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  • 1. LABORATORY DIAGNOSIS RED BLOOD CELLS
  • 2. PRONORMOBLASTPRONORMOBLAST  Size: 12-20 umSize: 12-20 um  Nucleus: round;Nucleus: round; nucleoli (1-2); finenucleoli (1-2); fine chromatinchromatin  Cytoplasm: dark blueCytoplasm: dark blue  N/C ratio: 8:1N/C ratio: 8:1  Reference interval:Reference interval: BM: 1%BM: 1% PB: 0%PB: 0%
  • 3. BASOPHILIC NORMOBLAST • Size: 10-15 um • Nucleus: round; nucleoli 0-1; slightly condensed chromatin • Cytoplasm: dark blue • N/C ratio: 6:1 • Reference interval: BM: 1-4% PB: 0%
  • 4. POLYCHROMATIC NORMOBLAST • Size: 10-12 um • Nucleus: round; nucleoli 0; quite condensed chromatin • Cytoplasm: gray blue • N/C ratio: 4:1 • Reference interval: BM: 10-20% PB: 0%
  • 5. ORTHOCHROMIC NORMOBLASTORTHOCHROMIC NORMOBLAST  Size : 8-10 umSize : 8-10 um  Nucleus : round ;Nucleus : round ; nucleoli = 0 ; fullynucleoli = 0 ; fully condensed chromatincondensed chromatin  Cytoplasm : blue toCytoplasm : blue to salmonsalmon  N/C ratio : 0.5:1N/C ratio : 0.5:1  Reference interval :Reference interval : BM : 5-10%BM : 5-10% PB : 0%PB : 0%
  • 6.  Size : 8-8.5 umSize : 8-8.5 um  Nucleus : absentNucleus : absent  Cytoplasm : blue toCytoplasm : blue to salmonsalmon  N/C ratio : NAN/C ratio : NA  Reference interval :Reference interval : BM : 1%BM : 1% PB : 0.5% - 2%PB : 0.5% - 2% POLYCHROMATIC ERYTHROCYTEPOLYCHROMATIC ERYTHROCYTE
  • 7.  Size : 7-8 umSize : 7-8 um  Nucleus : absentNucleus : absent  Cytoplasm : salmonCytoplasm : salmon  N/C ratio : NAN/C ratio : NA  Reference interval :Reference interval : BM : NABM : NA PB : PredominantPB : Predominant cell typecell type ERYTHROCYTEERYTHROCYTE
  • 8.  ASSOCIATED WITH:ASSOCIATED WITH: iron def. anemia,iron def. anemia, sideroblastic anemia,sideroblastic anemia, thalassemia minor,thalassemia minor, chronic diseasechronic disease (occasionally), lead(occasionally), lead poisoning, somepoisoning, some hemoglobinopathieshemoglobinopathies ERYTHROCYTE: VARIATIONS IN SIZEERYTHROCYTE: VARIATIONS IN SIZE MICROCYTE
  • 9.  Normal erythrocytesNormal erythrocytes are approximately theare approximately the same size as thesame size as the nucleus of a smallnucleus of a small lymphocytelymphocyte ERYTHROCYTE: VARIATIONS IN SIZEERYTHROCYTE: VARIATIONS IN SIZE NORMOCYTE
  • 10.  ASSOCIATED WITH:ASSOCIATED WITH: liver disease, vitaminliver disease, vitamin B12 deficiency, folateB12 deficiency, folate deficiency, neonatesdeficiency, neonates ERYTHROCYTE: VARIATIONS IN SIZEERYTHROCYTE: VARIATIONS IN SIZE MACROCYTES
  • 11.  ASSOCIATED WITH:ASSOCIATED WITH: transfusion,transfusion, myelodysplasticmyelodysplastic syndromes, vit. B12,syndromes, vit. B12, folate, or ironfolate, or iron deficiencies – early indeficiencies – early in treatment processtreatment process DIMORPHIC POPULATION OF ERYTHROCYTESDIMORPHIC POPULATION OF ERYTHROCYTES
  • 12.  NormochromicNormochromic erythrocyteserythrocytes HEMOGLOBIN CONTENT OF ERYTHROCYTESHEMOGLOBIN CONTENT OF ERYTHROCYTES
  • 13.  ASSOCIATED WITH:ASSOCIATED WITH: iron deficiencyiron deficiency anemia,anemia, thalassemias,thalassemias, sideroblastic anemia,sideroblastic anemia, lead poisoning, somelead poisoning, some cases of chroniccases of chronic diseasedisease HEMOGLOBIN CONTENT OF ERYTHROCYTESHEMOGLOBIN CONTENT OF ERYTHROCYTES Hypochromia
  • 14.  ASSOCIATED WITH:ASSOCIATED WITH: acute and chronicacute and chronic hemorrhage,hemorrhage, hemolysis, effectivehemolysis, effective treatment for anemia,treatment for anemia, neonatesneonates HEMOGLOBIN CONTENT OF ERYTHROCYTESHEMOGLOBIN CONTENT OF ERYTHROCYTES Polychromasia
  • 15. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Acanthocyte (Spur Cell) ASSOCIATED WITH: abetalipoproteinemia, severe liver disease, splenectomy, malabsorption, hypothyroidism, vit. E deficiency
