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BLOOD FILM ABNORMALITIES

BY DR SANA BUSHRA

Target cells
These contain excess membrane or insufficient haemoglobin and are recognized as target like with red peripheries, central pallor and with a dot of haemoglobin at the centre Post splenectomy Haemoglobinopathies(sickle cell,thalassemia disease plus trait) Severe iron deficiency Obstructive jaundice

Anisocytosis
Variation in size of erythrocytes Iron deficiency anemia Beta thalassemia Megaloblastic anemia

Howell- jolly bodies


Dense nuclear round remnants found within erythrocytes . Remnants of DNA and RNA Beta thalassemia Post splenectomy Megaloblastic anemia Sometimes found in premature infants

Poikilocytosis
Variation in shape of erythrocytes Severe iron deficiency Beta thalassemia

Heinz bodies
Denatured hemoglobin / hemoglobin remnant stained by supravital staining seen as a dark dot in erythrocyte. Red cell enzyme defects ( e.g G6PD deficiency , pyruvate kinase deficiency) Drugs and chemicals causing haemolytic anaemia

Left shift and leukaemoid reactions


Less mature white cells released prematurely from the bone marrow . Careful examination may be needed to distinguish from leukemia . Also refers to increased neutrophil/lymphocyte ratio. Sepsis ( caused by increased demand on neutrophils , less mature cells are released prematurely ) Tuberculosis Syphilis Toxoplasmosis Down syndrome

Rouleaux formation
Erythrocytes stacked in rows one on another Inflammation Malignancy

Spherocytes
Seen as spherical cells with no central pallor; give rise to a low MCV Hereditary spherocytosis Immune haemolytic anemia Severe burns Post transfusion

Dimorphic blood film


The presence of two differently sized populations of red cells , with increased red cell distribution width(RDW) Sideroblastic anemia(bone marrow cells unable to utilise iron to form haemoglobin characterized by ring sideroblasts in bone marrow; caused by inherited and acquired causes such as lead poisoning , anti TB drugs)

Continued
Combination of iron deficiency with a B12/folate deficiency Iron deficiency anaemia (with microcytosis) and having received a blood transfusion

Basophil stippling
Seen as numerous small dots in the red cell due to alpha chain clumping Lead poisoning Beta thalassemia

Tear drop cells

Acanthocytes
Red cells with spiny projections protruding from the surface Post splenectomy Abetalipoprotenemia