rbc&wbc abnormalities

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Abnormal Cells

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Red Cell Size

PAGE 1

RED CELL ABNORMALITIES

Red Cell SizeRed Cell TypeMorphologic AppearanceDefect or ChangeAssociated Conditions

NormocyticNormal sized biconcave disc RBCs, 6-8 um

NANA

MicrocyticSmaller RBCs, less than 6 um

MCV 100 fL

Impaired DNA syn.

Stress erythropoiesis

Excess surface membraneMegaloblastic anemia

Liver disease

Alcoholism

Red Cell Hemoglobin Content

Red Cell TypeMorphologic AppearanceDefect or ChangeAssociated Conditions

NormochromicNormal in color

NANA

HypochromicCentral pallor exceed 1/3 of the diameter of the cell

Reduced hemoglobin content (MCHC)Iron deficiency anemia

Thalassemia

HyperchromicNo central pallor

Greater than normal MCHCSpherocytosis

Red Cell Shape

Red Cell TypeMorphologic AppearanceDefect or ChangeAssociated Conditions

AcanthocyteSpheroid with 3-12 irregular spikes

Increased ratio of cholesterol to lecithinEnd stage liver disease

Pyruvate kinase deficiency

Abetalipoproteinemia

EchinocyteRegular 10-30 scalloped short projections

Depletion of ATP

Exposure to hypertonic solution

Artifact in dryingUremia

Cirrhosis

Hepatitis

Chronic renal disease

CodocytePeripheral rim of hemoglobin surrounded by clear area and central hemoglobinized area (bulls eye)

Excess surface membrane to volume ratioHemoglobinopathies

Thalassemia

Post-splenectomy

DacryocyteTeardrop or pear-shaped with single elongated point or tail

Squeezing and fragmentation during splenic passageMyeloid metaplasia

Hypersplenism

DrepanocyteCrescent shape cell that lacks zone of central pallor

Polymerization of deoxygenated hemoglobinSickle cell anemia

ElliptocyteRod or cigar shaped

Polymerization of hemoglobinHereditary elliptocytosis

SchistocyteFragments of RBCs varying in size and shape

Extreme fragmentation produced by damage of RBCs by fibrin, altered vessel walls and prosthetic heart valvesDisseminated intravascular coagulation (DIC)

Microangiopathic hemolytic anemia

SpherocyteSmaller in diameter than normal RBC with concentrated hemoglobin content

No visible central pallor

Lowest surface area to volume ration

Defective membraneHereditary spherocytosis

Immune hemolytic anemia

StomatocyteNormal sized cell with slit like area in center

Known to have increased permeability to sodiumHereditary stomatocytosis

Rh null disease

Red Cell Inclusions

Red Cell TypeMorphologic AppearanceDefect or ChangeAssociated Conditions

Howell-Jolly bodiesCoarse round densely stained purple 1-2 um granules eccentrically located on periphery of membrane

May be single or double

Nuclear remnants containing DNAMegaloblastic anemia

Accelerated erythropiesis

Cabot ringRings, loops or figure of eight; red to purple

Remnants of microtubules of mitotic spindleDyserythropoiesis

Heinz bodiesDeep purple irregular shaped inclusions 2 to 3 um

Found on RBC inner surface of membrane

Represent precipitated, denatured hemoglobin due to oxidative injuryHereditary defects in hexose monophosphate shunt

G6PD deficiency

Unstable hemoglobins

Basophilic stipplingRound dark blue granules uniformly distributed

Represents impaired erythropoiesisLead poisoning

Pyrimidine-5-nucleotidase deficiency

Pappenheimer bodiesSmall 2 to 3 um irregular basophilic inclusions that aggregate in small clusters near periphery with Wrights stain

Unused iron depositesSideroblastic anemia

Defective erythropoiesis

Ringed sideroblastNucleated RBC that contains nonheme iron particles arranged in ring form

Excessive iron overload in mitochondria of normoblasts

Due to defective heme synthesisSideroblastic anemia

SiderocyteNon-nucleated cell containing iron granules

Same as aboveSame as above

Miscellaneous RBC abnormalitiesRed Cell TypeMorphologic AppearanceDefect or ChangeAssociated Conditions

Autoagglutination

Clumping of RBCs

Presence of antibodyCold agglutinin

Autoimmune hemolytic anemia

RouleauxAlignment of RBCs linear appearing as stack of coins

Caused by increased concentration of globulinMultiple myeloma

Waldenstroms macroglobulinemia

WBC ABNORMALITIES

Abnormalities Associated with Granulocytes

DescriptionMorphologic AppearanceDefect or ChangeAssociated Conditions

Alder-Reilly granulesLarge purple-black coarse cytoplasmic granules

Accumulation of mucopolysaccharidesAlder-Reilly anomaly

Hunters syndrome

Auer rodsPink or red rod shaped cytoplasmic structures Fused primary granules

AML

Found in myeloid and monocytic series only

Chediak-Higashi granulesGiant red, blue to grayish round inclusions in cytoplasm

Large cytoplasmic inclusions of fused primary granules that are deficient in enzymes for phagocytosisChediak-Higashi syndrome

Albinism

Hypersegmented neutrophil >5 lobes

Abnormal DNA synthesisMegaloblastic anemia

Pelger-HuetSingle or bilobed nucleus

Decreased segmentationPelger-Huet anomaly

LE cellNeutrophil with large purple homogenous round inclusion with nucleus wrapped around

Three factors needed to produce LE cell: antinuclear antibodies, cell nuclei, phagocytes with ingested materialLupus erythematosus

Dhle bodiesSingle or multiple blue cytoplasmic inclusions in neutrophil

Aggregates of free ribososmes of rough endoplasmic reticulumSevere infections

Toxic states

Toxic granulesLarge purple to black azurophilic granules

Primary granulesInfections, toxic states

Toxic vacuolesLarge empty white areas within cytoplasm

Represent end stage phagocytosisSepticemia

Severe infections

Toxic states

Abnormalities Associated with Lymphocytes/Plasma cells

DescriptionMorphologic AppearanceDefect or ChangeAssociated Conditions

Basket cellDegenerated nucleus or ruptured cell in form of smudge or basket

Lymphocytes that are fragile and break upon smearingChronic lymphocytic leukemia

Small numbers are artifact

Hairy cellLymphocyte with hair-like cytoplasmic projections surrounding nucleus

Thought to be of B cell originHairy cell leukemia

Seary cellRound lymph cell with nucleus that is grooved or convoluted

Represents leukemic phase of mycosis fungoides

T-cell characteristicsSeary

Mycosis fungoides

Flame cellPlasma cell with red to pink cytoplasm

Associated with increase in IgAMultiple myeloma of IgA nature

Grape cellPlasma cell that contains small colorless vacuoles

Large protein globules giving the appearance of grapesMultiple myeloma

SOURCE: SAUNDERS MANUAL OF CLINICAL LABORATORY SCIENCE

LEAH MARCH2009BM smear, iron stain

Supravital stain

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