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    • Echinocyte // Burr cell
    • reversible structural change resulting in several (10 to 30) even, rounded spicules on the periphery of the cell
    • due to a variety of changes in concentrations of usual plasma components
    • found in conditions such as severe burns, renal and liver disease
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    • Acanthocyte // spiny cells // thorny apple cells
    • membrane has undergone an irreversible structural change resulting in a few (3 to 12) uneven, long, thin spicules on the periphery of the cell
    • result of excessive membrane cholesterol accumulation in such anomalies as liver disease and inherited lipid disorders and following splenectomy
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    • Normal RBC
    • biconcave disc without a nucleus
    • essentially a membrane bound bag of hemoglobin that stains a flat, pink color with a Wright’s stain and appears round with smooth edges
    • lighter center color which is referred to as central pallor
    • mean volume of 90 femtoliters (fL)
    • mean depth of 1.5 to 2.5 micrometers (μm)
    • mean diameter of 7 to 8 micrometers (μm)
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    • Microcyte
    • has a diameter of 6 µm or less.
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    Heinz bodies
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    • Howell-Jolly bodies
    • rounded DNA containing nuclear remnants
    • may appear as a single or multiple, dense blue-black spherical inclusions in either a nucleated or a non-nucleated red cell
    • most frequently seen in cases of rapid red cell development
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    • Rouleaux
    • abnormal red cell aggregation that appears as a stack of coins that has been tipped over but not scattered
    • caused by abnormal or excessive protein coating on red cell surfaces and is seen in diseases such as multiple myeloma and Waldenstrom’s macroglobulinemia
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    • Basophilic stippling
    • inclusions resulting from the precipitation of RNA and ribosomes or from the precipitation of mitochondrial remnants
    • varies in size from fine to coarse and in color from blue-green to blue-black
    • seen in toxic conditions such as lead poisoning and severe infection and in the thalassemias and other conditions with defective heme synthesis
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    • Macrocyte
    • has a diameter of 9 μm or more
    • normally seen in newborns and infants
    • If the majority of erythrocytes are macrocytic in patients other than infants and newborns, they are considered abnormal
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    • Schistocyte
    • fragmented red cell
    • fragmentation occurs in the membrane and cells can assume a variety of bizarre shapes
    • have undergone mechanical shearing as occurs in heart valve replacement or they have been exposed to a severe infection or a condition know as hemolytic anemia
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    • Spherocyte
    • has less membrane than a normal erythrocyte
    • round
    • have a smaller surface-to-volume ratio and a higher hemoglobin concentration than normal red blood cells
    • may be due to hereditary spherocytosis or membrane damage or reduction by splenic activity
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    • Pappenheimer bodies // siderocytic granules
    • small, irregular red cell inclusions found usually in clusters of two to four on Wright’s stain
    • presence of these inclusions calls for the use of a Prussian blue stain
    • If the inclusions appear on the Prussian blue stain they are referred to as siderocytic granules.
    • are found in such conditions as hemochromatosis, sideroblastic anemia and in the hemoglobinopathies
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    • Target cell // codocyte // leptocyte
    • has more membrane than a normal erythrocyte
    • In vivo, these cells resemble bells
    • these cells take on a target-like appearance due to a condensation of hemoglobin in the center and around the periphery of the cell
    • frequently found in patients with hemoglobinopathies, liver disease, splenectomies and iron deficiency anemia
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    • Teardrop cell
    • teardrop shaped in a blood smear
    • exact cause of this abnormality is unknown but these cells are found frequently in inclusion containing red cells and in cases of myelofibrosis
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    • Elliptocyte
    • equivalent, although slightly more mature, red cell morphology to an ovalocyte
    • longer and denser in color on Wright’s stain than the ovalocyte, often referred to as pencil or cigar shaped.
    • rarely, if ever, hypochromic
    • seen in hereditary elliptocytosis, idiopathic myelofibrosis and iron deficiency anemia
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    • Cabot's Ring
    • figure eight shaped erythrocyte inclusion found usually in heavily basophilic stippled cells
    • composed of arginine-rich histones and non-hemoglobin iron
    • found in megaloblastic anemias and thalassemias disease
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    • Ovalocyte
    • resembles a normal erythrocyte in terms of color and central pallor
    • differs in shape being more oval or “egg” shaped than the usual red blood cell
    • can be macrocytic or hypochromic
    • cause of ovalocytosis has yet to be defined although the bi-polarization of hemoglobin with an accompanying reduction in membrane cholesterol does seem to persist in these cells
    • seen in myelodysplastic disease, thalassemias and megaloblastic anemias
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    • Helmet Cell // keratocyte // bite cell
    • looks as if a bite has been taken out of it
    • seen in patients with large red cell inclusions where the morphology may be due to the pitting mechanism of the spleen
    • also seen in cases of glucose-6-phosphodehydrogenase deficiency and pulmonary emboli
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    • Polychromasia
    • erythrocyte has a bluish tinge when stained with a Wright’s stain
    • indicative of the presence of RNA along with hemoglobin and is usually seen in younger cells
    • generally are larger than normal erythrocytes and have no central pallor
    • usually stain as reticulocytes when treated with a supravital stain
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    • Hypochromia
    • central pallor of an erythrocyte is greater than 30% of the total cell size
    • indicative of reduced hemoglobin content
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    • Macroovalocyte
    • diameter is greater than 9 μm
    • shape is oval rather than circular
    • found in erythrocyte metabolism disorders
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    • Agglutination
    • form of abnormal red cell aggregation that appears as rounded or irregular clumps
    • primarily due to antibody antigen interaction
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    • Sickle Cell // Drepanocyte
    • result of a polymerized abnormal hemoglobin molecule which forces a distention of the red cell membrane resulting in a cell with a crescent shaped or sickled cell
    • seen in patients with high levels of hemoglobin S.
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    • Stomatocyte
    • has a narrow, elongated or slit-like central pallor on Wright’s stain
    • In a wet prep, it appears to be cup-like but will become spherocytic if allowed to sit long enough
    • have increased osmotic fragility due to their increased permeability to sodium
    • seen in hereditary spherocytosis, hereditary stomatocytosis, patients who are Rh null and in acute alcoholism
  25. What are the causes of the various inclusions in RBCs?
    • Howell-Jolly bodies: leftover DNA
    • Basophilic stippling: DNA remains in cell, evenly distributed
    • Pappenheimer bodies: Additional iron that isn't inclusive into Hgb
    • Heinz bodies: precipitated hgb, requires a different stain
    • Hemoglobin C crystals: precipitated hgb C (recessive condition) look like "bar of gold"
    • Cabot's ring: spindle formation, result of divisional error
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