Erythrocyte series

1. rubriblast

2. prorubricyte

3. basophilic rubricyte

4. polychromatophilic rubricyte.

5. metarubricyte

6. reticulocyte

7. RBC

STEM CELL (HAEMOCYTOBLAST)

1.Granulocyte series

2. Thrombocyte series

3.Erythrocyte series

• PRO-ERYTHROBLAST (Large nucleus, nucleoli )

• EARLY ERYTHROBLAST (No nucleoli )

• BASOPHILIC ERYTHROBLAST (Smaller, condensed chromatin)

• POLYCHROMATOPHILIC ERYTHROBLAST

• (Hb synthesis begins,)

• NORMOBLASTEarly–still contains viable nucleus

• Late–nucleus becomes non-viable

• (RETICULOCYTE) No nucleus–blue reticulum visible

• (Polychromatophilic macrocyte)

• NORMOCYTE

• (Erythrocyte) Adult red cell. Anuclear in mammals.

• Biconcave disc

Stages of RBC Maturation

Membrane abnormalities

• Acanthocytes or Spur/Spike cells

• Codocytes or Target cells

• Echinocytes and Burr cells

• Elliptocytes and Ovalocytes

• Spherocytes

• Stomatocytes or Mouth cells

• Drepanocytes or Sickle Cells

• Degmacytes or "bite cells"

Trauma

• Dacrocytes or Teardrop Cells

• Keratocytes

• Schistocytes

Acanthocytosis

Irregularly spiculated red cells with net gain in lipids and an asymmetry between the 2 lipid layers

Causes: Hemolytic and non-hemolytic

Q-What is the abnormality? What is the mechanism?

Spherocytosis

Mechanisms of Spherocytosis:-

Microspherocytosis: deficiency

of red cell surface

Immune hemolytic anemias

Hereditary spherocytosis

Heinz-body hemolytic anemia

Clostridial sepsis, Severe burns

Hypophosphatemia

Loss of membrane lipids leading to a reduction in surface area due to deficiencies of

red cell-hereditary spherocytosis

Removal of membrane material form antibody coated red cells by macrophages-

Immune hemolytic anemia

Removal of membrane associated Heinz bodies with the adjacent membrane lipids

by the spleen- Heinz body hemolytic anemia

Target red cells

Basophilic stippling

Mechanisms of basophilic stippling

Reticulocyte Count

Reticulocytes

Increased membrane surface

no hemolysis, cells are

flexible

Volume loss

Decreased Hb: iron

deficiency,

Hemolytic anemias

Iron deficiency

Thalassemias

Lead poisoning -Diffuse fine or coarse blue dots in the red cell representing

usually RNA residue

Many small bluish dots in portion of erythrocytes; from staining of clustered polyribosomes in young circulating red cells

Failure to digest/clear residual RNA due to

– Acquired and congenital hemolytic anemias

– Lead poisoning (lead inhibits pyrimidine 5’ nucleotidase which normally digests residual RNA)

• An accurate reticulocyte count is key to the

initial classification of anemia

• Represent new, young, just released red cells

• ribosomal RNA

• Blue or black punctate spots

• The residual RNA is metabolised over time

• Measure of red cell production

• Reticulocytopenia

– Early iron deficiency

– Primary bone marrow failure

– Secondary bone marrow

failure

• Reticulocytosis

– Acute blood loss

– Splenic sequestration

– Hemolysis

• Immune

• Non-immune

• Infection

• Membrane

Tear drop red cells

Rouleaux and Agglutination

Stomatocytosis

• Bone marrow infiltration

– Fibrosis

– Tumors

– Granulomas

• Slit-shaped central pallor • Hereditary forms due to red

cell overhydration

– Na and water gain

– Hemolysis +

Howell-Jolly bodies

Mechanisms of Howell Jolly bodies

What do you call these cells?

How was it stained?

Heinz bodies in red cells

• Usually one or at most a few purplish inclusions in the red cell visible on routine peripheral smear exam

• The bodies represent aggregates of denatured hemoglobin

• Associated with states of splenic hypofunction or splenectomy

• Heinz Bodies are large, blue-purple intracytoplasmic inclusions, mostly attached to the inner cell membrane.

• Heinz bodies consist of either precipitated normal or unstable hemoglobin. • Represent oxidative injury to the red cell • These inclusions are found in cases of hemolysis due to unstable hemoglobins, oxidant drugs (such as

primaquine), hemolytic anemia associated with severe liver disease and G-6PD deficiency and other enzymopathies.

Iron deficiency anemia

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Microcytic hypochromic red cells

• Iron deficiency

• Lead poisoning

• Anemia of chronic diseases