prussian blue iron stain Jun k NRBC Polychromasia Wright s stain Reticulocytes Supravital stain Lymph Supravital is Methylene blue RBC Inclusions A Diffuse Polychromasia faint dots B Stippled RBCs punctate dots B Heinz Bodies Wright s stain not visible Cabot Ring figure 8 Supravital stain A Heinz Bodies Supravital stain RBC Inclusions Malarial ring forms P falciparum Cabot rings Platelet on RBC Parasites Malarial gamete form P falciparum Malarial gamete form P vivax Identify the RBC inclusions at A B and C A B C A Basophilic stippling B Howell Jolly body C Pappenheimer bodies Five RBC morphological features are evaluated on the blood smear Variations in RBC Size Variations in RBC Color Variations in RBC Shape RBC Inclusions Variations in RBC Distribution Pattern Variations in RBC Distribution j Normal RBC Distribution RBC Agglutination Rouleaux Immunoglobulins proteins are antibodies ROULEAUX If concentration is too high it coats the red cells causes the erythrocytes to stick together because increased levels of proteins Higher than normal levels of immunoglobulins REVERSIBLE Can dilute using IV fluids for example causes cells to separate RBC Agglutination Cells are stuck together IRREVERSIBLE result of antigen antibody interaction antibody recognizes antigen on surface of body can be lethal depending on where it happens and extent if it is systemic in blood stream it can get deposited everywhere in the body Erroneous RBC Morphology due to Artifact Precipitated Stain Oil Artifact Crenated cells spherocytes due to poor smear wrong area Crenated cells something inadequate about fixing process methanol by which diluent is stained or TOO MUCH exposure to water during the buffer process Stain fixed buffer Summary for RBC Morphology RBC Morphology Size including alterations caused by a heterogeneous or dimorphic RBC population Haemoglobin content RNA concentration polychromasia reticulocytes Shape alterations RBC inclusion bodies Variations in red cell pattern Artifact synonyms for abnormal RBC morphology composition of RBC inclusion bodies including stains used to identify abnormal RBC morphology with associated conditions Polymorphism is when clonal development that can be differed is how you have two different issues at the same time 2 different abnormalities in the same patient Malaria found in tropical zones is now being found in places where it was never found before Global warming is the cause of this They