POIKILOCYTOSIS OF RBC

1. CATEGORY OF BLOOD VARIATION IN SHAPE “POIKILOCYTOSIS” PRINCESS ALEN AGUILAR

2. A. POIKILOCYTES SECONDARY TO DEVELOPMENTAL MACROCYTOSIS

3. OVAL MACROCYTES (OVALOCYTES) Inc. MCV CS= Megaloblastic Anemia most popular for this cell No cental pallor

4. B. POIKILOCYTES SECONDARY TO MEMBRANE ABNORMALITIES

5. SPHEROCYTES Dec. surface volume to ratio Defects on RBC membrane CHONs Spectrin deficiency CS= Hereditary spherocytosis, AIHA, G6PD, ABO-HDN, RC ENZYME DEF. Microcytic Hyperchromic anemia

6. ELLIPTOCYTES “ ciggar shape cell” CS= IDA, Pernicious Anemia , Hereditary elliptocytosis , Myelofibrosis w/ myeloid dysplasia, Megaloblastic Anemia , SCA, Thalassemia, Congenital disorder of diserythropoiesis

7. ECHINOCYTES (CRENATED RBC) Short equally spaced projections, regular spicules Present in prolonged standing artifacts Resembles to Burr Cells CS= pyruvate kinase def. , uremia , hepatic therapy, renal insufficiency, suddend change in pH

8. Burr cells “sea urchin” Irregular spicules, less pointed Also seen in Renal failure and uremia

9. Acanthocytes “Spur cells or thorn cells” Very spiny irregular projections CS= Abetalipoproteinemia , cirrhosis, HUS, post splenectomy, HA, PKD Lysine: Sphingomyosin def.

10. Stomatocytes “Mouth Cell” w/ slit like or mouth like central pallor CS=Rh null Disease, Renal Dse , Liver Dse Due to osmotic changes

11. TARGET CELLS/CODOCYTES MEXICAN HAT CELLS, LEPTOCYTES, PLATYCYTES, BULL’S EYE, GREEK HELMET CELLS INC. VOLUME RATIO CS= Liver Dse , Hemoglobinopathies , Thalassemia, IDA

12. C. POIKILOCYTES SECONDARY TO TRAUMA

13. SCHISTOCYTES “ Fragmentocytes or Egg shells” Cell fragments CS= Microangiopathic anemia , thermal injury, renal transplantation rejection, G6PD def , heart valve replacement, HA, severe burns, mechanical destruction due to TTP or DIC Fragmenting/disintegrating RBC

14. KERATOCYTES (HELMET CELLS) Horn like projections Red cell caught in fibrin strands Triangle cell, keratocytes of Bessis Fragile CS= Hemolytic Anemia

15. DACROCYTES (TEAR DROP) Round cell wth elongated tail Cells are squeezed into small opening CS= Myelofibrosis , Megaloblastic Anemia , Thalassemia, Pernicous Anemia

16. MICROSPHEROCYTES/ PYROPOIKILOCYTES Occurs in severe burns Low MCV 2-3um

17. D . POIKILOCYTES SECONDARY TO ABNORMAL Hgb CONTENT

18. SICKLE CELL/ DREPANOCYTES/ MENISCOCYTES THIN, ELONGATED, POINTED ENDS, APPEAR CRESCENT SHAPE RBC LACK CENTRAL PALLOR Hgbinopathies SS, SC, SD

19. Hgb CC Crystal Rhomboid, tetragonal or rod shaped, crystals of dense staining After splenectomy CS= Homozygous Hb SC Dse

20. BLISTER CELL Red cell w / single or multiple vacuoles or markedly thinned areas at the periphery Pre-cursor of helmet cells Microangiopathic Hemolytic Anemia

21. DEGMACYTE (BITE CELL) Drug-induced anemias G6PD Def., Thalassemia, Happened due to passing through the blood vessels of the spleen some parts of the cell remains

22. BASOPHILIC STIPPLING Fine= Inc. polychromatophilia Blueberry bagel appearance CS= Lead poisoning ( Plumbism ), Impaired Hgb synthesis, MA Remnants of RBC RNA

