rbc ajin (1).pptx rbc morphology, morphology

Medicine

1. AJIN Y V DNB TRAINEE PATHOLOGY RBC MORPHOLOGY

2. ERYTHROPOIESIS

3. RBC PRECURSOR MORPHOLOGY PRO ERYTHROBLAST 12-20 microns Nucleus with stippled chromatin , 1-2 nucleoli Basophilic cytoplasm with abundant mRNA EARLY/BASOPHILIC ERYTHROBLAST 12-16 microns Nuclear chromatin condenses, nucleoli are lost Light basophilic cytoplasm

4. INTERMEDIATE/POLYCHROMATOPHILIC ERYTHROBLAST 10-12 microns Nucleus is condensed Reddish tinge in the cytoplasm appears Cell division ceases at this satge LATE/ORTHOCHROMATIC ERYTHROBLAST Nucleus is densely pyknotic well hemoglobinized reddish cytoplasm Extrude nuclei to become reticulocytes

5. RETICULOCYTE Intermediate between nucleated Rbc and mature Red cells Retain functioning polyribososmes Stain bluer than mature Rbc on romanowsky stain Detected by supravital stains like Brilliant cresyl blue & New methylene blue When mature in to Red cells RNA gradually diminishes

6. Reticulocyte count is the window of erythropoietic activity of bone marrow & red cell production Increased Reticulocyte count Hemolytic anaemias Following therapy in iron/folic acid/B12 deficiency anemias Reduced Reticulocyte count Aplastic anemia Pure red cell aplasia

7. MATURE RBC – NORMAL MORPHOLOGY Anucleate Biconcave disc shape Central one third pallor Diameter around 6-8 micrometer Size is slightly smaller than nucleus of small lymphocyte In peripheral smear examined area with no rouleaux and red cells are touching with little overlap

8. Smear gives information about size , shape of RBC’S and their variations and the extend of hemoglobinization Normal red cells are described as normocytic and normochromic Red cell membrane Red cell enzymes Life span 100 – 120 days

9. Mechanisms of Red cell abnormalities Abnormal erythropoiesis Inadequate synthesis of Hb Damage or changes affecting red cells after leaving BM BM compensate for anaemia by increased erythropoiesis

10. Red cells with abnormal size Red cells with abnormal shape Red cells with abnormal staining Red cell inclusions Immature red cells Abnormal red cell arrangement Morphologic Abnormalities

11. RED CELLS WITH ABNORMAL SIZE Anisocytosis Microcytes Macrocytes Both

12. MICROCYTES Red cells smaller in size than normal Diameter < 7.2 , MCV < 80 fl Seen when hemoglobin synthesis is defective Iron deficiency anaemia Thalassemia Sideroblastic anaemia Anaemia of chronic disease

13. MACROCYTE Red cells are larger in size than normal Diameter > 7.8 microns , MCV > 100 fl Macrocyes in vit b12 and folic acid deficiency – Macroovalocytes Megaloblastic anaemia Aplastic anaemia Myelodysplastic syndrome Pt treated with Hydroxy carbamide Alcohol intake Benign familial macrocytosis

14. RED CELLS WITH ABNORMAL SHAPE Poiliocytosis Results from Abnormal erythropoiesis & Damage to red cells after their formation

15. ELLIPTOCYTES Red cells that are elongated Amount of hemoglobin is normal Change in cholesterol distribution in the red cell membrane leads to accumulation of cholesterol in opposing polar ends Hereditary elliptocytosis Macrocytic Anaemia Hereditary pyropoikilocytosis

16. OVALOCYTES Red cells are oval shaped South – East –Asian ovalocytosis characterized by Elliptocytes , Macro- ovalocytes , Stomatocytes

17. SPHEROCYTES Red cells which are slightly smaller in size than normal Round & stain intensely do not have central area of pallor Surface area of spherocytes less compared to volume Hereditary spherocytosis Autoimmune hemolytic anemia Delayed transfusion reactions ABO hemolytic disease of newborn

18. STOMATOCYES Red cells with slit like area of central pallor Wet preparation these red cells demonstrate a cup shaped appearance Hereditary stomatocytosis Severe liver disease Rh null phenotype

19. ACANTHOCYTES Red cells with irregularly spaced sharp projections on surface . Abetalipoproteinemia Pyruvate kinase deficiency Post splenectomy

20. BURR CELLS/ ECHINOCYTES Red cells with uniform projections in size and are regularly spaced. Crenation regularly develops if blood is allowed to stand overnight at 20 degree celcius Uraemia Premature infants after ET or transfusion of normal red cells

21. TARGET CELL Only peripheral and central regions of the cells appear hemoglobinized Thalessemias Sickle cell Anaemia Obstructive jaundice Post splenectomy

22. SCHISTOCYTE Fragmented red cells which take various forms like Helmet,Crescent ,Triangle etc usually have surface projections or spicules Sometimes round in contour,usually staining deeply,occasionally pale If both round and densely staining called microspherocyes Hemolytic Anaemia DIC Cardiac hemolytic anaemia Micro angiopathic hemolytic anemia Severe burns

23. TEARDROP CELLS / DACRYOCYTES Tapering drop like shape Myelofibrosis Myelophthisic anaemia

24. BITE CELLS S plenic macrophages take bite of portion of red cell which contained Heinz body G6PD deficiency

25. BLISTER CELLS / HEMI GHOST CELLS Splenic reticulum cells remove Heinz body along with some part of red cell Membrane intact Unstained non- Hb cell membrane give appearance of a blister G6PD deficiency

26. SICKLE CELLS Thin elongated slightly curved red cells when red cell containing hemoglobin S is deprived of oxygen Sickle cells are not seen on blood smear in neonates with sickle cell disease?

