Rbc Morphology

Front 1

Anisocytosis

Back 1

unequal size and shape

RDW will be increased

Front 2

Clinical disorders associated with anisocytosis

Back 2

any severe anemia, eg. iron deficiency, megaloblastic

Front 3

Basophilic stippling

Back 3

fine punctuate basophilic inclusions in the red cells; seen especially in lead poisoning but can occur in other conditions

Front 4

Clinical disorders associated with basophilic stippling

Back 4

hemolytic anemia, blood loss, uremia, following treatment of iron deficiency or megaloblastic anemias; punctate stippling seen in lead poisoning (mitochondrial RNA and iron)

Front 5

Dimorphic population

Back 5

looks like two separate populations of cells; most commonly seen after transfusion but also think of sideroblastic anemia or paroxysmal nocturnal hemoglobinuria

Front 6

Clinical disorders or a dimorphic population

Back 6

1) post transfusion
2) sideroblastic anemia
3) "PNH"

Front 7

Elliptocyte

Back 7

elliptical in shape

not hypochromic

Front 8

Physiologic significance of elliptocyte

Back 8

1. hereditary abnormality
2. acquired alteration

Front 9

Clinical disorders with elliptocytes

Back 9

1. hereditary elliptocytosis
2. in various anemias, especially megaloblastic

Front 10

Hypersegmented polys

Back 10

seen in B12 or folate deficiency

use the rule of 5's...ie if 5% of the cells have 5 or more lobes then call hypersegmented; BUT if you see one 7 lobed or two 6-lobed polys, you can call hypersegmentation

Clinical disorders: megaloblastic states

Front 11

Hypochromic cell

Back 11

exaggeration of normal central pallor; usually also microcytic

Front 12

Physciologic significance of hypochromic cells

Back 12

failure of hemoglobin synthesis due to:

1. lack of iron
2. defective globin synthesis
3. defective porphyrin synthesis

Front 13

Clinical disorders of hypochromic cells

Back 13

1. iron-deficiency anemia, anemia of chronic disease (?)
2. thalassemia, some hemoglobinopathies (C, E)
3. sideroblastic anemias

Front 14

Leptocyte

Back 14

thin, hypochromic cell; diamter is normal; MCV is decreased

(rarely used term at DHMC)

Front 15

Clinical disorders regarding leptocyte

Back 15

thalassemia

Front 16

Macrocyte

Back 16

larger than normal ( > 8.5 micrometers)

well filled with hemoglobin

Front 17

Physiological significance of macrocytes

Back 17

1. young RBC (? skipped generation; early loss of nucleus)

2. DNA synthesis-impaired megaloblastic maturation

Front 18

Clinical disorders associated with macrocytes

Back 18

1. accelerated erythropoiesis

2. B12 or folate deficiency

Front 19

"Thin macrocyte"

Back 19

diameter increased but MCV is normal

often hypochromic

Front 20

Physiologic significance of "thin macrocyte"

Back 20

membrane cholesterol AND lecithin increased

Front 21

Clinical disorders or "thin macrocyte"

Back 21

liver disease post-splenectomy

Front 22

Macroovalocyte

Back 22

larger than normal ( > 8.5 micrometers)

well filled with hemoglobin

Front 23

Physiological significance of macroovalocytes

Back 23

1. young RBC (? skipped generation; early loss of nucleus)

2. DNA synthesis-impaired megaloblastic maturation

Front 24

Clinical disorders of macroovalocytes

Back 24

1. accelerated erythropoiesis

2. B12 or folate deficiency

Front 25

Microcyte

Back 25

smaller than normal ( < 7.0 micrometers)

Front 26

Physiological significance of microcytes

Back 26

differs according to whether or not:

1. well filled with Hgb
2. its shape is normal

Front 27

Clinical disorders associated with microcytes

Back 27

1. Fe deficiency
2. thalassemia
3. anemia of chronic disease
4. sideroblastic anemia
5. lead poisoning also - fragment spherocytes

Front 28

nucleated red cells

Back 28

should not be seen in peripheral blood

seen occasionally in severe anemia of any type; presence may indicate megaloblastic process or myeloproliferative syndrome

Front 29

Clinical disorders of nucleated red cells

Back 29

hemolytic anemias, leukemias, myeloproliferative syndrome, polycythemia vera, myelophthisic anemia (neoplastic, granulomatous, or fibrotic marrow infiltration), multiple myeloma, extramedullary hematopoiesis, megaloblastic anemias, any severe anemia

Front 30

Poikilocytosis

Back 30

different shapes

seen with many conditions

Front 31

Clinical disorders of poikilocytosis

Back 31

any severe anemia, eg. megaloblastic, iron deficiency, myeloproliferative syndrome, hemolytic; certain shapes are diagnostically helpful

(eg. spherocytosis through teardrop cells)

Front 32

Polychromasia

Back 32

different colors especially bluish appearance of the RBCs; means early release of cells from marrow - still containing RNA

reticulocytes are polychromatophilia but not all polychromatophilia cells are reticulocytes