23. HOWELL JOLLY BODIES Single: nuclear chromatic remnants, MA, HA Double: MA, Abnormal Erythropoiesis Large single inclusions Related to DNA remnants

24. PAPPENHEIMER BODIES SIDEROTIC GRANULES SMALL DARK BLUE PURPLE PRUSSIAN BLUE= Staining non- heme iron granules WRIGHTS STAIN= Faint blue Granules clumped together CS= Sideroblastic anemia , Hgbinoathies , Thalassemia, MA, myelodysplatic syndrome

25. CABOT RINGS Ring shape, figure of 8 Double or several concentrics Microtubules remnants or mitotic spindle Rarely seen in PA, lead poisoning Abnormal erythropoiesis

26. HEINZ BODIES Denatured Hgb Residues of oxidized Hgb Presence in indicative of RBC injury w/ alcoholism G6PD def , unstable Hgb

27. Hb H INCLUSIONS “ GOLF BALL DENTS ” Multiple blue green spherical inclusins stained with Brilliant Cresyl Blue (BCB)

28. MALARIAL INCLUSIONS

29. WBC anomalies

30. Toxic granulation Dark blue-black cytoplasmic granules in neutrophil Thought as primary granules Show inc.alkaline phosphatase activity Found in: acute infections drug poisoning burns

31. Dohle Bodies Single or multiple light blue or gray areas in cytoplasm of neutrophils RER & represent failure of cytoplasm to mature Found in: infections poisoning burns following chemotherapy

32. Hypersegmented Neutrophils Neutrophils with six or more lobed nucleus Represents an abnormality in maturation of neutrophil Acquired(in megaloblastic erythropoiesis) or inherited( Undritz anomaly) Found in: pernicious anemia folic acid deficiency chronic infections

33. Barr Body Sex chromatin Represents the second X chromosome in females (2-3% of neutrophils in females) Small,well-defined,round projection of nuclear chromatin These cells are not found in normal males.

34. Degenerated Neutrophil w/ pyknotic nucleus Result from condensing of nuclear chromatin into a solid structure mass with no pattern Not counted in differential cell count

35. Vacuolated neutrophil Degeneration of cytoplasm begins to acquire holes or as result of active phagocytosis May reflect increased lysosomal activity Found in: septicemia severe infection

36. Giant Neutrophils Can be seen occasionally in normal peripheral blood smear Larger than normal neutrophils and genrally hyperlobulated Found in frequency of 1 in every 20,000 neutrophils but increase in disease states

37. Pelger-Huet Anomaly Indicates failure of neutrophil to segment properly Bi-lobed nucleus; chromatin is coarsely clumped May be inherited or acquired (as in leukemias ) Heterozygous for this char.shows numerous bi-lobed ( dumbell shape); homozygous-round neutrophil

38. Chediak -Higashi Syndrome (Autosomal recessive disorder) Rare,fatal disprder found in children Inherited as an autosomal recessive char. Contain very large,reddish -purple or greenish- gray staining granules in the cytoplasm of granulocytes In monocytes & lymphocytes, stain bluish-purple These granules represent abnormal lysosomes Found in: anemia neutropenia thrombocytopenia

39. Alder-Reilly anomaly Heavy,coarse blue-black granules of BEN & sometimes lymphocytes & monocytes Inherited condition Associated with Hurler’s syndrome & Hunter’s syndrome

40. May- Hegglin Anomaly Inherited anomaly affecting neutrophils and platelets Larger than usual Dohle -like bodies Giant bizarre platelets is present & function may be abnormal

41. Auer rods Rod-like bodies representing aggregated primary granules that stain reddish purple Found in : cytoplasm of myeloblast , monoblast and promyelocytes in acute monocytic or acute myelogenous leukemia and eythroleukemia

42. Smudge or Basket cell Disintegrating nucleus of ruptured WBC

43. PLATELETS SATELLITOSIS Platelets encircling the peripheral borders of neutrophils This phenomenon is thought to be due to a serum factor which reacts in the presence of EDTA.