  • 16. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Echinocytes (Burr Cell) ASSOCIATED WITH: uremia, pyruvate kinase def., microangiopathic hemolytic anemia, artifact
  • 17. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Spherocytes ASSOCIATED WITH: hereditary spherocytosis, some hemolytic anemias, transfused cells, severe burns
  • 18. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Codocyte (Target cell) ASSOCIATED WITH: hemoglobinopathies, thalassemia, iron deficiency anemia, splenectomy, obstructive liver disease
  • 19. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Drepanocyte (Sickle cell) ASSOCIATED WITH: Homozygous hemoglobin S disease
  • 20. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Stomatocyte ASSOCIATED WITH: Hereditary stomatocytosis, alcoholism, liver disease, Rh null phenotype, artifact
  • 21. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Elliptocytes ASSOCIATED WITH: Hereditary elliptocytosis or ovalocytosis, thalassemia major, iron deficiency anemia, megaloblastic anemias (macro ovalocytes), myelopthisic anemias Ovalocytes
  • 22. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Schizocyte (Schistocyte) ASSOCIATED WITH: Microangiopathic hemolytic anemia (DIC), severe burns, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, renal graft rejection
  • 23. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Dacryocyte (Tear Drop Cell) ASSOCIATED WITH: Myelofibrosis with myeloid metaplasia, thalassemias, myelophthisic anemias, other causes of extramedullary hematopoiesis
  • 24. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Rouleaux formation ASSOCIATED WITH: Increased concentrations of globulins and/or paraproteins
  • 25. VARIATIONS IN SHAPE AND COLORVARIATIONS IN SHAPE AND COLOR Autoagglutination ASSOCIATED WITH: Antigen/ antibody reactions
  • 26. INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES  Color : Dark blue to purpleColor : Dark blue to purple  Shape : round to ovalShape : round to oval  Size : 1 umSize : 1 um  Number per cell : usuallyNumber per cell : usually 1; maybe multiple1; maybe multiple  Composition : DNAComposition : DNA  Associated with :Associated with : Splenectomy,Splenectomy, hyposplenism,hyposplenism, megaloblastic anemia,megaloblastic anemia, hemolytic anemiahemolytic anemia Howell-Jolly bodies
  • 27. INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES  Color : Dark blue to purpleColor : Dark blue to purple  Shape : fine or coarseShape : fine or coarse granulesgranules  Number per cell :Number per cell : numerous with fairly evennumerous with fairly even distributiondistribution  Composition : RNAComposition : RNA  Associated with : LeadAssociated with : Lead intoxication, thalassemia,intoxication, thalassemia, abnormal heme synthesisabnormal heme synthesis Basophilic stippling
  • 28. INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES  Color : light blueColor : light blue  Shape : fine irregularShape : fine irregular granules in clustersgranules in clusters  Number per cell : usuallyNumber per cell : usually one clusters; may beone clusters; may be multiples. Often atmultiples. Often at periphery of cellperiphery of cell  Composition : IronComposition : Iron  Associated with :Associated with : Splenectomy, hemolyticSplenectomy, hemolytic anemia, sideroblasticanemia, sideroblastic anemia, megaloblasticanemia, megaloblastic anemia,anemia, hemoglobinopathieshemoglobinopathiesPappenheimer bodies (Siderotic granules)
