Variation in the color/central pallor (hemoglobin content) of red blood cells.

With a central pallor greater than 1/3 of cell diameter.

Usually microcytic also.

Anulocyte (also known as Pessary cell or Ghost cell is an RBC with a thin rim of hemoglobin and a large, clear center. This may be observed in IDA.

RBCs that lack a central pallor, usually caused by a shape change

Occurs when there is a high MCHC

Hereditary spherocytosis is the only disease in which MCHC is high or above the reference range.

Larger than normal

Associated with impaired synthesis of DNA (megaloblastic anemia).

Smaller than normal.

Associated with defective formation of hemoglobin.

Usually, a microcytic cell will shift the curve to what direction?

Ø Small, round dense RBC with no central pallor.

Identify the red blood cell morphology shown in the image.

Identify the red blood cell morphology shown in the image.

Identify the red blood cell morphology shown in the image.

Identify the red blood cell morphology shown in the image.

Associated conditions: Hereditary spherocytosis, autoimmune hemolytic anemia, burns, ABO HDN, following transfusion of stored blood

Which of the following has a tendency to be wrongly reported if the feathered edge of a blood film is examined because the RBCs in this area lack central pallor?

Which of the following can result from natural RBC death (extravascular hemolysis)?

Associated conditions: Hereditary elliptocytosis or ovalocytosis, iron deficiency anemia, thalassemia major, myelophthisic anemias

Ø A.K.A. mouth cell.

Associated conditions: Rh deficiency syndrome, alcoholism, electrolyte imbalance, severe liver diseases, overhydrated heredit. stomatocytosis, dehydrated hereditary stomatocytosis (most common form)

Which of the following is an RBC with slit-like central pallor?

Ø Sickle or crescent-shaped RBCs.

Identify the red blood cell morphology shown in the image:

A.K.A. Drepanocyte, Meniscocyte

Associated conditions: Sickle cell anemia, hemoglobin SC disease, etc

Which of the following form of sickle cell is Crescent-shaped?

Which of the following form of sickle cell has long projections?

Which of the following form of sickle cell fragments when reoxygenated?

Which of the following form of sickle cell is reversible?

Which of the following form of sickle cell has less pronounced projections?

Which of the following form of sickle cell reverts to original biconcave shape when reoxygenated?

Hexagonal crystal of dense hemoglobin formed within the RBC membrane.

Which of the following has a bar of gold appearance?

Identify the red blood cell morphology shown in the image:

Associated condition: Hb C disease

Associated condition: Hb SC disease

Fingerlike or quartzlike crystal of dense hemoglobin protruding from the RBC membrane

Which of the following has a washington monument appearance?

Identify the red blood cell morphology shown in the image:

RBCs that show a centrally stained area with a thin outer rim of hemoglobin.

A.K.A. Leptocytes, Platycyte, Greek Helmet cell, Mexican hat cell, Bull’s eye cell, Target cell

Identify the red blood cell morphology shown in the image:

Associated conditions: Liver disease, some hemoglobinopathies, Thalassemia, LCAT deficiency

Fragmented RBC caused by rupture in the peripheral circulation

Identify the red blood cell morphology shown in the image:

Associated conditions: Microangiopathic hemolytic anemia (along with microspherocytes), Macroangiopathic hemolytic anemia, extensive burns; patients with artificial heart valves, uremia.

MAHA (Microangiopathic hemolytic anemias): Ø Group of disorders characterized by RBC fragmentation and thrombocytopenia. Ø Major MAHAs: TTP (Thrombotic thrombocytopenic purpura), HELLP syndrome (Hemolysis, elevated liver enzymes, low platelet count), HUS (Hemolytic uremic syndrome), DIC

RBC fragment that is shaped like a helmet.

Same conditions associated with schistocytes.

Small, dense RBC with few irregularly spaced projections of different lengths.

Identify the red blood cell morphology shown in the image:

Associated conditions: Severe liver disease (Spur cell anemia), Neuroacanthocytosis (Abetalipoproteinemia or BassenKornzweig Syndrome, McLeod syndrome).

RBC with blunt or pointed, short projections that are usually evenly spaced over the surface of the cell. (should be present in all fields of blood film).

Identify the red blood cell morphology shown in the image:

A.K.A. Burr cell

Associated conditions: Uremia, Pyruvate Kinase deficiency

When these cells are not evenly distributed in a blood film or not present in all fields, it is more likely to be a “drying artifact”. These artifacts are sometimes called “crenated RBCs”.

RBC with a single pointed extension resembling a teardrop or pear.

Identify the red blood cell morphology shown in the image:

Associated conditions: Primary myelofibrosis, myelophthisic anemia, thalassemia, megaloblastic anemia.

Which of the following inclusion bodies contains Precipitated RNA?

Associated with: Lead poisoning Thalassemia Hemoglobinopathy Megaloblastic anemia Myelodysplastic syndrome

Which of the following inclusion bodies contains RNA?

Associated with: Hemolytic anemia, post-treatment for iron, vitamin B12, or folate deficiency

Which of the following inclusion bodies contains DNA (Nuclear fragment)?

Associated with: Hyposplenism, Postsplenectomy, Megaloblastic anemia, Hemolytic anemia, Thalassemia, Myelodysplastic syndrome

Which of the following inclusion bodies contains Denatured Hgb?

