Practical of Clinical - PowerPoint Presentation

Slide1

Practical of Clinical

Hematology

Lab 2

RBC’s MorphologySlide2

RBCs Abnormal morphology

Peripheral Blood MorphologySlide3

Abnormal erythrocyte morphology

Is found in pathological states that may be abnormalities in

Red cell distribution.Size (anisocytosis).

Hemoglobin content – Color Variation .

Shape (poikilocytosis).

The presence of inclusion bodies in erythrocyte.Slide4

Erythrocyte Distribution Abnormalities

Rouleaux formation

Stacking of RBCs due to increased

plasma proteins

coating RBCs (resembling a stack of coins)

Found in:

-

Hyperfibrinogenaemia

-

Hyperglobulinaemia

Agglutination

Antibody-mediated Irregular clumping , temperature dependent

Found in:

- Cold agglutinins

- Warm autoimmune hemolysisSlide5
Slide6
Slide7

Variation in erythrocyte size (anisocytosis)

Anisocytosis

: Variations in size (Microcyte and Macrocyte)

Normocytic RBC’s

Normal size of RBC (8 μm) with a range of 7 to 9 μm.

The nucleus of a small lymphocyte (± 8 µm) is a useful guide to the size of a red blood cell).Slide8

Microcytic

RBC cell smaller than the normal RBC ( <7 μm), and is associated with a decrease in hemoglobin synthesis

Found in:

Iron deficiency anemia.

Thalassaemia.

Sideroblastic

anemia.

Lead poisoning.

Anemia of chronic disease.Slide9

Macrocyte

RBC larger than the normal (

<9 μm) and is the result of a defect in nuclear maturation or stimulated erythropoiesis

. May be round or oval in shape, the diagnostic significance being different.

Found in:

Folate and B12 deficiencies (oval)

Ethanol (round)

Liver disease (round)

Reticulocytosis (round)Slide10

Example : Film Study

Most erythrocytes presented in the picture are

microcytes (compare with the small lymphocyte). The degree of

hemoglobinization

is sufficient. Normal platelets and single

ovalocytes

are present.

1. microcyte   2. normocyteSlide11

Variation in erythrocyte color

A

normal erythrocyte has a pinkish-red color with a slightly lighter-colored center (central pallor) when stained with a blood stain, such as Wright.

The color of the erythrocyte is representative

of

hemoglobin

concentration

in the cell.

Under normal conditions, when the color, central pallor, and hemoglobin are proportional, the erythrocyte is referred to as

Normochromic

.Slide12

Hypochromia

Increased central pallor and decreased hemoglobin concentration, the central pallor occupies more than the normal third of the red cell diameter.

Found in: Iron deficiency

Thalassaemia

any of the conditions

leading to MicrocytosisSlide13

Polychromasia

Red cells stain shades of blue-gray as a consequence of uptake of both eosin (by hemoglobin) and basic dyes (by residual ribosomal RNA). Often slightly larger than normal red cells and round in shape - round macrocytosis.

Found in:

Any situation with reticulocytosis – for example bleeding, hemolysis or response to heamatinic factor replacementSlide14

What Abnormal Results Mean

This test is used to diagnose the cause of anemia. The following are the types of anemia and their causes:Normocytic/ normochromic (NC/NC) anemia is caused by sudden blood loss, prosthetic heart valves, sepsis, tumor, long-term disease or aplastic anemia.

Microcytic/ hypochromic anemia is caused by iron deficiency, lead poisoning, or thalassemia.Microcytic/ normochromic anemia results from a deficiency of the hormone erythropoietin from kidney failure.Macrocytic /normochromic anemia results from chemotherapy, folate deficiency, or vitamin B-12 deficiency.Slide15

Shape Abnormalities of Erythrocytes

Poikilocytosis

is the general term for mature erythrocytes that have a shape other than the round, biconcave disk.

