the presentation will allow you to identify the different state maturation of RBC and to see the the different abnormally including the cell membrane abnormality , the inclusion bodies may appear in RBC ,and other cell abnormality.
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Morphological abnormality of red blood cell
1. RED BLOOD CELL NORMAL &
ABNORMAL
NAZAR AHMED MOHAMED ABD-ALLA
BSC - OMDURMAN AHLIA
HIGH DOPLOMA DGREE - ELZAEM EL-AZHARY
FORMER HEAD OF HEMATOLOGY & BLOOD BANK
MINISTRY OF HEALTH – LABORATORY ADMINISTRATION
KHARTOUM STATE
MARKETING MANAGER-LAB EQP –DIVISION
ALGAM COMPANY FOR DRUGS & CHEMICAL LTD
1
NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
2. Learning Objective
*MAIN OBJECTIVE OF PRESENTATION IS TO
KNOW DIFFERENT TYPE OF NORMAL RED
BLOOD CELL AND ABNORMAL CELL AND
CASES WHERE THIS TYPE OS CELL CAN BE
PRESENT
2
NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
3. RED BLOOD CELL MORPHOLOGY
*Red blood when it get mature it compose of :
-Cell membrane: (compose of protein 50% , lipid 40% and carbohydrate
10%)
-Enzyme: (Mainly Glucose 6 phosphate dehydrogenase and pyrovate
kinas)
-Cytoplasm: (Which Hemoglobin) …..
*Any abnormality in this composition acquire or inherited lead to
abnormal production or a viability of red cell.
*This abnormality are vary which may be:
-Abnormal in shape (poikelocytosis).
-Abnormal in size (Anisocytosis).
-Presences of inclusion or Parasite.
*All this change will give type of abnormal cell as we can see in the
following topic.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
5. 1- RBC MATURATION:
1-Pronormoblast
*Rarely seen in peripheral blood picture
except in acute erythrocytic leukemia (M6) if
seen in peripheral can be comment as blast
cell.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
7. 2-Basophilic Normoblast
*NRBC which appear in peripheral due to
hemolysis (observe the preneuclear zone to
distinguish from myeloblasts) USUALLY SEEN
IN BONE MARROW.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
11. 4-ORTHOPHILIC NORMOBLAST
*Late NRBC also appear due to increase
RBC destruction & bone marrow
compensation.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
13. 5-Polychromatic RBC
*This cell appears in the peripheral
usual in ratio up to 1.5% when stain
with retics stain appears as
Reticlocyte.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
19. 2-MORPHOLOGY ASSOCIATED WITH
MEMBRANE DEFECT
*1-ACANTHOCYTE:
*The acanthocyte is an abnormally crenated
RBC.
*It is the consequences of a defect in the cell
membrane.
*Observed in:
-Abetalipoproteinemia.
-Liver disorders.
-Lipid metabolism disorders.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
21. 2-SPHEROCYTE
*The spherocyte is an erythrocyte in which
the biconcave disc profile is lost.
*It appears as a smaller and denser RBC.
*Observed in:
*Immune induced hemolysis.
*Post blood transfusions
*Congenital anemia.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
23. 3-Stomatocyte
*Stomatocyte is characterized by a slit-like or narrow
rectangular area of pallor in the cell.
*It is observed in:
-Liver disease.
-Alcoholism.
-Electrolyte imbalance.
-Hereditary stomatocytosis.
-Infectious mononucleosis.
-Lead poisoning.
-Malignancies.
-Thalassemia minor.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
25. 4-Elliptocytosis
*There is known to be a hereditary defect present in
the RBC cytoskeletal proteins (the spectrin chain).
*These cells observed in varying percentages in:
-Iron deficiency anemia.
-Leukemia associated anemias.
-Thalassemia.
-Dyserythropoiesis.
*Patients with congenital elliptocytosis may
demonstrate up to 90% distinctly oval shaped cells.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
27. 3- CONDITION ASSOCIATED WITH HEMOGLOBIN
DEFECT
* 1-HbC Crystal:
*Found in:
-Hemoglobin C .
-Hemoglobin SC disease.
*If the condition is severe,then up to 10% of
the RBC’s may contain these crystals.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
29. 2-Sickle cell
*There are two basic types of sickle cells:
*[1] the oat cell, slightly sickled variation,
and/or holly leaf.
*[2] The second type form very distorted
filamentous forms.
*In the presence of a reduced oxygen
atmosphere these cells form, but when the
oxygen pressure is normalized, they do NOT
revert back to the normal discoid shape.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
31. 4-RBC INCLUSION BODIES.
:BASOPHILLING SSIPPLING-1*
*Basophilic stippling (also called punctate
basophilia), is characterized by the presence of
numerous granules in the erythrocyte.
