Red blood Cells Morphology detailed .ppt

Discussion of rbcs morphology

1. Red Cell Morphology

2. Introduction
Appearance of the erythrocytes on a blood
film.
Careful examination of the red cells for the
purpose of identifying abnormalities is
essential.

3. Why
To differentiating normal morphology from
abnormal and artificial morphology.
provide valuable diagnostic information to the
physician,
provide a quality control mechanism to verify
red cell indices values as determined by
automated or manual methods.

4. How
By examining the smear in the thinner
edge where the RBC are randomly
distributed and, for the most part, lie
singly, with occasional doublets.
This area is referred to as the "critical
area."

5. How
If the area is too thin, the red cells will appear
flat and somewhat square (cobblestone effect)
with no central pallor.
If the area examined is too thick, the cells will
be too close together to evaluate the
morphology of individual cells.

6. Normal RBC’s
Round, elastic, non-
nucleated, bi-concave
discs
Many RBCs have an area
of central pallor which
covers about one-third
of the cell.

7. Normal RBC’s
Average diameter of
7.2 microns with a
range of 6-9
microns, almost the
same size as the
nucleus of a small
lymphocyte,

8. Critical area 10x
A view of the
"critical area" using
the low power (10X)
objective is shown
here.

9. Critical area 100x
Once the correct
area has been located
on low power, switch
to oil immersion
Notice the red cells
are lying singly with
occasional doublets.

10. Too thin
The area shown in this field
is too thin for accurate red
cell morphology evaluation.
The cells have large spaces
between them, show no
central pallor and many are
somewhat square, showing a
"cobblestone effect."

11. Too thick
These cells are in an area
which is too thick, and should
not be used for red cell
morphology assessment.
Some of the cells appear to be
stacked like coins because of
the large number of cells
present in this section of the
slide.

12. The morphology seen in the too thin
and too thick areas of the smear is
referred to as artificial morphology.

14. Size Variation

15. Size variation
Red blood cells can vary in size from
smaller than normal, microcytes, to larger
than normal, macrocytes.
When red cells of normal size, microcytes
and macrocytes are present in the same
field, the term anisocytosis is used.

16. Normal size
Size of normal RBC
is almost the size of
the nucleus of the
lymphocyte.

17. Microcyte
Smaller than a
nucleus of the
lymphocyte, central
pallor is greater
than 1/3 of the cell

18. Microcyte, increased central pallor

19. Microcyte, normal Hb content

20. Microcytes

21. summary
microcytes have a diameter of less than
7 microns and an MCV of less than 80
cubic microns.
Two types of microcytes can be seen,
those with increased central pallor and
those with normal central pallor.

22. This microcyte with normal Hb content
can be seen in some hemolytic anemias
and the rare enzyme deficiency,
pyruvate kinase deficiency anemia.

23. Macrocyte (megalocyte)
Diameter of 9-14
microns (1.5 - 2
times larger than
normal red cells)
MCV is 100 or more.

24. Megalocytes
Megalocytes are the result of decreased
DNA synthesis, frequently due to vitamin
B12 and/or folic acid deficiencies.
Decreased DNA synthesis causes the
nucleus in the developing red cells to
mature at a slower than normal rate.
Since hemoglobin production is not
affected, the mature red cell is larger
than normal

25. Macrocytes

27. Pseudomacrocytes
appears larger than the
lymphocyte but in contrast
to megalocytes has an area
of central pallor.
in patients with cirrhosis
of the liver, obstructive
jaundice, post
splenectomy.

28. Psudomacrocytes

30. Summary
two types of macrocytes:-
•True macrocytes (megalocytes).
Increased MCV, MCH
•Pseudomacrocytes.

31. Anisocytosis
Increased variation in size of the red
cell population present on a blood
smear.
Normal, small and large cells can be
seen in one field.
Normal MCV, high RDW
As the severity of the anemia
increases, the amount of significant
anisocytosis present also increases.

32. Anisocytosis

33. Anisocytosis

34. RDW
•RDW is an expression of the homogeneity of the RBC
population size.
•A large RDW says there's a wide variation in the RBC
diameters within the test pool. 
•It doesn't say the cells are large or small, rather
that the population is not homogenous. 

35. Microcytes

36. Anisocytosis

37. Pseudo macrocytes

38. Normal

39. Anisocytosis

40. RBC Color

41. RBC Color
Erythrocytes, when spread on a glass
slide, show varying degrees of central
pallor
This central pallor is related to the
hemoglobin concentration present in the
red cells.

42. RBC Color
the central area (1/3 of the cell) is white, while
hemoglobin is visible in the outer 2/3 of the cell.
 The MCHC (32-36 %) is the index value which is
used to verify the presence of adequate
haemoglobin concentration in the cells visible on
the peripheral smear.

43. RBC Color
A decreased amount of hemoglobin is
referred to as hypochromasia or hypochromia.
MCHC values of 30% or less reflect this
condition.
Hyperchromasia and hyperchromia, refer to a
hypothetical situation rather than an actual
occurrence.

44. RBC Color
Cells located in the "too thin" portion of
the smear often appear to be
"hyperchromic".
Megalocytes (macrocytes) are
normochromic.

45. Normochromic cells

46. Hypochromic cells

47. Hyperchromia

48. Hypochromia

49. Hyperchromasia

50. Polychromasia

51. Polychromasia (or Polychromatophilia) is having red blood
cells of multiple colors.
This is due to differing amounts of hemoglobin in each cell,
which is due to inappropriate, premature release from the
bone marrow.
This is commonly due to leukemia, metastatic disease,
pyruvate kinase deficiency and autoimmune hemolytic
anemia (AIHA)

56. Poikilocytosis

57. Poikilocytosis
Variations in shape.

59. Acanthocytes
•3-12 thorn-like projections
irregularly spaced around the
cell.
•Smaller than normal and have
little or no central pallor.
• Acanthocytes have an
excess of cholesterol

60. Acanthocytes
•Abetalipoproteinemia
•Hereditary
acanthocytosis,50 –
100% of blood cells.
•Alcoholic cirrhosis
•lipid disorders

61. Acanthocyte

62. Codocyte
•Target cells are thin-
walled cells showing a
darkly-stained centre
area of hemoglobin
which has been
separated from the
peripheral ring of
hemoglobin.

63. Codocyte
Codocytes appear in conditions which
cause the surface of the red cell to
increase disproportionately to its
volume.
This may result from a decrease in
hemoglobin, as in iron deficiency
anemia, or an increase in cell
membrane.

64. Codocyte
Thalassemias, Hb C disease, post
splenectomy, obstructive jaundice.

66. Dacrocyte
•Dacryocytes are pear-
shaped or teardrop
shaped cells.
•myelofibrosis