Poikilocytes can be seen in many shapes.(e.g. Acanthocyte, Spherocytosis,……)Slide16

Shape Abnormalities of Erythrocytes

Terminology

Description

Condition

Target Cells

Central Hemoglobin;

target shaped

Liver Disease;

Thalassaemia, Abnormal Hb; Iron Deficiency

Echinocyte

Short specula's, equally-spaced

Uremia, Hypokalemia,

Artifact

Acanthocyte

Speculated, Irregular

Liver disease (Alcohol), Post-

spleenoctomy

.

Spherocyte

Spherical, no central pallor

HS, immune Hemolytic

anemia

Shistocyte

Fragmented RBC, Helmet cells

MAHA, burns

Ovalocyte

Oval / Elliptical shaped

Hereditary elliptocytosis, Megaloblastic anemia.

Sickle Cell

Bipolar

speculated shape “ banana” shaped

Hb S-containing

hemoglobinopathy

Teardrop cell

Single elongated extremity

Myelophthistic

changes

Bite

cells

Irregular gap in membrane

G6PD deficiencySlide17

Red cell with a “target” or bull’s-eye appearance. The cell appears with a central bull’s eye that is surrounded by a clear ring and then an outer red ring

.

Found in:

Obstructive liver disease

Severe iron deficiency

Thalassaemia

Haemoglobinopathies

(S and C)

Post splenectomy

Lipid disorders

Target cellSlide18

Red cells are more spherical. Lack the central area of pallor on a stained blood film.

Found in:

Hereditary

spherocytosis

Immune haemolytic anemia

Zieve's

syndrome

Microangiopathic haemolytic

Spherocytosis:Slide19

Red cells with a central linear slit or stoma. Seen as mouth-shaped form in peripheral smear.

Found in:

- Alcohol excess- Alcoholic liver disease

- Hereditary stomatocytosis

Stomatocytosis:Slide20

Ovalocyte :

An elongated oval cell. They are a result of a membrane defect.

Found in:Thalassaemia major.

Hereditary ovalocytosis.

Sickle cell anemiaSlide21

Elliptocytosis

:

The red cells are oval or elliptical in shape. Long axis is twice the short axis.

Found in:

- Hereditary elliptocytosis

- Megaloblastic anemia

- Iron deficiency

- Thalassaemia

- MyelofibrosisSlide22

red cell fragments that are irregular in shape and size. They are usually half the size of the normal RBC; therefore, they have a deeper red color.

Found in:

DIC

Micro

angiopathic

haemolytic anemia

Mechanical haemolytic anemia

Schistocyte:Slide23

Have

accentric

hallow area. Resemble a women's handbag and may be called pocket-book cell.

Found in:

Microangiopathic hemolytic anemia

Blister cell: pre keratocyteSlide24

Part of the cell fuses back leaving two or three horn-like projections. The keratocyte is a fragile cell and remains in circulation for only a few hours.

Found in:- Uraemia

- Severe burns

- EDTA artifact

- Liver disease

Also called helmet cells

Keratocytes (horn cell)Slide25

Degmacyte "bite cell"

An abnormally shaped red blood cell with one or more semicircular portions removed from the cell margin.

These "bites" result from the removal of denatured hemoglobin by macrophages in the spleen.

Found In:

G-6-PD deficiency, in which uncontrolled oxidative stress causes hemoglobin to denature and form Heinz bodies, is a common disorder that leads to the formation of bite cellsSlide26

Sickle shaped red cells

Found in:

Hb-S disease and traitSickle Cells:Slide27

Red cell with 30 or more, short blunt projections which are regularly distributed on their surface

Found in:

Usually artifactual— the result of slow drying under humid conditions.

Sometimes are non - artifactual, indicating uremia or

pyruvate

kinase

deficiency.

Hemolytic anemia

Uremia.

Megaloblastic anemia

Cells retain the central pallor.

Echinocyte

“

Burr” (crenation ) cell:Slide28

Echinocytes (Burr Cells)Slide29

Red blood cells with irregularly spaced projections, these projections very in width but usually contain a rounded end

Found in:

- Liver disease

- Post splenectomy

- Anorexia nervosa and starvation

Acanthocytosis (Spur Cells):Slide30

Acanthocytes (Spur Cells)Slide31

Resembles a tear and usually smaller than the normal RBC.

