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Morphology OF
RED BLOOD CELLS
 NORMAL RED BLOOD CELLS

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 Red Cell Profile
 Biconcave, disk- Diameter, shape, color and inclusions
shaped and lack
nucleus
 Average diameter of 7
um. (6-8um)
normocytic
 Normal body function
requires that a
minimum of 4.5-
5.9x1012/L(male) 4.5-
 Abnormal
Erythrocyte
Morphology
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Abnormal erythrocyte morphology is found

in pathological states that may be :
 abnormalities in size (anisocytosis).
 abnormalities in shape (poikilocytosis).
 abnormalities in hemoglobin content or
the presence of inclusion bodies in
erythrocyte. 5
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 I- Variation in Red Cells
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Distribution
1- Rouleaux Formation:
 Morphology:
Stacks of RBC's resembling
a stack of coins.
 Found in:
- Hyperfibrinogenemia
- Hyperglobulinemia 7
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2- Red cell-
agglutination:
 Morphology:
Irregular clumps of red
cells
 Found in:
- Cold agglutinins
- Warm autoimmune 8

hemolysis
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II-Variation in erythrocyte size

(anisocytosis)
1-Microcytosis: Decrease in the red cell size. Red
cells are smaller than 6µm in diameter. The
nucleus of a small lymphocyte (± 8,µm) is a useful
guide to the size of a red blood cell.
Found in:
- Iron deficiency anemia.
- Thalassemia/Hb E disease and trait
- Sideroblastic anemia.
- Lead poisoning.
- Anemia of chronic disease. 9
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Microcytes
Most erythrocytes
presented in the picture
are microcytes
(compare with the small
lymphocyte).
The degree of
hemoglobinization is
sufficient.
Normal platelets.
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Macrocytes
2-Macrocytosis: Increase in the
size of a red cell. Red cells are
larger than 8µm in diameter. May
be round or oval in shape.
MCV>100fL
Found in:
- Megaloblastic: Folate and B12
deficiencies (oval)
- Myelodysplastic syndrome, BM
failure 11

- Chronic Liver disease (round)

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III-Variation in Hemoglobin Content

1-Hypochromasia: Increase RBC
central pallor which occupies
more than the normal third of
the red cell diameter.
-MCH and MCHC are usually
decreased
Found in:
- Iron deficiency
- Thalassemia, any of the 12

conditions leading to
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2- Polychromasia: RBC shades of

blue-gray as a affinity of both
eosin (by hemoglobin) and basic
dyes (by residual ribosomal RNA).
Often slightly larger than normal
RBC and round in shape - round
macrocytosis.
Found in:
Any situation with reticulocytosis -
for example bleeding, hemolysis
or response to hematinic factor
replacement. 13
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IV- Variation of red cells shape

(Poikilocytosis)
ACANTHOCYTES(Spur cell):small,
dense RBC with multiple thorny,
spike-liked projections, have few
spicules
 Found in:
- abetalipoproteinemia
- severe liver disease (spur cell A)
-Post splenectomy
- Anorexia nervosa and starvation
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Blister cell (prekeratocyte)

Morphology:
0ne or more vacuoles.
Resemble a women's
handbag
Found in:
Microangiopathic
hemolytic anemia
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Burr (crenation ) cell/Echinocyte:

Morphology:
RBC with uniformly spiny, pointed
projections on their surface.
Less spherical
Found in:
- hemolytic anemia
-PK deficiency
- Uremia.
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- Megaloblastic anemia
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Echinocytes (crenated)

Morphology:
short, scalloped or
spike-like irregularly
distributed.

Found in:
- osmotic imbalance
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Elliptocytes

Morphology:
The red cells are oval or elliptical
in shape. Long axis is twice the
short axis.

