RBC MORPH

PRONORMOBLAST......RUBRIBLAST.............14-20 um, dark blue cyto, large nuke, perinuke halo....lighter around nuke....1-2 nucleoli, in bone marrow

 

BASOPHILIC NORMOBLAST......PRORUBRICYTE..........12-17 um,  sl inc cyto, dark blue, 3/4 nuke in center, nucleoli not visible, in bone marrow

 

POLYCHROMATOPHILIC NORMOBLAST........RUBRICYTE.........10-15 um, blue-gray to pink gray cyto, due to beginning of hemoglob production......1/4 to 1/2 nuke condensed and coarse chromatin, last stage of duplication

bone marrow

 

ORTHOCHROMATIC NORMOBLAST......METARUBRICYTE........7-12 um, pinker cyto increased, round pyknotic nuke, in bone marrow......last stage with nuke

 

RETICULOCYTE......7-10 um.....1st non nuke cell, rna remnants remain, lt blue to green in new methylene blue stain, deep blue reticulum, smal number found in perif blood, which is index of erythopoietic fxn,

 

MATURE ERYTHROCYTE........RBC........6-8 um,  pink cyto, biconcave round disc, flexible, inc surface area to carry oxy,

 

ANISOCYTOSIS......variation is SIZE

                1.   MACROCYTE....>9um    due to defect in nuke maturation sequence...........liver disease

                2.   MICROCYTE.....<6um  due to defect in Hgb synthesis....in anemias and thalassemia

 

POIKILOCYTOSIS....variation in SHAPE

                1.   DREPANOCYTES....SICKLE LIKE......distinct point, due to Hgb S......sickle cell dis and trait

 

                2.   OVALOCYTE, ELLIPTOCYTE...oval, hereditary elliptocytosis

 

                3.   SPHEROCYTE.....spheres, no central palor, smaller surf area,  MCHC inc,    hemolyt anemia, spherocytosis, ABO  HDN

 

                4.   DACROCYTE..TEAR DROP....pt at one end, splenic phagocyt, pernicious anemia, myeloid metaplasia, thalassemia, hemolyt anemias

 

                5.   BURR CELL...uniformly spaced pointed projections, due to artifact, uremia, liver dis in new borns, actue blood loss

 

                6.   STOMATOCYTE...CUP CELL...uniconcave, rectangle in middle, liv diseas, alcoholism, electrolyte imbalance, stomoatocytosis

 

                7.   CODOCYTE...TARGET CELL...inc pallor with central dot,   liv disease, hemoglobinopathyies

 

                8.   SCHISTOCYTES..SCHIZOCYTE...fragmetns, microangiopathic hemoly anemia, burns,

 

                9.   ACANTHOCYTE...few irregular spaced projections,  abetalipoproteinemia, live and lipid metab disorders

                10.   CRENATED OR ECHINOCYTE.....evenly blunt projections......not reported, mechanically due to us

 

ANISOCHROMASIA...variations in color

                1.   HYPOCHROMASIA....dec Hgb conc, large central pallor,...iron def anemia and other anemias

                2.   POLYCHROMASIA...diffuse basophilia....indicates young RBC, large pink blue cell, anemias and acute blood loss

 

INCLUSIONS.......need SUPROVITAL STAINS....stain in the living condition to see

 

                1.   BASOPHILIC STIPPLING....fine to course granuals, made of RNA,  heavy metal poisoning, anemias and alcoholism

                2.   HOWELL JOLLY BODYS....one round dot,  composed of DNA,  wrights stain,  anemic cond, splenectomy patients, forms of nuke matuation defects

 

                3.   PAPPENHEIMER BODIES....small irreg granules near periph of cell, made of iron, PRUSSIAN BLUE stain to confirm, seen in writes or supravital, 

                                a.  non nuke confirmed by stain is SIDEROCYTE,  nukleated is SIDEROBLAST

                4.   CABOTS RINGS...thin loops nuke remnants....severe pernicious anemia

 

                5.   HEINZ BODIES....supravital stains, round refractile inclusions, denatured globin,  drugs, G6DP def, unstable Hgb disease

                6.   MALARIA....ringforms...trophozoites, schuffner granules, gametocytes, microctic to macro

 

ROULEAUX.......stacks..can be artifact from smear, high globulins or fibrinogen, or MULT MYELOM, macroglobinemia

