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Dr Jamil Mourad
Hypochromia
Corresponds to a very thin rim of Hgb and a larger center pale area.
These red cells are often microcytic and are seen in iron deficiency,
thalassemias
sideroblastic anemia
Microcytosis
<6 micrometers in diameter
These cells are usually hypochromic and have prominent central pallor. Differential diagnosis includes
Macrocytosis
>9 micrometers in diameter
Differential diagnosis includes liver disease alcoholism aplastic anemia myelodysplasia
Megaloblastic anemias (B12 and folate deficiencies) have macro-ovalocytes (large oval cells). Reticulocytes are large immature red cells with polychromatophilia.
Schistocytes
fragmented cells
Schistocytes are caused by mechanical disruption of cells in the microvasculature by fibrin strands or by mechanical prosthetic heart valves.
Acanthocytes
speculated cells with irregular projections of varying length
These are often seen with liver disease.
Crenated/Burr Cells
cells with short, evenly spaced cytoplasmic projections
Crenated cells may be an artifact of slide preparation or found in
renal failure
uremia
Heinz bodies:
inclusions seen only on staining with violet crystal
Heinz bodies represent denatured Hgb found in glucose-6-phosphate dehydrogenase after oxidative stress
Bite Cells
cells with a smooth semicircle extracted
Bite Cells are due to: spleen phagocytes that have removed Heinz bodies consisting of denatured Hgb. They are found in
Spherocytes
round, dense cells with an absent central pallor
Spherocytes are seen in immune hemolytic anemia hereditary spherocytosis.
Sickle Cells
sickle-shaped cells
Sickle cells are due to polymerization of Hgb S This occurs from the substitution of a valine for glutamic acid as the sixth amino acid of the beta globin chain,
which produces a hemoglobin tetramer (alpha2/beta S2) that is poorly soluble when deoxygenated.
They are found in sickle cell disease
Target Cells
cells with extra hemoglobin in the center surrounded by a rim of pallor; bulls eye appearance
Target cells are due to an increase in the ratio of cell membrane surface area to Hgb volume within the cell.
They have a central spot of Hgb surrounded by a ring of pallor from the redundancy in the cell membrane.
They are found in liver disease,
post splenectomy,
in hemoglobinopathies.
Teardrop cells/dacryocytes
teardrop-shaped cells
These are found in myelofibrosis myelophthisic states of bone marrow
Polychromatophilia
blue hue of cytoplasm
This is due to the presence of RNA and ribosomes in reticulocytes.
Howell-Jolly bodies
small, single, purple cytoplasmic inclusions
These represent nuclear remnant DNA and are found after Splenectomy with functional asplenism
Basophilic Stippling
Dark-purple inclusions, usually multiple
Basophilic stippling arises from precipitated RNA found in lead poisoning thalassemia
Parasites
A variety of parasites, including malaria, trepanozoma, and babesiosis, may be seen with red blood cells
Rouleaux
red cell aggregates resembling a stack of coins
Rouleaux is due to the loss of normal electrostatic charge-repelling red cells due to coating with abnormal paraprotein, Which is present in multiple myeloma.