*They are observed in:
-Lead poisoning.
-Hemoglobinopathy.
-Alcoholism.
-Megaloblastic anemias.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
33. 2-CABOT RING
* The Cabot ring is a purple staining ring-like
filament or figure-8 and is thought to be
formed from the microtubules of the mitotic
spindle.
*It is most likely to be seen in:
-Severe anemias (example: pernicious
anemia) and lead poisoning.
33
NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
35. 3-HIENZ BODIES
*These consist of precipitate globins chain of
hemoglobin .
*They occur when there is defective
reducing capacity in the cell as in glucose -6-
phosphate dehydrogenase deficiency .
*Particularly after drugs which stress this
pathway.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
37. 4-HOWELL-JOLLY BODY
*They are usually observed in the mature erythrocyte,
but may also be seen in the
*They are formed during the process of karyorrhexis,
usually in the megaloblast.
*If more than two “HoJo bodies” are present in the red
cells, then the patient may have megaloblastic anemia.
*They are also observed in:
-Hemolytic anemias.
-Pernicious anemia.
-Post-operative conditions.
-Splenectomy.
-Splenic atrophy.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
39. 5-Pappenheimer BODIES
*These granules (which are
aggregates of mitochondria,
ribosome's and iron particles)
seen in hyposplenism and
hemolytic anemia.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
41. 6-MALARIA PARASITE
* Observe in patient infected with malaria
parasite of one of 4 species
*The cell may contain:
-Schizont.
-Trophozite.
-Gametocyte which depends on the type of
species.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
43. 5-Miscellaneous
1-Fragmented cell
*Fragments of erythrocytes with wide variation
in sizes and shapes, usually microcytic in size.
*Schistocytes are seen in:
-Vascular lesions.
-Uremia.
-Microangiopathic hemolytic anemias.
-Hemolytic anemias cause by physical agents.
-Dintravascular coagulation (DIC).
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
45. 2-Target cell
*This cell is characterized by an abnormally thin
membrane with an increase incorporation of
cholesterol into the cell membrane.
*It is observed in:
-Hemoglobinopathy.
-Hepatic diseases,
-Iron deficiency anemia.
-Hemolytic anemia.
-Splenectomy.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
49. 4-Microcytic cell
*Cell seen in:
-Low MCV value associated with:
- (IDA, THALASSEMIA, SIDROBLASTIC, And
ANEMIA OF CHRONIC DISORDER)
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
51. 5-Leptocyte
*Thin cell that is large in diameter and
generally displays a thin rim of hemoglobin at
the periphery and a large area of central
pallor.
*This cell is seen in liver disease and
hypochromic anemias.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
53. 6-Kinzocyte
*Knizocytes are RBC’s with more than two
concavities.
*They are observed in hemolytic anemia and
hereditary spherocytosis.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
55. 7-Macrocytic cell
*This can be seen in:
-Vitamin B12 deficiency.
-Folic acid deficiency.
-Disease of the liver.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
57. 8-Echinocyte cell
*Crenation is usually not an indicator of a
pathological problem.
*It is usually an artifact due to:
*[1] loss of intracellular fluid.
*[2] increased anti-coagulant blood ratios (due to a
technique during a phlebotomy or manufacturing
error in measuring anticoagulant in the vacutainer
tube).
*[3] slow drying of the blood film
*[4] the patient being dehydrated
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
60. 10-Burr cell
*The burr cells are characterized by abnormal
cytoplasmic projections, but not to the same
extent as that of the acanthocyte.
*These cells are observed in:
-Uremia.
-Acute blood loss.
-Stomach cancer.
-Pyruvate kinase deficiency.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
62. 11-Ovalocyte cell
*The cell become oval in shape
Condition which can be seen in pernicious
anemia (macro ovalocyte).
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
64. 12-Rouleaux formation
*They are sometimes present as”
-A slide artifact due to a delay in the spreading of blood .
-The settling out phenomenon in the thick portion of the blood
smear.
*Rouleaux appear in :
-Chronic inflammatory disorders.
-Multiple myeloma.
-Hyperproteinemia.
-Waldenström’s macroglobulinemia.
*Increased amount of fibrinogen in the blood can cause rouleaux
formation.
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NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007
73. Learning Outcome
*KNOW DIFFERENT TYPE OF NORMAL RED
BLOOD CELL AND ABNORMAL CELL AND
CASES WHERE THIS TYPE OS CELL CAN BE
PRESENT
NAZAR AHMED MOHMED
ABDALLA(SANGOOR)
73
74. THANK YOU FOR GOOD ATTENTION
NAZAR AHMED MOHMED
ABDALLA(SANGOOR)
74