27. RED CELLS WITH ABNORMAL STAINING Due to inadequate hemoglobin formation Hypochromia Anisochromasia

28. HYPOCHROMIA Presence of red cells that stain unusually palely Red cells with increased area of central pallor Due to lowered Hb concentration & Abnormal thinness of red cells Iron deficiency Thalassemias Anaemia of chronic disease Sideroblastic Anaemia

29. ANISOCHROMASIA Abnormal variability in staining of red cells Some but not all of the red cells stain palely During development or resolution of Iron deficiency Anaemia or Anaemia of chronic disease

30. DIMORPHIC RED CELL POPULATION There are two distinct population seen in same smear Iron deficiency Anaemia respond to Fe therapy After transfusion of normal blood to patient with hypochromic Anaemia Sideroblastic Anaemia

31. RED CELL INCLUSIONS Basophilic stippling Heinz body Howell – jolly bodies Pappenheimer bodies Cabot’s rings Hemoglobin H inclusions & Alpha chain inclusions Parasites causing inclusions

32. BASOPHILIC STIPPLING R andomly distributed fine to coarsely granular blue black inclusions p recipitated ribososmal RNA I ndicative of impaired erythropoiesis Lead poisoning Megaloblastic Anaemias Thalessemias Sideroblastic Anaemias Pyrimidine -5- nucleotide deficiency

33. HEINZ BODY These are insoluble denatured globin chains attatched to red cell membrane Exposure to oxidant drugs or chemicals in Glucose-6-phosphate deficiency Unstable haemoglobin diseases

34. HOWELL – JOLLY BODIES Small round purple staining nuclear remnants [ Feulgen positive for DNA] located peripherally in red cells Seen in Red cells , Intermediate/Late normoblasts Megaloblastic Anemias Thalessemias Hemolytic Anemias Post splenectomy

35. CABOT RING Fine reddish- purple or red ring like structures They appear like oval,circular or figure of 8 structures Indicate impaired erythropoiesis Probably artefacts resulting from damage to lipoprotein of the stroma of red cell Megaloblastic Anaemia Lead poisoning

36. PAPPENHEIMER BODIES Basophilic small iron containing granules in red cells They give positive perl’s Prussian blue reaction These are few in number and are not distributed throughout of red cell Post splenectomy Thalassemias Sideroblastic Anaemias

37. Hemoglobin H inclusions & Alpha chain inclusions Precipitated tetramers of Beta globin chains Seen in Alpha thalassemia

38. MALARIAL PARASITES PLASMODIUM VIVAX

39. PLASMODIUM FALCIPARUM Ring form Gametocyte

40. BABESIA & TRYPANOSOMA

41. IMMATURE RED CELLS Polychromatic red cells Nucleated red cells

42. POLYCHROMATIC RED CELLS Young red cells with remnants of RNA Slightly larger than normal red cells Red cells being stained many colours Some stain shades of bluish grey[reticulocytes] Polychromasia due to uptake of acid stain by Hb & basic stain by RNA Indicative of compensatory increase in erythropoiesis Acute blood loss Following specific therapy for nutritional Anaemia Hemolytic Anaemia

43. NUCLEATED RED CELLS Red cell precursors [Erythroblasts] Released prematurely in peripheral blood from BM Normal in cord blood of newborns Hemolytic disease of newborn Hemolytic Anaemia Leukemias Myelophthisic Anaemia and Myelofibrosis Leucoerythroblastic blood picture myelofibrosis,metastatic deposits in BM

44. ABNORMAL RED CELL ARRANGEMENT Rouleux formation Autoagglutination

45. ROULEAUX FORMATION Alignment of red cells on top of each other like stack of coins Seen in cases in which Gamma globilin is increased Multiple myeloma Kala- azar Waldenstrom’s macroglobulinemia Hyper gammaglobulinemia Hyperfibrinogenemia

46. AUTOAGGLUTINATION Clumping of red cells in large,irregular groups on blood smear Cold agglutinin disease , presence of IgM type of antibodies

47. POST SPLENECTOMY

48. ERYTHROBLASTAEMIA Indicative of compensatory increase in erythropoiesis Small numbers found in cord blood of normal infants Large numbers found in premature infants Extramedullary foci of erythropoiesis Haemolytic disease of newborn Primary myelofibrosis Post splenectomy