Found in:

Bone marrow fibrosis

Megaloblastic anemia

Iron deficiency

Thalassaemia

Dacryocytes (

Teardrop):Slide32

Envelope form cell

Found in

Thalassaemia Sickle cell anemiaSlide33

Erythrocyte Inclusions with Wright’s Stain

Inclusion

CompositionAppearance

Condition

Basophilic

stippling

Precipitated ribosomes

Evenly dispersed fine or coarse granules

- Lead poisoning

Thalassaemia , other anemia.

Howell-Jolly

bodies

DNA in origin

Nuclear Fragment

Dense,

round blue granule

Post

– SplenectomyPappenheimer bodiesIron-containing granulesSmall blue granules in clusters

Anemia's

Heinz

bodies

Denatured

Hemoglobin

Round blue precipitates

G6PD

Cabot Rings

Remnants of Nuclear membrane

Reddish

-blue thread like rings

Severe

anemia, Lead poisoning.

Organism

Small blue inclusion

Malaria

BabesiosisSlide34

Small round cytoplasmic red cell inclusion with same staining characteristics as nuclei

Found in:Post splenectomyMegaloblastic

anemia

Howell-Jolly Bodies:Slide35

These are iron containing granules in red blood cells that are seen because the iron is aggregated with mitochondria and ribosomes. They appear as faint violet or magenta specks, often in small clusters, due to staining of the associated protein.

They are associated with severe anemias and thalassemias. Pappenheimer bodies can be increased in hemolytic anemia, infections and post-splenectomy.

Siderotic Granules (Pappenheimer Bodies)Slide36

Considerable numbers of small basophilic inclusions in red cells.

Found in:

- Thalassaemia- Megaloblastic anemia

- Hemolytic anemia

- Liver disease

- Heavy metal poisoning.

Basophilic stippling:Slide37

Represent denatured hemoglobin (methemoglobin - Fe+++) within a cell.

With a supravital stain like crystal violet, Heinz bodies appear as round blue precipitates.

Presence of Heinz bodies indicates red cell injury and is usually associated with G6PD-deficiency.

Heinz Bodies:Slide38

Heinz Body Preparation. RBC are incubated

supravitally in new Methylene blue to identify precipitates of oxidatively

denatured hemoglobin.Slide39

Reddish-blue threadlike rings in RBCs of severe anemia's. These are remnants of the nuclear membrane or remnants of microtubules and appear as a ring or figure 8 pattern.

Very rare finding in patients with

Megaloblastic anemia.

severe anemia's.

lead poisoning.

Dyserythropoiesis

.

Cabot Rings:

A - Cabot ring

B - Howell-Jolly bodySlide40

Two organisms are have a tendency to

invade the RBCs

.

All 4 species of the malaria parasite will invade RBCs. We will see the Plasmodium of different species in RBCs

.

Theileria

microti

(

Bebesia

microti

)

Parasites of Red Cell:Slide41

MalariaSlide42

RBCs Abnormal morphology

Depiction of red blood cell morphologies that may appear on a peripheral smear, showing:

basophilic stippling,

Howell-Jolly bodies,

Cabot's ring bodies and

Heinz's bodies. Slide43

Blood Film in Some CasesSlide44

Normal Peripheral SmearSlide45

Autoimmune Hemolytic Anemia

SpherocytesSlide46

Hereditary Spherocytosis

SpherocytesSlide47

Hereditary pyropoikilocytosisSlide48

Microangiopathic Hemolytic Anemia

SchistocytesSlide49

Sickle Cell Anemia

Hb SSSlide50

Idiopathic myelofibrosis

DacryocytesSlide51

Iron Deficiency Anemia

Severe HypochromiaSlide52

Treated Iron Deficiency Anemia

Mixed Population: Slide53

Alpha Thalassaemia (

a

-/--)

Microcytic HypochromiaSlide54

Target

Cells

Spur Cells

Morphologic Changes in Liver DiseaseSlide55

Hepatorenal Syndrome

Burr + Spur Cells