  • 29. INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES  Color : dark blue to purpleColor : dark blue to purple  Shape : loop, ring, orShape : loop, ring, or figure of eight; may lookfigure of eight; may look like beads on a stringlike beads on a string  Number per cell : 1-2Number per cell : 1-2  Composition : thought toComposition : thought to be remnants of mitoticbe remnants of mitotic spindlespindle  Associated with :Associated with : Myelodysplastic syndrome,Myelodysplastic syndrome, megaloblastic anemiamegaloblastic anemia Cabot ring
  • 30. INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES  Stained with NewStained with New Methylene BlueMethylene Blue  Cell : anuclearCell : anuclear immature erythrocytesimmature erythrocytes  Composition :Composition : precipitated RNAprecipitated RNA  Number :Number : ≥2/cell≥2/cell  Color : dark blueColor : dark blue  Associated with:Associated with: erythrocyte maturationerythrocyte maturation Reticulocytes
  • 31. INCLUSIONS IN ERYTHROCYTESINCLUSIONS IN ERYTHROCYTES  Stained with NewStained with New Methylene BlueMethylene Blue  Cell : mature RBCCell : mature RBC  Composition : precipitatedComposition : precipitated hgbhgb  Number : single orNumber : single or multiple, generallymultiple, generally membrane boundmembrane bound  Color : dark blue to purpleColor : dark blue to purple  Associated with: UnstableAssociated with: Unstable hgb, somehgb, some hemoglobinopathies, somehemoglobinopathies, some RBC enzyme deficienciesRBC enzyme deficiencies Heinz bodies
  • 32. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES Iron Deficiency Anemia
  • 33. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES Thalassemia minor PB : microcytosis, slight hypochromia, codocytes, basophilic stippling
  • 34. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES Thalassemia major PB : numerous nucleated RBC’s, microcytes, hypochromia, codocytes, basophilic stippling, many dacyocytes, many schizocytes, polychromasia
  • 35. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES Macrocytic anemia (nonmegaloblastic type) PB : round macrocytes (MCV = 112 fl), leukocyte and platelet counts usually normal BM : no megaloblastic changes
  • 36. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES Megaloblastic anemia PB : pancytopenia, oval macrocytes, Howell-Jolly bodies, nucleated RBC’s, basophilic stippling, hypersegmentation of neutrophils, giant platelets, codocytes, schizocytes, spherocytes, dacrocytes
  • 37. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES Aplastic anemia PB : pancytopenia, normocytic, normochromic (occasional macrocytes) BM : hypocellular; lymphocytes may predominate
  • 38. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : spherocytes, schizocytes, polychromasia, nucleated RBC’s Immune Hemolytic Anemia
  • 39. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : increased number of nucleated erythrocytes, macrocytic/normochromic, polychromasia, spherocytes Hemolytic Disease of the Newborn
  • 40. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : Spherocytes (variable in number), polychromasia; nucleated erythrocytes possible Hereditary Spherocytosis
  • 41. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : >25% elliptocytes, usually >60% elliptocytes; indices are normocytic, normochromic Hereditary Elliptocytosis
  • 42. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : Codocytes, spherocytes, microcytes, polychromasia, intracellular or rod-shaped crystals possible Hemoglobin CC disease
  • 43. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : Drepanocytes (in crises), codocytes, nucleated rbc’s, schizocytes, Howell-Jolly bodies, basophilic stippling, polychromasia, increased leukocyte count with neutrophilia, increased platelet count Hemoglobin SS disease
  • 44. DISEASES AFFECTING ERYTHROCYTESDISEASES AFFECTING ERYTHROCYTES PB : Few sickle cells, codocytes, intraerythrocytic crystals. Crystalline aggregates of hemoglobin SC may protrude from the erythrocyte membrane Hemoglobin SC disease