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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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- 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
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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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