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RBCs Abnormal morphology

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RBCs Abnormal morphology Mohammed laqqan Mohammed laqqan IV -Erythrocyte inclusion bodies 6- Parasites of Red Cell: Are protozoan parasites which occur in many ... – PowerPoint PPT presentation

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Title: RBCs Abnormal morphology


1
RBCs Abnormal morphology
2
Blood Cells
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Abnormal erythrocyte morphology
  • 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.

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I- Variation in red cells Distribution
  • 1- Rouleaux Formation
  • Morphology
  • Stacks of RBC's resembling a stack of coins.
  • Found in- Hyperfibrinogenaemia-
    Hyperglobulinaemia

8
I- Variation in red cells Distribution
  • 2- Red cell-agglutination
  • Morphology
  • Irregular clumps of red cells
  • Found in- Cold agglutinins- Warm autoimmune
    hemolysis

9
Terms
  • Normochromic
  • A descriptive term applied to a red blood cell
    with a normal concentration of hemoglobin.
  • Normocytic
  • A descriptive term applied to normal size of RBC.
    Hypochromic
  • A descriptive term applied to a red blood cell
    with a decreased concentration of hemoglobin.
  • Macrocytic
  • A descriptive term applied to a larger than
    normal red blood cell.

10
II-Variation in erythrocyte size (anisocytosis)
  • 1-Microcytosis
  • Morphology
  • - Decrease in the red cell size. Red cells are
    smaller than 7µm 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.- Thalassaemia.-
    Sideroblastic anemia.- Lead poisoning.- Anemia
    of chronic disease.

11
II-Variation in erythrocyte size (anisocytosis)
  • Comment
  • Most erythrocytes presented in the picture are
    microcytes (compare with the small lymphocyte).
    The degree of hemoglobinization is sufficient.
    Normal platelets and single ovalocytes are
    present.

12
II-Variation in erythrocyte size (anisocytosis)
  • 2-Macrocytosis
  • MorphologyIncrease in the size of a red cell.
    Red cells are larger than 9µm in diameter. May be
    round or oval in shape, the diagnostic
    significance being different.
  • Found in- Folate and B12 deficiencies (oval)-
    Ethanol (round)- Liver disease (round)-
    Reticulocytosis (round)

13
III-Variation in hemoglobin content
  • 1-Hypochromasia
  • MorphologyIncrease in the red cells' central
    pallor which occupies more than the normal third
    of the red cell diameter.
  • Found in - Iron deficiency- Thalassaemia any
    of the conditions leading to Microcytosis

14
III-Variation in hemoglobin content
  • 2- Polychromasia
  • MorphologyRed cells stain shades of blue-gray
    as a consequence of uptake of both eosin (by
    hemoglobin) and basic dyes (by residual ribosomal
    RNA). Often slightly larger than normal red cells
    and round in shape - round macrocytosis.
  • Found inAny situation with reticulocytosis -
    for example bleeding, hemolysis or response to
    heamatinic factor replacement.

15
IV- Variation of red cells shape (Poikilocytosis)
  • 1- Spherocytosis
  • MorphologyRed cells are more spherical. Lack
    the central area of pallor on a stained blood
    film.
  • Found in- Hereditary spherocytosis.- Immune
    haemolytic anemia.- Zieve's syndrome (Look to
    the margin). - Microangiopathic haemolytic
    anemia.

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IV- Variation of red cells shape (Poikilocytosis)
  • 2-Target Cells
  • MorphologyRed 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)- Haemoglobinopathies (S
    and C)- Post splenectomy

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IV- Variation of red cells shape (Poikilocytosis)
  • 3- Ovalocytes
  • Morphologyoval shape red blood cell
  • Found in- Thalassaemia major.
  • - Hereditary ovalocytosis.
  • - Sickle cell anemia

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IV- Variation of red cells shape (Poikilocytosis)
  • 4- Elliptocytosis
  • MorphologyThe red cells are oval or elliptical
    in shape. Long axis is twice the short axis.
  • Found in
  • - Hereditary elliptocytosis- Megaloblastic
    anemia- Iron deficiency - Thalassaemia-
    Myelofibrosis

19
IV- Variation of red cells shape (Poikilocytosis)
  • 5- Tear Drop Cells
  • MorphologyRed cells shaped like a tear drop or
    pear.
  • Found in
  • - Bone marrow fibrosis- Megaloblastic
    anemia- Iron deficiency- Thalassaemia

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IV- Variation of red cells shape (Poikilocytosis)
  • 6- Blister cell (prekeratocyte)
  • Morphology
  • Have accentric hallow area.
  • Resemble a women's handbag
  • Found in
  • Microangiopathic hemolytic anemia

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IV- Variation of red cells shape (Poikilocytosis)
  • 7- Keratocytes (horn cell)
  • MorphologyPart 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- Uraemia- Severe burns- EDTA
    artifact- Liver disease

22
IV- Variation of red cells shape (Poikilocytosis)
  • 8- Burr (crenation ) cell
  • Morphology
  • Red cell with uniformly spaced, pointed
    projections on their surface.
  • Found in- hemolytic anemia
  • - Uremia.
  • - Megaloblastic anemia

23
IV- Variation of red cells shape (Poikilocytosis)
  • 9- Acanthocytosis
  • Morphologyare red blood cells with irregularly
    spaced projections, these projections very in
    width but usually contain a rounded end
  • Found in- Liver disease - Post splenectomy-
    Anorexia nervosa and starvation

24
IV- Variation of red cells shape (Poikilocytosis)
  • 10- Schistocytosis
  • Morphology
  • Fragmentation of the red cells.
  • Found in - DIC - Micro angiopathic hemolytic
    anemia- Mechanical haemolytic anemia

25
IV- Variation of red cells shape (Poikilocytosis)
  • 11- Stomatocytosis
  • 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

26
IV- Variation of red cells shape (Poikilocytosis)
  • 12- Sickle Cells
  • Morphology
  • Sickle shaped red cells.
  • Found in
  • Hb-S disease

27
IV- Variation of red cells shape (Poikilocytosis)
  • 13- 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.

28
Envelope form cell
  • Found in
  • thalassemia
  • Sickle cell anemia

29
V -Erythrocyte inclusion bodies
  • 1- Howell-Jolly Bodies
  • MorphologySmall round cytoplasmic red cell
    inclusion with same staining characteristics as
    nuclei
  • Found in- Post splenectomy- Megaloblastic
    anemia

30
V -Erythrocyte inclusion bodies
  • 2- Siderotic Granules
  • RBCs which contain no 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.

31
V -Erythrocyte inclusion bodies
  • 3- Basophilic stippling
  • MorphologyConsiderable numbers of small
    basophilic inclusions in red cells.
  • Found in- Thalassaemia- Megaloblastic anemia-
    Hemolytic anemia - Liver disease- Heavy metal
    poisoning.

32
V -Erythrocyte inclusion bodies
  • 4- 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.

33
V -Erythrocyte inclusion bodies
  • 5- 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.

34
IV -Erythrocyte inclusion bodies
  • 6- 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

35
RBCs Abnormal morphology
  • Depiction of red blood cell morphologies that may
    appear on a peripheral smear, showing
  • (A) basophilic stippling,
  • (B) Howell-Jolly bodies,
  • (C) Cabot's ring bodies and (D) Heinz's bodies.
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