Associated with: G6PD deficiency, Unstable Hgb, Oxidant drugs/chemicals

Which of the following inclusion bodies contains Iron?

Associated with: Sideroblastic anemia, Hemoglobinopathies, Thalassemia, Megaloblastic anemia, Myelodysplastic syndrome, Hyposplenism, Postsplenectomy

Which of the following inclusion bodies contains Mitotic spindle remnant?

Associated with: Megaloblastic anemia, Myelodysplastic syndromes

Associated with: Hb H disease

Which of the following inclusion bodies contains Precipitated βglobin chains of hemoglobin?

What does basophilic stippling contain?

What does diffuse basophilia contain?

What does howell-jolly body contain?

What does heinz body contain?

What does Pappenheimer bodies contain?

What does Cabot ring contain?

What does Hemoglobin H contain?

Ø Refers to the production of erythroid precursor cells that are defective

Examples: Megaloblastic anemia, thalassemia, sideroblastic anemia.

Refers to a decrease in the number of erythroid precursors in the bone marrow, resulting in decreased RBC production

Examples: EPO deficiency, iron deficiency, aplastic anemia, acute pure red cell aplasia, infection.

Ø Aplastic anemia

Ø Kidney disease

Ø Acute blood loss

PNH

PCH

SCD

Ø Enzyme deficiency

Ø Other hemolytic anemia

Rare but potentially deadly bone marrow failure syndrome

Characteristics: Ø Pancytopenia (markedly decreased number of all blood cells) Reticulocytopenia (inability to produce effective reticulocytes) Ø Bone marrow hypocellularity Ø HSC depletion

An inherited associated disease of Aplastic anemia that is a member of Telomere biology disorders (TBD), a group of diseases caused by germline mutations that affect genomic stability, resulting in premature aging.

What is the drug most frequently implicated in acquired aplastic anemia?

An inherited associated disease of Aplastic anemia that clinically presents with a triad of abnormal skin presentation, dystrophic nails, and oral leukoplakia.

Characterized by pancreatic insufficiency, cytopenia, skeletal abnormalities and predisposition for hematologic abnormalities

The most common of the inherited bone marrow failure syndromes

Physical presentations: skeletal abnormalities (thumb malformations, radial hypoplasia, microcephaly, hip dislocation, and scoliosis); skin pigmentation (hyperpigmentation, hypopigmentation, café-aulait lesions); short stature; and abnormalities of the eyes, kidneys, and genitals.

Caused by the deficiency of CD55 (Decay-accelerating factor, DAF), and CD59 (Membrane inhibitor or reactive lysis, MIRL).

A.k.a. Marchiafava-Micheli syndrome

Acute form of cold-reactive hemolytic anemia.

May be idiopathic or secondary

Secondary form of this disease is most commonly seen in young children after a viral respiratory infection.

A.k.a. Donath-Landsteiner antibody

Anti-P autoantibody binds to the P antigen on RBCs at cold temperature leading to ____ as it react with complement C1 to C4.

Which type of activation of anti-P autoantibody only occurs on warming?

Ø Have normal MCV and MCHC.

Aplastic anemia

Fanconi anemia

PNH

PCH

Ø Have high MCV and normal MCHC.

Megaloblastic anemia

Nonmegaloblastic anemia

Ø Have low MCV and MCHC.

"CTAILS"

Sideroblastic anemia

Chronic blood loss

Lead poisoning

Iron Deficiency Anemia

Anemia of Chronic inflammation

Thalassemia

Characterized by impaired DNA synthesis caused by Vitamin B12 or folate deficiency

The MCV can be markedly increased (up to 150 fL), but 100- 115 fL is most common

Characterized by large RBCs and are typically related to membrane changes caused by disruption of the cholesterol-to-phospholipid ratio.

It is rare for the MCV to be >115 fL in

Ø Inadequate intake Ø Increased need Ø Renal dialysis

Ø Increased need (pregnancy, lactation, growth). Ø Competition (infection with D. latum) Ø Lack of intrinsic factor (IF), aka Pernicious anemia

has noticeable neurologic and neuropsychiatric symptoms.

Characteristics: ü Hypersegmented neutrophils (with >6 lobes) ü Oval macrocytes ü Presence of megaloblasts in the bone marrow

The most common anemia among hospitalized patients

Associated with chronic infections

Central feature: Sideropenia in the face of abundant iron stores.

Develops when protoporphyrin production or the inclusion of iron into protoporphyrin is prevented.

Which of the following is a liver hormone that regulates iron absorption by inactivation of ferroportin?

Which of the following competes with microorganisms for iron directly?

Iron is trapped in mitochondria

Ø Characterized with a dimorphic peripheral blood picture.

The most common anemia

nucleated RBC precursor with cytoplasmic iron granules

anucleated RBC with iron granules.

(Stored iron)

Only ferritin or stored iron is decreased.

Ferritin and serum iron are decreased. ü Increased Total Iron Binding Capacity (TIBC). ü Hemoglobin level is normal

Ferritin and serum iron are decreased. ü Increased Total Iron Binding Capacity (TIBC). ü Hemoglobin level is decreased

Ferritin and serum iron in Transport Iron depletion

Ferritin in storage iron depletion

Hgb in functional iron depletion

TIBC in Transport Iron depletion

Hgb in Transport Iron depletion