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LABORATORY DIAGNOSIS

LABORATORY DIAGNOSIS. RED BLOOD CELLS. PRONORMOBLAST. Size: 12-20 um Nucleus: round; nucleoli (1-2); fine chromatin Cytoplasm: dark blue N/C ratio: 8:1 Reference interval: BM: 1% PB: 0%. BASOPHILIC NORMOBLAST. Size: 10-15 um

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LABORATORY DIAGNOSIS

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  1. LABORATORY DIAGNOSIS RED BLOOD CELLS

  2. PRONORMOBLAST • Size: 12-20 um • Nucleus: round; nucleoli (1-2); fine chromatin • Cytoplasm: dark blue • N/C ratio: 8:1 • Reference interval: BM: 1% PB: 0%

  3. BASOPHILIC NORMOBLAST • Size: 10-15 um • Nucleus: round; nucleoli 0-1; slightly condensed chromatin • Cytoplasm: dark blue • N/C ratio: 6:1 • Reference interval: • BM: 1-4% • PB: 0%

  4. POLYCHROMATIC NORMOBLAST • Size: 10-12 um • Nucleus: round; nucleoli 0; quite condensed chromatin • Cytoplasm: gray blue • N/C ratio: 4:1 • Reference interval: • BM: 10-20% • PB: 0%

  5. ORTHOCHROMIC NORMOBLAST • Size : 8-10 um • Nucleus : round ; nucleoli = 0 ; fully condensed chromatin • Cytoplasm : blue to salmon • N/C ratio : 0.5:1 • Reference interval : BM : 5-10% PB : 0%

  6. POLYCHROMATIC ERYTHROCYTE • Size : 8-8.5 um • Nucleus : absent • Cytoplasm : blue to salmon • N/C ratio : NA • Reference interval : BM : 1% PB : 0.5% - 2%

  7. ERYTHROCYTE • Size : 7-8 um • Nucleus : absent • Cytoplasm : salmon • N/C ratio : NA • Reference interval : BM : NA PB : Predominant cell type

  8. ERYTHROCYTE: VARIATIONS IN SIZE • ASSOCIATED WITH: iron def. anemia, sideroblastic anemia, thalassemia minor, chronic disease (occasionally), lead poisoning, some hemoglobinopathies MICROCYTE

  9. ERYTHROCYTE: VARIATIONS IN SIZE • Normal erythrocytes are approximately the same size as the nucleus of a small lymphocyte NORMOCYTE

  10. ERYTHROCYTE: VARIATIONS IN SIZE • ASSOCIATED WITH: liver disease, vitamin B12 deficiency, folate deficiency, neonates MACROCYTES

  11. DIMORPHIC POPULATION OF ERYTHROCYTES • ASSOCIATED WITH: transfusion, myelodysplastic syndromes, vit. B12, folate, or iron deficiencies – early in treatment process

  12. HEMOGLOBIN CONTENT OF ERYTHROCYTES • Normochromic erythrocytes

  13. HEMOGLOBIN CONTENT OF ERYTHROCYTES • ASSOCIATED WITH: iron deficiency anemia, thalassemias, sideroblastic anemia, lead poisoning, some cases of chronic disease Hypochromia

  14. HEMOGLOBIN CONTENT OF ERYTHROCYTES • ASSOCIATED WITH: acute and chronic hemorrhage, hemolysis, effective treatment for anemia, neonates Polychromasia

  15. VARIATIONS IN SHAPE AND COLOR Acanthocyte (Spur Cell) ASSOCIATED WITH: abetalipoproteinemia, severe liver disease, splenectomy, malabsorption, hypothyroidism, vit. E deficiency

  16. VARIATIONS IN SHAPE AND COLOR Echinocytes (Burr Cell) ASSOCIATED WITH: uremia, pyruvate kinase def., microangiopathic hemolytic anemia, artifact

  17. VARIATIONS IN SHAPE AND COLOR Spherocytes ASSOCIATED WITH: hereditary spherocytosis, some hemolytic anemias, transfused cells, severe burns

  18. VARIATIONS IN SHAPE AND COLOR Codocyte (Target cell) ASSOCIATED WITH: hemoglobinopathies, thalassemia, iron deficiency anemia, splenectomy, obstructive liver disease

  19. VARIATIONS IN SHAPE AND COLOR Drepanocyte (Sickle cell) ASSOCIATED WITH: Homozygous hemoglobin S disease

  20. VARIATIONS IN SHAPE AND COLOR Stomatocyte ASSOCIATED WITH: Hereditary stomatocytosis, alcoholism, liver disease, Rh null phenotype, artifact

  21. VARIATIONS IN SHAPE AND COLOR Elliptocytes Ovalocytes ASSOCIATED WITH: Hereditary elliptocytosis or ovalocytosis, thalassemia major, iron deficiency anemia, megaloblastic anemias (macro ovalocytes), myelopthisic anemias

  22. VARIATIONS IN SHAPE AND COLOR Schizocyte (Schistocyte) ASSOCIATED WITH: Microangiopathic hemolytic anemia (DIC), severe burns, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, renal graft rejection

