RBC MORPHOLOGY AND INCLUSIONS
Pyknocyte
SIZE VARIATIONS (ANISOCYTOSIS)
Macrocytosis
- megaloblastic, pernicious
anemia and folic acid
deficiency
Microcytosis
-iron deficiency anemia
SHAPE VARIATIONS (POIKILOCYTOSIS)
Spiculated Erythrocytes:
Acanthocytes
-irregular few spicules
-Abetalipoproteinemia,
hepatic etc,
postsplenectomy
Burr Cells
-less spherical than
Acanthocytes
- beelding gastric ulcer,
gastric carcinoma, peptic
ulcer, renal insufficiency,
pyruvate kinase
deficiency, uremia
Echinocytes
-regular spicules
- crenated RBC – no
disease correlation
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Blister Cells vs.
-pulmonary emboli in sickle cell
anemia, microangiopathic
haemolytic anemia
Keratocytes/ Helmet Cells
-partially deformed, not
cut. Half-moon or spindle
(two-horns)
- Dissociated intravascular
coagulopathy
Schistocytes (Schizocytes)
- half an RBC, deeper red
appearance
-hemolytic anemia rel.
burns/prosthetic implants,
renal transplant rejection
Elliptocytes
-affect globin chain
-malignancy anemias, Hb C disease, sometimes
haemolytic anemia, hereditary elliptocytosis
Megalocytes (Oval
macrocyte)
-B12 and folate
deficiency,
reticulocytes
Spherocytes
-intense orang red color
-HDN, acquired hemolytic
anemia, DIC, blood
transfusion reactions,
congenital spherocytosis

Knizocytes
-pinched-bottle shape
-hemolytic anemia, heriditary
spherocytosis
COLOR ALTERATIONS (ANISOCHROMIA)
Hypochromia
-iron deficiency anemia
Hyperchromia

Sickle Cell (Drepanocytes)

-at least one end is
pointed
-from gelation of
polymerized deoxygenatd
HbS
-Sickle cell anemia

Teardrop cells Basophilic erythrocyte /Polychromatophilia

(Dacrocytes) --rapid blood regeneration
-homozygous beta
thalassemia,
myoproliferative
syndromes, pernicious and
severe anemia

Stomatocytes
-increase na decreased k,
Rh null disease
-Alcoholic cirrhosis,
glutathione def, heriditary
spherocytosis, infectious INCLUSION VARIATIONS
mononucleosis, Pb
poisioning, malignancies, Basophilic stippling
thalassemia minor (punctuate stippling)
-tiny round dark blue
Target Cells (Codocytes) granules (RNA)
-excessive ratio of -disturbed erythropoiesis,
membrane lipid to cell vol sev anemia & Pb poisoning
- cholesterol and
phosphatidylcholine incr.
-Hb C, S-C, S-S, sickle cell
thalassemia
Cabot rings
Leptocytes -ring shaped figure eight. Microtubule remnants. In Pb
-like codocyte but inner part poisoning and pernicious anemia
not completely detached
-Hepatic disorders, iron def
anemia, thalassemia

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 Crystals
-Hb C crsytals. Hb H
brilliant cresyl blue stain –
polymers of beta chains of
Hb A

Heinz bodies
-precipitated denatured
haemoglobin in g6pd def,
haemolytic anemia secondary
to drugs (phenacetin)

Howell-Jolly bodies
-nuclear remnants (DNA)
accelerated erythropoiesis
-in haemolytic, pernicious
anemia postsplenectomy,
atrophy of spleen

Pappenheimer bodies
(siderotic granules)
- aggregates of mitochondria,
ribosomes, iron particles
- iron loading anemia,
hyposplenism, hemoltyic
anemias

RBC DISTRIBUTION ALTERATIONS

Agglutination

Rouleaux formation
-stacks of coins,
abnormal if in thin area
of blood smear
-presence of
cryoglobulins (treated
with plasma expander)

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