Front 33

Clinical disorders of polychromasia

Back 33

a state with increased reticulocytes, eg. bleeding or hemolysis

Front 34

Pyknocyte

Back 34

distorted and contracted RBC, similar to echinocyte

this is rarely seen

Front 35

Clinical disorders with pyknocyte

Back 35

"infantile pyknocytosis"

Front 36

Rouleaux

Back 36

alignment of cells in long stacks seen in myeloma or other diseases

Front 37

Clinical disorders of Rouleaux

Back 37

multiple myeloma, Waldenstrom's macroglobulinemia, hypergammaglobinemia, cold agglutin disease, viral infections

Front 38

Schistocyte

Back 38

helmet or triangular shaped, fragmented or greatly distorted RBC; smaller than normal

Front 39

Physiologic significance of schistocyte

Back 39

RBCs lose fragments after impact with fibrin strands, walls of diseased vessels, and artificial surfaces in the circulation

Front 40

Clinical disorders of schistocytes

Back 40

1. microangiopathic hemolytic anemia

2. hemolytic anemia due to physical agents

3. also in uremia, malignant hypertension

Front 41

Sickle cell

Back 41

in shape of sickle

form assumed especially on deprivation of oxygen

Front 42

Physiologic significance of sickle cell

Back 42

molecular aggregation of Hgb S

Front 43

Clinical disorders of sickle cell

Back 43

Hgb S trait or disorder

also seen with: Hgb 1, Hgb C (harlem), Hgb C (Capetown)

Front 44

Spherocyte

Back 44

spherical, not hypochromic

usually also microcytic

surface : volume ratio decreased

Front 45

Physiologic significance of spherocytes

Back 45

1. RBC membrane abnormality

2. RBCs lose fragments after impact with fibrin strands, walls of diseased vessels, and artificial surfaces in the circulation

Front 46

Clinical disorders of spherocytes

Back 46

1. hereditary spherocytosis
2. acquired immunohemolytic anemia

Front 47

Spicule cell

Back 47

RBC with spiny projections on surface

has 2 types

Front 48

Acanthocyte

Back 48

type of spicule cell
"spur cell"

has 5-10 spicules at various lengths, irregular in spacing and thickness

Front 49

Physiologic significance of acanthocytes

Back 49

ratio of cholesterol lecithin of RBC membrane increased when associated with liver disease; can be converted to normal shape by non-ionic detergents

Front 50

Clinical disorders of acanthocyte

Back 50

1. in abetalipoproteinemia
2. liver disease with hemolytic anemia
3. post-splenectomy (few)
4. pyruvate kinase deficiency

Front 51

Echinocyte

Back 51

type of spicule cell
sea-urchin cell, crenated cell, burr cell

has 10-30 spicules, evenly distributed over surface of RBC

Front 52

Physiologic significance of echinocyte

Back 52

reult of alteration of intra- and extracellular environment

can be brought about by accumulation of fatty acid or lysolecithin on RBC surface or both, as result of changes in plasma or in RBC metabolism

Front 53

Clinical disorders with echinocyte

Back 53

1. uremia, bleeding peptic ulcer, Ca of stomach

2. commonly artifactual

3. pyruvate kinase deficiency

Front 54

Stomatocyte

Back 54

uniconcave, as contrasted with normal biconcave RBC, slit-like instead of central pallor in RBC

Front 55

Physiologic significance of stomatocyte

Back 55

1. hereditary...primary defects in membrane structure or function, resulting in abnormalities of cation permeability content and flux

2. acquired alteration in cation content and flux

Front 56

Clinical disorders of stomatocyte

Back 56

1. hereditary stomatocytosis, several forms

2. smaller numbers seen in alcoholic cirrhosis, acute alcoholism, obstructive liver disease, malignancies, etc., and perhaps as artifacts

Front 57

Target cell

Back 57

hypochromic, with central pigment thing cell; surface volume ratio increased

Front 58

Physiologic significance of target cells

Back 58

1. splenectomy decreases rate and extent of loss of lipids from reticulocytes

2. accumulation of both cholesterol and phospholipid on RBC

3. congenital

Front 59

Clinical disorders of target cells

Back 59

as for hypochromic cells, also:

1. post-splenectomy
2. in liver disease, especially obstructive jaundice
3. LCAT deficiency
4. thalassemia
5. severe iron deficiency

Front 60

"Teardrop" RBC

Back 60

shape of drop

usually microcytic

often also hypochromic

Front 61

Physiologic significance of "teardrop" RBC

Back 61

distorted or fragmented RBC

1. especially in myelofibrosis

2. less frequently in other forms of anemia (eg. thalassemia)

Front 62

Clinical disorders of "teardrop" RBC

Back 62

1. especially in myelofibrosis

2. less frequently in other forms of anemia, eg. thalassemia

Front 63

Toxic granulation

Back 63

granules of polys larger and stain more darkly

means the poly has been "turned on" eg. by infection, but can also be seen with cancer, CT disease, etc.

toxic granulation usually means infection