  23. VARIATIONS IN SHAPE AND COLOR Dacryocyte (Tear Drop Cell) ASSOCIATED WITH: Myelofibrosis with myeloid metaplasia, thalassemias, myelophthisic anemias, other causes of extramedullary hematopoiesis

  24. VARIATIONS IN SHAPE AND COLOR Rouleaux formation ASSOCIATED WITH: Increased concentrations of globulins and/or paraproteins

  25. VARIATIONS IN SHAPE AND COLOR Autoagglutination ASSOCIATED WITH: Antigen/ antibody reactions

  26. INCLUSIONS IN ERYTHROCYTES • Color : Dark blue to purple • Shape : round to oval • Size : 1 um • Number per cell : usually 1; maybe multiple • Composition : DNA • Associated with : Splenectomy, hyposplenism, megaloblastic anemia, hemolytic anemia Howell-Jolly bodies

  27. INCLUSIONS IN ERYTHROCYTES • Color : Dark blue to purple • Shape : fine or coarse granules • Number per cell : numerous with fairly even distribution • Composition : RNA • Associated with : Lead intoxication, thalassemia, abnormal heme synthesis Basophilic stippling

  28. INCLUSIONS IN ERYTHROCYTES • Color : light blue • Shape : fine irregular granules in clusters • Number per cell : usually one clusters; may be multiples. Often at periphery of cell • Composition : Iron • Associated with : Splenectomy, hemolytic anemia, sideroblastic anemia, megaloblastic anemia, hemoglobinopathies Pappenheimer bodies (Siderotic granules)

  29. INCLUSIONS IN ERYTHROCYTES • Color : dark blue to purple • Shape : loop, ring, or figure of eight; may look like beads on a string • Number per cell : 1-2 • Composition : thought to be remnants of mitotic spindle • Associated with : Myelodysplastic syndrome, megaloblastic anemia Cabot ring

  30. INCLUSIONS IN ERYTHROCYTES • Stained with New Methylene Blue • Cell : anuclear immature erythrocytes • Composition : precipitated RNA • Number : ≥2/cell • Color : dark blue • Associated with: erythrocyte maturation Reticulocytes

  31. INCLUSIONS IN ERYTHROCYTES • Stained with New Methylene Blue • Cell : mature RBC • Composition : precipitated hgb • Number : single or multiple, generally membrane bound • Color : dark blue to purple • Associated with: Unstable hgb, some hemoglobinopathies, some RBC enzyme deficiencies Heinz bodies

  32. DISEASES AFFECTING ERYTHROCYTES Iron Deficiency Anemia

  33. DISEASES AFFECTING ERYTHROCYTES Thalassemia minor PB : microcytosis, slight hypochromia, codocytes, basophilic stippling

  34. DISEASES AFFECTING ERYTHROCYTES Thalassemia major PB : numerous nucleated RBC’s, microcytes, hypochromia, codocytes, basophilic stippling, many dacyocytes, many schizocytes, polychromasia

  35. DISEASES AFFECTING ERYTHROCYTES Macrocytic anemia (nonmegaloblastic type) PB : round macrocytes (MCV = 112 fl), leukocyte and platelet counts usually normal BM : no megaloblastic changes

  36. DISEASES AFFECTING ERYTHROCYTES Megaloblastic anemia PB : pancytopenia, oval macrocytes, Howell-Jolly bodies, nucleated RBC’s, basophilic stippling, hypersegmentation of neutrophils, giant platelets, codocytes, schizocytes, spherocytes, dacrocytes

  37. DISEASES AFFECTING ERYTHROCYTES Aplastic anemia PB : pancytopenia, normocytic, normochromic (occasional macrocytes) BM : hypocellular; lymphocytes may predominate

  38. DISEASES AFFECTING ERYTHROCYTES Immune Hemolytic Anemia PB : spherocytes, schizocytes, polychromasia, nucleated RBC’s

  39. DISEASES AFFECTING ERYTHROCYTES Hemolytic Disease of the Newborn PB : increased number of nucleated erythrocytes, macrocytic/normochromic, polychromasia, spherocytes

  40. DISEASES AFFECTING ERYTHROCYTES Hereditary Spherocytosis PB : Spherocytes (variable in number), polychromasia; nucleated erythrocytes possible

  41. DISEASES AFFECTING ERYTHROCYTES Hereditary Elliptocytosis PB : >25% elliptocytes, usually >60% elliptocytes; indices are normocytic, normochromic

  42. DISEASES AFFECTING ERYTHROCYTES Hemoglobin CC disease PB : Codocytes, spherocytes, microcytes, polychromasia, intracellular or rod-shaped crystals possible

  43. DISEASES AFFECTING ERYTHROCYTES Hemoglobin SS disease PB : Drepanocytes (in crises), codocytes, nucleated rbc’s, schizocytes, Howell-Jolly bodies, basophilic stippling, polychromasia, increased leukocyte count with neutrophilia, increased platelet count

  44. DISEASES AFFECTING ERYTHROCYTES Hemoglobin SC disease PB : Few sickle cells, codocytes, intraerythrocytic crystals. Crystalline aggregates of hemoglobin SC may protrude from the erythrocyte membrane

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