LABORATORY DIAGNOSIS

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LABORATORY DIAGNOSIS
RED BLOOD CELLS
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PRONORMOBLAST

• Size 12-20 um
• Nucleus round nucleoli (1-2) fine chromatin
• Cytoplasm dark blue
• N/C ratio 81
• Reference interval
• BM 1
• PB 0

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BASOPHILIC NORMOBLAST

• Size 10-15 um
• Nucleus round nucleoli 0-1 slightly
  condensed chromatin
• Cytoplasm dark blue
• N/C ratio 61
• Reference interval
• BM 1-4
• PB 0

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POLYCHROMATIC NORMOBLAST

• Size 10-12 um
• Nucleus round nucleoli 0 quite condensed
  chromatin
• Cytoplasm gray blue
• N/C ratio 41
• Reference interval
• BM 10-20
• PB 0

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ORTHOCHROMIC NORMOBLAST

• Size 8-10 um
• Nucleus round nucleoli 0 fully condensed
  chromatin
• Cytoplasm blue to salmon
• N/C ratio 0.51
• Reference interval
• BM 5-10
• PB 0

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POLYCHROMATIC ERYTHROCYTE

• Size 8-8.5 um
• Nucleus absent
• Cytoplasm blue to salmon
• N/C ratio NA
• Reference interval
• BM 1
• PB 0.5 - 2

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ERYTHROCYTE

• Size 7-8 um
• Nucleus absent
• Cytoplasm salmon
• N/C ratio NA
• Reference interval
• BM NA
• PB Predominant
• cell type

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ERYTHROCYTE VARIATIONS IN SIZE
MICROCYTE

• ASSOCIATED WITH iron def. anemia, sideroblastic
  anemia, thalassemia minor, chronic disease
  (occasionally), lead poisoning, some
  hemoglobinopathies

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ERYTHROCYTE VARIATIONS IN SIZE
NORMOCYTE

• Normal erythrocytes are approximately the same
  size as the nucleus of a small lymphocyte

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ERYTHROCYTE VARIATIONS IN SIZE
MACROCYTES

• ASSOCIATED WITH liver disease, vitamin B12
  deficiency, folate deficiency, neonates

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DIMORPHIC POPULATION OF ERYTHROCYTES

• ASSOCIATED WITH transfusion, myelodysplastic
  syndromes, vit. B12, folate, or iron deficiencies
  early in treatment process

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HEMOGLOBIN CONTENT OF ERYTHROCYTES

• Normochromic erythrocytes

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HEMOGLOBIN CONTENT OF ERYTHROCYTES

• ASSOCIATED WITH iron deficiency anemia,
  thalassemias, sideroblastic anemia, lead
  poisoning, some cases of chronic disease

Hypochromia
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HEMOGLOBIN CONTENT OF ERYTHROCYTES

• ASSOCIATED WITH acute and chronic hemorrhage,
  hemolysis, effective treatment for anemia,
  neonates

Polychromasia
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VARIATIONS IN SHAPE AND COLOR
Acanthocyte (Spur Cell)
ASSOCIATED WITH abetalipoproteinemia, severe
liver disease, splenectomy, malabsorption,
hypothyroidism, vit. E deficiency
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VARIATIONS IN SHAPE AND COLOR
Echinocytes (Burr Cell)
ASSOCIATED WITH uremia, pyruvate kinase def.,
microangiopathic hemolytic anemia, artifact
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VARIATIONS IN SHAPE AND COLOR
Spherocytes
ASSOCIATED WITH hereditary spherocytosis, some
hemolytic anemias, transfused cells, severe burns
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VARIATIONS IN SHAPE AND COLOR
Codocyte (Target cell)
ASSOCIATED WITH hemoglobinopathies, thalassemia,
iron deficiency anemia, splenectomy, obstructive
liver disease
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VARIATIONS IN SHAPE AND COLOR
Drepanocyte (Sickle cell)
ASSOCIATED WITH Homozygous hemoglobin S disease
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VARIATIONS IN SHAPE AND COLOR
Stomatocyte
ASSOCIATED WITH Hereditary stomatocytosis,
alcoholism, liver disease, Rh null phenotype,
artifact
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VARIATIONS IN SHAPE AND COLOR
Elliptocytes
Ovalocytes
ASSOCIATED WITH Hereditary elliptocytosis or
ovalocytosis, thalassemia major, iron deficiency
anemia, megaloblastic anemias (macro ovalocytes),
myelopthisic anemias
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VARIATIONS IN SHAPE AND COLOR
Schizocyte (Schistocyte)
ASSOCIATED WITH Microangiopathic hemolytic
anemia (DIC), severe burns, hemolytic uremic
syndrome, thrombotic thrombocytopenic purpura,
renal graft rejection
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VARIATIONS IN SHAPE AND COLOR
Dacryocyte (Tear Drop Cell)
ASSOCIATED WITH Myelofibrosis with myeloid
metaplasia, thalassemias, myelophthisic anemias,
other causes of extramedullary hematopoiesis
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VARIATIONS IN SHAPE AND COLOR
Rouleaux formation
ASSOCIATED WITH Increased concentrations of
globulins and/or paraproteins
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VARIATIONS IN SHAPE AND COLOR
Autoagglutination
ASSOCIATED WITH Antigen/ antibody reactions
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INCLUSIONS IN ERYTHROCYTES

