MLAB 1415: Hematology Laboratory

#6
RBC Morphology on a
Peripheral Blood Smear
Laboratory #6: RBC Morphology on a Peripheral Blood Smear
Sill!" #$ pt!
Objectives:
1% &denti'y e(ample! o' abnormal red blood )ell *RBC+ morphology and in)l,!ion!%
#% -o determine .ithin one /,alitati0e ,nit the abnormal red blood )ell morphology ob!er0ed
on a peripheral blood !mear%
Principle:
Peripheral blood !mear! are e0al,ated to determine )ell morphology1 0eri'y a,tomated )ell )o,nt!1
and determine the per)entage o' ea)h type o' 2BC% -oday3! lab 'o),!e! on identi'ying red blood
)ell in)l,!ion! and abnormal RBC morphology%
Reagents, Supplies, and Equipment:
1% Prepared !lide!
2. Mi)ro!)ope1 immer!ion oil and len! paper
Procedure:
1% Pla)e a 2right !tained !lide on !tage%
#% 4!ing the 10X ob5e)ti0e1 'ind an area .here 5$6 o' the RBC! are !lightly o0erlapping and
5$6 o' the RBC! are not to,)hing *to.ard the 'eathered edge+% -he red blood )ell!
!ho,ld ha0e a )entral pallor%
7% 4!ing the t,rret1 !.it)h to the 1$$8 oil ob5e)ti0e1 add oil1 and 'o),! on the red blood
)ell!%
4% &n at lea!t 1$ )on!e),ti0e 'ield!1 ob!er0e the n,mber o' in)l,!ion!1 and9or e(ample! o'
abnormal RBC morphology% &' abnormalitie! are ob!er0ed1 )al),late the a0erage n,mber
ob!er0ed per 'ield%
5% Semi-quantitate any 0ariation 'rom normal morphology ,!ing the table! belo.%
6% &' no !igni'i)ant RBC morphology i! !een1 report RBC morphology a! :;ormal<%
=% Re)ord re!,lt! on re!,lt! 'orm belo.%
>% Repeat .ith a !e)ond !lide%
MLAB 1415: Hematology Laboratory
#6
RBC Morphology on a
Peripheral Blood Smear
Procedural notes:
R! inclusions and morp"olog# de$initions
%ariation &bnormalit# 'escription
Anisocytosis Variation in RBC size
Poikilocytosis
Variation in RBC shape (clarify particular
variation such as 1+schistocytes, 2+ codocytes)
Abnormal Size 'escription
icrocytosis
A!nor"ally s"all RBC #ith CV $%&f' and
dia"eter less than ()& *"
acrocytosis A!nor"ally lar+e RBC #ith CV ,1&&f')
&bnormal !olor 'escription
-ypochro"ia
.nlar+ed area of pallor due to cell/s decreased
he"o+lo!in content
Polychro"asia
Bluish0purple hue in youn+ RBCs due to residual
R1A
&bnormal S"ape 'escription
.chinocyte or Burr Cell (Crenated RBC)
RBCs #ith "any !lunt spicules) 2his can !e
caused !y !iolo+ic reasons (ure"ia, Vit) .
deficiency a!etalipoproteine"ia, post3
splenecto"y) or artifactual (slo# dryin+, old
RBCs, in thick area of slide)) 4o not +rade
these cells in the thick area of the slide)
4repanocyte (5ickle cell)
.lon+ated cell #ith point on each end6 "ay !e
curved or 53shaped)
5chistocyte or schi7ocyte (cell fra+"ent)
8ra+"ented erythrocyte in "any shapes and
si7es6 can display pointed e9tre"ities
-.'.2 C.'' (!ite cell)
5pecial schistocyte6 Results fro" R.5 takin+ a
:!ite; out of RBC) 'ooks like 1<2&s foot!all
hel"et)
MLAB 1415: Hematology Laboratory
#6
RBC Morphology on a
Peripheral Blood Smear
Codocyte (tar+et cell)
Bull/s eye lookin+ RBC) Central concentration of
he"o+lo!in surrounded !y colorless area #ith
peripheral rin+ of he"o+lo!in) ay also !e !ell
or cup shaped) 5ee atlas)
4acryocyte (2ear drop cell)
RBC shaped like a tear or pear) Before
reportin+ "ake sure that they are not artifactual
due to slide preparation (all pointin+ sa"e
direction)
5to"atocyte RBC #ith slitlike (s"ile) area of central pallor)
Acanthocyte (spur cell)
RBC #ith irre+ularly spaced pro=ections that
vary in #idth, len+th and nu"!er)
.lliptocyte or >valocyte
.llipto? ci+ar3shapped RBC
>valo? e++3shaped RBC
5pherocyte
5"all, +lo!ular, co"pletely he"o+lo!inated
RBC #ithout central pallor
(nclusions 'escriptions
-e"o+lo!in C crystal 4ark red he9a+onal RBC inclusion
Basophilic stipplin+
Bluish3!lack +ranules (@ri+ht/s stain) in RBCs
fro" precipitatin+ ri!onucleoproteins and
"itochondrial re"nants in to9ic states (lead
poisonin+)
-o#ell3Aolly !odies
4ark purple spherical +ranule near periphery of
RBC co"posed of re"nants of 41A
Pappenhei"er !odies
Cluster of iron3containin+ particles usually found
at the periphery of "ature RBCs
alaria Can appear as rin+s #ithin RBC
&rrangement 'escriptions
Rouleau9
5tacked coin appearance of RBCs (in the
e9a"inin+ area of the s"ear)
MLAB 1415: Hematology Laboratory
#6
RBC Morphology on a
Peripheral Blood Smear
R! )orp"olog# *rading S#stem+"p$ ,100X oil-
&bnormalit# Slig"t 1. /. 0. 1.