Found in:
- Hereditary elliptocytosis
- Megaloblastic anemia
- Iron deficiency
- Thalassaemia 18
- Myelofibrosis
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Helmet cells

 Morphology:
Fragmentation(helmet-
shaped) of the red cells.
 Found in:
- DIC
- Micro angiopathic
hemolytic anemia
- Mechanical hemolytic
anemia
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Keratocytes (horn cell):

 Morphology:
Part of the cell fuses back leaving
two or three horn-like projections.
The keratocyte is a fragile cell
and remains in circulation for only
a few hours.
 Found in:
- Uremia
- Severe burns
- EDTA artifact 20

- Liver disease
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Ovalocytes
Morphology:
oval shape or egg-like
appearance

Found in:
- Vit. B12 deficiencies
- Hereditary ovalocytosis.
- Thalassemia major 21
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Sickle Cells (drepanocytes):

 Morphology:
Sickle shaped red cells.

 Found in:
Hb-S disease

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Spherocytes

Morphology:
Red cells are more spherical.
Lack the central area of pallor on
a stained blood film.
Found in:
- Hereditary spherocytosis.
- Immune hemolytic anemia.
- Microangiopathic hemolytic
anemia. 23
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Stomatocytes (mouth cells)

 Morphology:
Red cells with a central linear slit or
stoma. Seen as mouth-shaped form
in peripheral smear.
 Found in:
- Alcohol excess
- Alcoholic liver disease
- Hereditary stomatocytosis
- Hereditary spherocytosis
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Target Cells
Morphology:
Red cells have an area of
increased staining which appears
in the area of central pallor.
Found in:
-Obstructive liver disease
- Thalassaemia (not I.D.A)
- Hemoglobinopathies (S and C)
- Post splenectomy
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Tear Drop Cells (dacryocytes)

Morphology:
Red cells shaped like a tear
drop or pear.

Found in:
- Bone marrow fibrosis
- Megaloblastic anemia
- Iron deficiency
- Thalassemia 26
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Nucleated Red Blood Cells

 These red blood cells are

released from the bone
marrow early into the blood
stream, due to the need for
oxygen.
 Normal red blood cells do
not contain a nucleus on a
peripheral smear. 27
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Envelope form cell

Found in:
- thalassemia
- Sickle cell
anemia

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 V -Erythrocyte inclusion
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bodies
1- Howell-Jolly Bodies:
Morphology:
Small round cytoplasmic red
cell inclusion with same staining
characteristics as nuclei
Found in:
- Post splenectomy
- Megaloblastic anemia

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Siderotic Granules
RBCs which contain number of
hemoglobin iron granules.
They appear as dense blue, irregular
granules which are unevenly
distributed in Wright stained RBCs.
Pappenheimer bodies can be
increased in hemolytic anemia,
infections and post-splenectomy.

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Basophilic stippling(PUNCTATE BASOPHILIA)

Morphology:
Considerable numbers of small
basophilic inclusions in red cells.
Found in:
- Thalassaemia
- Megaloblastic anemia
- Hemolytic anemia
- Liver disease
- Heavy metal poisoning.
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Heinz Bodies
Represent denatured hemoglobin
(methemoglobin - Fe+++) within a
cell. With a supravital stain like
crystal violet, Heinz bodies appear
as round blue precipitates.
Presence of Heinz bodies indicates
red cell injury and is usually
associated with G6PD-deficiency.

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Cabot Rings
Reddish-blue threadlike rings in
RBCs of severe anemia's. These are
remnants of the nuclear membrane
and appear as a ring or figure 8
pattern.
Very rare finding in patients with
Megaloblastic anemia, severe
anemia's, lead poisoning, and
dyserythropoiesis.
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Parasites of Red Cell

Are protozoan parasites which
occur in many species of birds
and are the cause of avian
malaria.
Transmitted by mosquitoes,
infection with Plasmodium spp
can be a cause of hemolytic
anemia
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RBC Abnormal Morphology

(A) Basophilic
stippling
(B) Howell-Jolly
bodies
(C) Cabot's ring
bodies
(D) Heinz's bodies. 35
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…The end
sana ikaw ang RBC ko…“
para daloy ka ng daloy sa
….”katawan ko

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