• Color Dark blue to purple
• Shape round to oval
• Size 1 um
• Number per cell usually 1 maybe multiple
• Composition DNA
• Associated with Splenectomy, hyposplenism,
  megaloblastic anemia, hemolytic anemia

Howell-Jolly bodies
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INCLUSIONS IN ERYTHROCYTES

• Color Dark blue to purple
• Shape fine or coarse granules
• Number per cell numerous with fairly even
  distribution
• Composition RNA
• Associated with Lead intoxication, thalassemia,
  abnormal heme synthesis

Basophilic stippling
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INCLUSIONS IN ERYTHROCYTES

• Color light blue
• Shape fine irregular granules in clusters
• Number per cell usually one clusters may be
  multiples. Often at periphery of cell
• Composition Iron
• Associated with Splenectomy, hemolytic anemia,
  sideroblastic anemia, megaloblastic anemia,
  hemoglobinopathies

Pappenheimer bodies (Siderotic granules)
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INCLUSIONS IN ERYTHROCYTES

• Color dark blue to purple
• Shape loop, ring, or figure of eight may look
  like beads on a string
• Number per cell 1-2
• Composition thought to be remnants of mitotic
  spindle
• Associated with Myelodysplastic syndrome,
  megaloblastic anemia

Cabot ring
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INCLUSIONS IN ERYTHROCYTES

• Stained with New Methylene Blue
• Cell anuclear immature erythrocytes
• Composition precipitated RNA
• Number 2/cell
• Color dark blue
• Associated with erythrocyte maturation

Reticulocytes
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INCLUSIONS IN ERYTHROCYTES

• Stained with New Methylene Blue
• Cell mature RBC
• Composition precipitated hgb
• Number single or multiple, generally membrane
  bound
• Color dark blue to purple
• Associated with Unstable hgb, some
  hemoglobinopathies, some RBC enzyme deficiencies

Heinz bodies
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DISEASES AFFECTING ERYTHROCYTES
Iron Deficiency Anemia
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DISEASES AFFECTING ERYTHROCYTES
Thalassemia minor
PB microcytosis, slight hypochromia, codocytes,
basophilic stippling
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DISEASES AFFECTING ERYTHROCYTES
Thalassemia major
PB numerous nucleated RBCs, microcytes,
hypochromia, codocytes, basophilic stippling,
many dacyocytes, many schizocytes, polychromasia
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DISEASES AFFECTING ERYTHROCYTES
Macrocytic anemia (nonmegaloblastic type)
PB round macrocytes (MCV 112 fl), leukocyte
and platelet counts usually normal
BM no megaloblastic changes
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DISEASES AFFECTING ERYTHROCYTES
Megaloblastic anemia
PB pancytopenia, oval macrocytes, Howell-Jolly
bodies, nucleated RBCs, basophilic stippling,
hypersegmentation of neutrophils, giant
platelets, codocytes, schizocytes, spherocytes,
dacrocytes
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DISEASES AFFECTING ERYTHROCYTES
Aplastic anemia
PB pancytopenia, normocytic, normochromic
(occasional macrocytes)
BM hypocellular lymphocytes may predominate
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DISEASES AFFECTING ERYTHROCYTES
Immune Hemolytic Anemia
PB spherocytes, schizocytes, polychromasia,
nucleated RBCs
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DISEASES AFFECTING ERYTHROCYTES
Hemolytic Disease of the Newborn
PB increased number of nucleated erythrocytes,
macrocytic/normochromic, polychromasia,
spherocytes
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DISEASES AFFECTING ERYTHROCYTES
Hereditary Spherocytosis
PB Spherocytes (variable in number),
polychromasia nucleated erythrocytes possible
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DISEASES AFFECTING ERYTHROCYTES
Hereditary Elliptocytosis
PB gt25 elliptocytes, usually gt60
elliptocytes indices are normocytic, normochromic
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DISEASES AFFECTING ERYTHROCYTES
Hemoglobin CC disease
PB Codocytes, spherocytes, microcytes,
polychromasia, intracellular or rod-shaped
crystals possible
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DISEASES AFFECTING ERYTHROCYTES
Hemoglobin SS disease
PB Drepanocytes (in crises), codocytes,
nucleated rbcs, schizocytes, Howell-Jolly
bodies, basophilic stippling, polychromasia,
increased leukocyte count with neutrophilia,
increased platelet count
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DISEASES AFFECTING ERYTHROCYTES
Hemoglobin SC disease
PB Few sickle cells, codocytes,
intraerythrocytic crystals. Crystalline
aggregates of hemoglobin SC may protrude from the
erythrocyte membrane