%ariation &bnormalit# Re!er0ed 'or
e(treme
)a!e! .here
?$@1$$6 o'
the )ell! are
abnormal
Re!er0ed 'or
e(treme
)a!e! .here
?$@1$$6 o'
the )ell! are
abnormal
Anisocytosis
A156 15@#56 #6@4?6 5$@>?6
Poikilocytosis
A1 &' B SL-1 Crade ea)h type o' abnormal !hape
&bnormal Si2e
icrocytosis
DCC9Ee.
3it"out !!:
#56 !maller than
n,)le,! o' !mall lymph
3it"out !!:
#6@4?6 !maller
than n,)le,! o'
!mall lymph
3it"out !!:
F5$6 !maller
than n,)le,! o'
!mall lymph
MCG =5@=? MCG =$@=5 MCG A=$
acrocytosis
DCC9Ee.
3it"out !!:
#56 larger than
n,)le,! o' !mall lymph
3it"out !!:
#6@4?6 larger
than n,)le,! o'
!mall lymph
3it"out !!:
F5$6 larger than
n,)le,! o' !mall
lymph
MCG 1$$@15$ MCG 1$5@11$ MCG B11$
&bnormal !olor
-ypochro"ia
Ee.
3it"out !!:
#56 larger area o'
)entral pallor
3it"out !!:
#6@4?6 larger
area o' )entral
pallor
3it"out !!:
F5$6 larger area
o' )entral pallor
MCHC #>@71 MCHC #4@#= A#4
Polychro"asia
#
7@4 5@= B>
&bnormal S"ape
.chinocyte or Burr
Cell (Crenated
RBC)
A1 1@7 4@5 B5
Codocyte (tar+et
cell)
1@# 7@4 5@= F>
5chistocyte or
schi7ocyte (cell
fra+"ent)
A1 1@7 4@5 B5
-.'.2 C.''
(!ite cell)
A1 1@7 4@5 B5
4repanocyte
(5ickle cell)
A1 1@7 4@5 B5
4acryocyte (2ear
drop cell)
A1 1@7 4@5 B5
5to"atocyte
A1 1@7 4@5 B5
Acanthocyte (spur
cell)
A1 1@7 4@5 B5
.lliptocyte or
>valocyte
# 7@4 5@= B>
MLAB 1415: Hematology Laboratory
#6
RBC Morphology on a
Peripheral Blood Smear
5pherocyte
# 7@4 5@= B>
(nclusions
-e"o+lo!in C
crystal
A1 1@7 4@5 B5
Basophilic stipplin+
A1 1@7 4@5 B5
-o#ell3Aolly !odies
A1 1@7 4@5 B5
Pappenhei"er
!odies
A1 1@7 4@5 B5
&rrangement
Rouleau9 $1&B
11@1?6 #16@4?6 F5$6
MLAB 1415: Hematology Laboratory #6
RBC Morphology on a Peripheral Blood Smear
;ame: HHHHHHHHHHHHHHHHH
Iate:HHHHHHHHHHHHHHHHHH
Laboratory #6: RBC Morphology on a Peripheral Smear
Report Eorm
#$ pt!
Slide 4 or Patient
5ame
&bnormal variation
,aniso+ poi6-
&bnormal Si2e &bnormal S"apes (nclusions+ R!
!olor
MLAB 1415: Hematology Laboratory
#6
RBC Morphology on a
Peripheral Blood Smear
;ame: HHHHHHHHHHHHHHHHH
Iate:HHHHHHHHHHHHHHHHHH
Laboratory #6: RBC Morphology on a peripheral Smear
St,dy J,e!tion!
1$ pt!%
1% Poiilo)yto!i! i! the term 'or 0ariation in HHHHHHHHHHHHHHHHH%
#% Mi)ro)yte! are de'ined a! ha0ing an MCG le!! than HHHHHHHHHHHH%
7% Ho.ell@Kolly bodie! are )ompo!ed o' HHHHHHHHHHHHHHHH%
4% A))ording to the ACC RBC morphology grading !)heme1 i' an a0erage o' = bl,i!h@p,rple
yo,ng RBC! .ere ob!er0ed in 1$ 1$$(9oil 'ield!1 .hat morphology abnormality .o,ld yo,
do),ment and ho. .o,ld yo, grade itL *#pt!+
5% A))ording to the ACC RBC morphology grading !)heme1 i' an a0erage o' 4$6 o' the
RBCS in 1$ 1$$(9oil 'ield! had a !igni'i)antly larger than normal )entral pallor1 .hat
morphology abnormality .o,ld yo, do),ment1 and ho. .o,ld yo, grade itL *#pt!+
6% Pappenheimer bodie! are )ompo!ed o' HHHHHHHHHH%
=% A !)hi!to)yte i! al!o no.n a! a )ell HHHHHHHHHHHHHH%
>% A !i)le )ell i! al!o no.n a! a HHHHHHHHHHHH%