AGGLUTINATION....clumping...autoimmune hemolyt anmeia

 

scan slide for RBC morph......10 oil immersion fields of 200 to 250 cells per field

 

refer to SOP as to how to report

NORMAL....N/N

ABNORMAL...BE SPECIFIC

RETICULOCYTE COUNTS..........seen in bone marrow ajd blood

                1.   2-3 days in marrow,  loses RNA after 1 day in blood

                2.   reflects blood cell production

                3.   view under supravital stain

                                a.   1:1 ratio of stain to blood, incubate 15 min, make smear, use oil obj

                                b.   count 5 fields of 200 cells or milers disk....count 20 fields...rbcs in center and retics around it

                                c.   express as percent

                                d.   #retics / 10  =%retics

                                e.  millers disk.....#retics/ rbc’s (9)  X  100  =  %retics

                4.  corrected for anemia......patient hct/norm hct  X  retic ct  =  corrected %

                                do on patients with low HCT

                5.   absolute retic count...comparable basis for following progession or treatment of anemia

                                % retic X rbc  =  retics/L

                                normal range......between 10-110 X 10 (9) L

                6.  retic production index.....measures erythropoietic activity when stress retics are present

                                corr retic ct / time in days  = RPI

                                normal bone marrow has RPI of 1.......hemolytic anemmias its 3-7 times higher and 2% less in bone marrow damage

                7.   ref range........birth  2.0 - 6.5%

                                            adults 0.5- 1.5%          absolute ct....

                8.  sources of error.....precipitated stain, old specimen, RBC inclusions

                9.   flow cytometry now used to automate it

 

ESR....distance cells settle per time

                1.  lag phase...10 min,  rouleaux

                2.   decantation phase....40 min,  settle

                3.  10 min, compacting of cells

                WESTERGREN PROCEDURE........NCCLS METHOD OF CHOICE...done in lab

4 part blood to 1 part diluent      males  0-10, fem...0-15, kids...0-10

FACTORS AFFECTING ESR

                1.   LARGE CELLS SETTLE FASTER

                2.   FEWER SETTLE FASTER THEN LOTS

                3.   VARIATION NI SHAPE DEC ESR CUZ CANT CMOPACT

                4.   AGGLUTINATION INC ESR

                5.   PLASMA PROT..cause rouleaux and thus FASTER SETLEING

               

FALSE DECREASED ESR

                1.   TOO MUCH EDTA

                2.   >2 HRS ROOM TEMP OR > 6 HRS COLD

                3.   STAND LESS THEN 1 HR

                4.   REFRIDG BLOOD OR COLD TEMP

 

FALSE INC ESR

                1.   TUBE ON INCLINE

                2.   LONGER THEN HOUR

                3.   HIGH TEMP

                4.   VIBRATION

SCREENING TEST FOR INFLAMATION, affedted by anemia, mult myeloma and pregnancy

nonspecific and nondiagnostic

INC IN INFECTIONS, REUMATIOID ARTH, HEART ATTACK, ACUTE HEP, TUBERC

DEC IN POLYCYTHEMIA, heart failure, hypofibrinogenemia, and rbc abnormalities

 

PLATELETS...THROMBOCYTES...a fragment of a megakaryocyte cytoplasm found in periph blood

                1.   CHROMOMERE.......granular and central part

                2..  HYALOMERE...surronds chromoere and is clear to lt blue

 

MEGAKARYOBLAST.........20-50 um, small cyto lt blue, small pseudopods, round oval nuke, fine and multiple nucleoli

 

PROMEGAKARYOCYTE.....20-60um....more cyto, less basophilic, nuke irregular, coarser adn multi nuke

 

MATURE MEGAKARYOCYTE.....40-120 um,...largest CELL IN BONE MARROW,  cyto forms lil bundles that become platelets, no nucleoli, multilobed nuclei

 

PLATELETS.......1-4 um, lt blue to purp cyto, no nuke, 9-12 day life span....come from megakaryocyte cytoplasm

 

PLATELET ESTIMATE.....semi quantitative

                scan oil immersion, check feathered edge, must not be clumped, evaluate for platelet morph

                                5 morphs to look for........1.  large size,  2.  inc hyalomere, 3.  dec granuales,  4.  zoned appearance,  5.  bizarre or irreg appearance

 

ESTIMATE PLATELET COUNT.....based on # per oil immersion field....OIF

                adequate........8-20

                decreased...less then 8

                increased....more then 20

each platelet on field represents.........20,000 plt/uL