Caangay Family Site Uremia

					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
          • Nucleus: round;
          nucleoli 0-1; slightly
          condensed chromatin
          • Cytoplasm: dark blue
          • N/C ratio: 6:1
          • Reference interval:
                BM: 1-4%
                PB: 0%
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%
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%
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%
ERYTHROCYTE



        Size : 7-8 um
        Nucleus : absent
        Cytoplasm : salmon
        N/C ratio : NA
        Reference interval :
             BM : NA
             PB : Predominant
                    cell type
ERYTHROCYTE: VARIATIONS IN SIZE


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




                NORMOCYTE

                 Normal erythrocytes
                  are approximately the
                  same size as the
                  nucleus of a small
                  lymphocyte
ERYTHROCYTE: VARIATIONS IN SIZE




                MACROCYTES

                ASSOCIATED WITH:
                 liver disease, vitamin
                 B12 deficiency, folate
                 deficiency, neonates
DIMORPHIC POPULATION OF ERYTHROCYTES




                  ASSOCIATED WITH:
                   transfusion,
                   myelodysplastic
                   syndromes, vit. B12,
                   folate, or iron
                   deficiencies – early in
                   treatment process
HEMOGLOBIN CONTENT OF ERYTHROCYTES




                    Normochromic
                     erythrocytes
HEMOGLOBIN CONTENT OF ERYTHROCYTES



                   ASSOCIATED WITH:
                    iron deficiency
                    anemia,
                    thalassemias,
                    sideroblastic anemia,
                    lead poisoning, some
                    cases of chronic
                    disease


   Hypochromia
HEMOGLOBIN CONTENT OF ERYTHROCYTES



                   ASSOCIATED WITH:
                    acute and chronic
                    hemorrhage,
                    hemolysis, effective
                    treatment for anemia,
                    neonates



  Polychromasia
  VARIATIONS IN SHAPE AND COLOR




           Acanthocyte (Spur Cell)

ASSOCIATED WITH: abetalipoproteinemia, severe
  liver disease, splenectomy, malabsorption,
        hypothyroidism, vit. E deficiency
  VARIATIONS IN SHAPE AND COLOR




           Echinocytes (Burr Cell)

ASSOCIATED WITH: uremia, pyruvate kinase def.,
  microangiopathic hemolytic anemia, artifact
  VARIATIONS IN SHAPE AND COLOR




                 Spherocytes

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




             Codocyte (Target cell)

    ASSOCIATED WITH: hemoglobinopathies,
thalassemia, iron deficiency anemia, splenectomy,
            obstructive liver disease
 VARIATIONS IN SHAPE AND COLOR




         Drepanocyte (Sickle cell)

ASSOCIATED WITH: Homozygous hemoglobin S
                disease
 VARIATIONS IN SHAPE AND COLOR




                Stomatocyte

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




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




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




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




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




          Autoagglutination
ASSOCIATED WITH: Antigen/ antibody reactions
  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
     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
     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,
Pappenheimer bodies       hemoglobinopathies
 (Siderotic granules)
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
 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
 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
DISEASES AFFECTING ERYTHROCYTES




         Iron Deficiency Anemia
DISEASES AFFECTING ERYTHROCYTES




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




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




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




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




                Immune Hemolytic Anemia

PB : spherocytes, schizocytes, polychromasia, nucleated RBC’s
DISEASES AFFECTING ERYTHROCYTES




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




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




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




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




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