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MLAB 1415: Hematology Keri Brophy -Martinez

MLAB 1415: Hematology Keri Brophy -Martinez. Chapter 8: Anemia Part Four. Variations in RBC Distribution. Agglutination. Irregular clumps of RBCs from antigen-antibody reactions See in cold hemagglutinin disease and paroxysmal nocturnal hemoglobinuria(PNH) . Agglutination.

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MLAB 1415: Hematology Keri Brophy -Martinez

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  1. MLAB 1415: HematologyKeri Brophy-Martinez Chapter 8: Anemia Part Four

  2. Variations in RBC Distribution

  3. Agglutination • Irregular clumps of RBCs from antigen-antibody reactions • See in cold hemagglutinin disease and paroxysmal nocturnal hemoglobinuria(PNH) 

  4. Agglutination • Use of saline will not disperse clumps; however, warming specimen helps to break clumps up. • MCHC usually falsely elevated.

  5. Rouleaux • Appears as a stack of coins . • Use of saline disperses formation of stacks. • Correlates well with elevated sedimentation rate. 

  6. Rouleaux • Caused by increased or abnormal plasma proteins • Result of protein deposits on the erythrocyte membrane • Seen in patients with multiple myeloma, Waldenstrom'smacroglobulinemia, and chronic inflammatory disease.

  7. RBC Inclusions

  8. Howell-Jolly Bodies • Are nuclear remnants containing DNA. • Are 1-2um in size and appear singly around periphery of red cell membrane. • Develop during periods of accelerated or abnormal erythropoiesis.

  9. Howell-Jolly Bodies • Spleen usually removes them; however, during times of erythroid stress, spleen cannot keep up with formation of inclusions. • Seen following splenectomy, in thalassemia, hemolytic anemias, and in megaloblasticanemias.

  10. Basophilic Stippling • Contain aggregated ribosomes  • Stippling may be the result of the RBCs drying on the blood smear. • May be seen in lead poisoning, defective or accelerated heme synthesis and thalassemia.

  11. Basophilic Stippling • May be classified as three forms: • Diffuse or fine - looks like fine blue dusting. • Coarse - dots are larger and more easily defined. • Punctate - coalescing of smaller forms.  Very prominent and easily defined.

  12. Siderotic Granules and Pappenheimer Bodies • Siderotic granules are small, irregular, magenta inclusions seen along the periphery of the cell membrane. • Appear in clusters. • Prussian blue stain required for confirmation

  13. Siderotic Granules and Pappenheimer Bodies • Causes of: • Sideroblastic anemias • Any condition leading to hemochromatosis.  • Hemoglobinopathies • Post-splenectomy patients.

  14. Heinz Bodies • Formed as result of denaturation or precipitation of hemoglobin. • Are large inclusions that are rigid and severely distort cell.  • Supravital stains used to visualize • I.E. Crystal violet, brillant cresyl blue • Causes of: • Alpha thalassemias • Glucose-6-phosphate deficiency (G6PD) • Any of unstable hemoglobin syndromes. • Red cell injury from chemicals.

  15. Cabot Rings • Found in heavily stippled cells • Appear in figure-eight configuration • Causes of: • Megaloblastic anemias • Homozygous thalassemias • Post-splenectomy.

  16. Sideroblasts/Siderocytes • Sideroblasts • Nucleated erythrocyte that has stainable iron granules • Siderocytes • Non-nucleated erythrocyte containing iron granules • Must use Prussian blue stain to identify Siderocyte

  17. References • Harmening, D. M. (2009). Clinical Hematology and Fundamentals of Hemostasis. Philadelphia: F.A Davis. • McKenzie, S. B., & Williams, J. L. (2010). Clinical Laboratory Hematology . Upper Saddle River: Pearson Education, Inc. • http://www.ezhemeonc.com/index.php/hematological-disorders/ • http://www.wiwe.net/irene/lab/chemheme/heme/microscope/stomatocyte.htm

  18. References • http://home.ccr.cancer.gov/oncology/oncogenomics/WEBHemOncFiles/Review%20of%20Terms.html • http://tiny.cc/85k0b • http://image.bloodline.net/stories/storyReader$1214 • http://www.comlexflashcards.com/wp-content/uploads/2010/06/image970.png

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