Dr Samson Ehe Teron SpPK

Clinical Pthologist
NORMOCYTIC (NORMAL SIZE)
 biconcave shape , no nucleus
SIZE
 7.2 X 2.1 µm
NORMOCHROMIC
 Hemoglobin content in rbc.
 Normal colour : pinkish red
(wright / leishman staining).
 Pale central area -1/3 of total
surface
 normocytic

microcytic
marcocytic
 MCV < 90 fl
 Defect in nuclear maturation /
stimulated erythrocytes.
Disorder : Folate and vitamin B12
deficiency , reticulocytosis.
m
i  Low in hemoglobin
c synthesis.
 MCV > 80 fl
r  Disorder : iron
deficiency anaemia ,
o thalassemia and
c hemoglobinopathies ,
malabsorption syndrome.
y
t
i
c
 Target
Sickle cell cell
Tear drop cell
(drepanocyte (codocyte
(dacryocytes)
s) s)

Helmet cell Thorn cell

(schizocyte (acanthocyte
s) s)
Shape
variation
Burr cell
(echinocytes)
Blister
cell Ovalocytes
/
Spherocyte elliptocyte Stomatocyte
s s s
 Sickle cell
(drepanocytes)
No central pallor
Usually forming the shape
of a cresent or banana.

Dense hemoglobin
(dark red to light
purple)

Disorder : sickle
cell anemia
 About the same size
Target cell as normal RBC
(codocytes)

Disorder : liver
disease , thalassemia

Bull’s eye appearance

(resembles the target sign)

Due to excess membrane

cholesterol or low haemoglobin
content
 Thorn cell (acanthocytes)
Multiple thorny , spikes.

No central
pallor

Rare thorn cell may be

seen in a blood smear
Also known as spur cell which may be due to the
very old RBC’s

Disorder : cirrhosis , neonatal

hepatitis and post-splenectomy
Causes : decrease deformability which leads
to increasing cell rigidity and premature
destruction.

Disorder : bleeding in gastric

ulcers , peptic ulcer and
gastric carcinoma.

Evenly
distributed ,
uniformly sized
spicules

BURR CELL
(ECHINOCYTES)
Due to underlying “slit-like” or
RBC membrane “mouth-like “
defect. central pallor.

Compact and Disorder : alcoholism ,

round shape thalassemia minor ,
hereditary spherocytosis.

STOMATOCYTES
 Disorder : thalassemia
, hemolytic anemia ,
Usually iron deficiency
longer and anemia.
narrower
than normal
RBC.

Usually has
a central
OVALOCYTES / pallor

ELLIPTOCYTES
 No central Doughnut
pallor shaped

SPHEROCYTES
Due to loss of
MCV may be normal of membrane due to
slightly decreased aging , antibody
coating or genetic
defect.
Disorder : autoimmune
hemolytic anemia , transfusion
reaction
 BLISTER Vacuoles may
CELL ruptured

Thinner area at periphery / outer

membrane of cell membrane.

Disorder : pulmonary
emboli in sickle cell
anemia , microangiopathic
hemolytic anemia
 An army helmet
features with short
straps.

Remains after Disorder : emboli ,

rupturing of G6PD deficiency ,
blister cell hemolytic anemia

HELMET CELL
(SCHIZOCYTES)
 TEAR DROP CELL
(DACRYOCYTES)
Increase number of
tear drop RBC is a clue
Unipolar tapered to a possible
end with a blunt tip underlying marrow
process.

Disorder : thalassemia , severe

anemia , megaloblastic anemia ,
mylefibrosis.
 Normal erythrocytes
: pinkish red with
lighted coloured Anisochromia : uneven
centre. coloration of erythrocytes.

Hypochromia : central pallor

exceed 1/3 of the cell membrane.
Hyperchromia :
erythrocytes is
intensively coloured.
Polychromatophilia :
cytoplasm is greyish-
orange in colour.

VARIATION IN RED CELL

COLORATION
 AGGLUTINATION
Irregular overlapping
aggregate of RBC’s.
Seen in cold antibody
syndrome
Reaction of antibodies with
antigens on erythrocytes
VARIATION IN RED CELL
DISTRIBUTION
ROULEAUX FORMATION
Caused by concentration of
fibrinogen or immunoglobulin
Arrangement of
erythrocytes in groups
that resembles stacks of
coins
Seen in multiple myeloma ,
inflammation
 C Howell- Basophilic
crystal jolly stippling /
bodies punctate
basiphilia

Malaria
parasites
Pappenheimer
RBC bodies
inclusion (siderocytes)

Reticulocytes
H
Heinz inclusion
Cabot bodies
ring
 Nuclear / cytoplasmic
aggregates of stainable
substances , usually protein.

condition
 formed if there is the
abnormalitiy
 invoved virus infection
 classified according to staining
 Composed of
May be centrally fragments of DNA
located or sometimes in
the periphery

Caused by
acceleration /
ineffective
erythropoiesis in
Staining : which chromosome
Romanowsy (eosin- fragments are left
metilena blue) in the cytoplasm

Disorder : splenectomy and in thalassemia

, hemolytic anemia

HOWELL-JOLLY BODIES
 BASOPHILIC STIPPLING /
PUNCTATE BASOPHILIA

Very small blue /

Staining : romanowsy
blue-gray
(eosin-metilena blue
granules
distributed
Artifactual caused by throughout the
precipitation of RNA cytoplasm of
during staining RBC’s

Disorder : defective /
Composed of accelerated heme synthesis
ribosomes , lead poisoning anf
thalassemia
 PAPPENHEIMER BODIES
(SIDEROCYTE)

Staining : prussian blue

Caused by excess
available iron
throughout the body

Purplish irregular aggregates of

granules composed of ferric iron

Disorder : sideroblastic
anemia , thalassemia ,
asplenism
 H INCLUSION Blue-green dots
can be seen in
Stain with supravital the red blood
stain four drops of blood cell
is incubated with 0.5ml
of brilliant cresyl blue
for 20 minutes at 37°c

Composed of precipitated chains of

beta-hemoglobin

Can be seen in HbH disease

because of the deposit of the
unstable hemoglobin red blood
cell,HbH.
Purple-blue inclusions visible only after
supravital stain

Composed of
denatures hemoglobin

Seen in alpha thalassemia ,

G6PD deficiency and
unstable hemoglobin
syndromes
HEINZ
BODIES
 CABOT RING
Purplish ring-shaped , figure-8 /
loop shaped structure composed
of nuclear membrane remnants

Rarely seen
Exact mechanism
unknown
Disorder : pernicious
anemia , lead
poisoning ,
Staining : romanowsky homozygous
thalassemia and
post-splenectomy
Round to oval ring-
shaped intracellular
parasite in RBC’s

MALARIA
PARASITES

Found in malaria

Usually <2 micrometer in

young trphozoites
 C
CRYSTAL
Hexagon shaped /
rhomboid shaped
crystalline structures
in RBC’s.
Variable sized RBC
crystalline dark blue-
purple inclusions.

Disorder : hemoglobin C
, hemoglobin SC
 RETICULOCYTES
Young red blood cells that
contains ribonucleic acid
and ribosomes

Seen As dark
blue granule or
filament

Staining : Supravital stains (such as brilliant

cresyl blue, as used here) clump RNA and
mitochondria and permit easy identification
of reticulocytes, as compared to mature RBC