This presentation contain information about red blood cell morphology with images and with disease information.

1. RED Blood Cells
Morphology and disease
that may be associated
with abnormal
MorphologiesFaheem Javed
BSc, Microscopist

2. Acknowledgment
Assalam-wa-Alekum everyone!
I’m a Medical Technologist and I am also a science
graduate. I prepared this presentation for Doctors and
Paramedics because I wanted to tell them about the importance
of Red Blood Cell Morphology and Disease that may be
associated with abnormal morphologies. This presentation is
really useful for Laboratory Technicians especially for beginners.
The information contained this presentation is obtained via
different sources e.g. internet and some hematology books, I
selected best image and best definition for explanation of
morphology, hope this going to be work. Feedback as the quality
and usefulness of this book is solicited and suggestions for
improvement are welcome. Please forward your remarks by
e-mail faheem.javed89@hotmail.com or
contact on Mobile: 0306-2631619.
Best regards
FAHEEM JAVED

3. Normal Mature Red Blood Cells.
Normal mature RBC are
biconcave, round discs that
are about 6 – 8 in diameter,
which is only slightly smaller
than the normal small mature
lymphocytes ( about 6 - 10 in
diameter).
The term used to indicate red blood cells of normal size and shape
is
normocytic. The term used to indicate a normal color or central
pallor
(i.e., normal hemoglobin content) is normochromic.

4. Definitions:
Hypochromic: Erythrocytes that demonstrate a central pale
area
that becomes larger and paler as the hemoglobin
content diminishes.
Normocytic Hypochromic

5. Definitions:
Anisochromic or dimorphic: indicates the presence of
both
normochromic and
Hypochromic
Normocytic Normochromic,
Hypochromic

6. Definitions:
Polychromacia and polychromatophilia.
Changeable terms used to indicate the increased presence of non-
nucleated immature erythrocytes (Polychromatophilic
erythrocytes) that contain residual RNS which gives a blue-gray
tint to the red cells. These cells, which remain after ejection of
the nucleus from the orthochromatic erythroblast are slightly
larger than mature erythrocytes. After exposure to a supravital
stain, the cytoplasm organelles of these cells clump into an
easily recognized blue-staining reticulum and the cells is called a
reticulocytes.

7. Polychromacia and polychromatophilia.
Normocytic Anisochromic or
dimorphic

8. Microcytic: Are abnormally small erythrocytes (i.e., less than 6
in
diameter).
Lymphocytes 06~10 diameter
Definitions:
Normocytic Microcytic
RBC 6~8 diameter (predominant)

9. Macrocytic: Are abnormally large erythrocytes (i.e., less than 8
in
diameter).
Lymphocytes 06~10 diameter
Definitions:
Normocytic Macrocytic
RBC 6~8 diameter

10. Definitions:
Anisocytosis: is a “generic” term used to indicate variation in
shape of erythrocytes (e.g. oval, pear-shaped, teardrop-shaped,
saddle-shaped, helmet-shaped, sickle-shaped, and irregularly
shaped).
Normocytic Anisocytosis
Normocytic, Macrocytic,
Microcytic.

11. Definitions:
Elliptocytes and Ovalocytes: are interchangeable terms
used to indicate ovalshaped erythrocytes.
Normocytic Elliptocytes /
Ovalocytes

12. Definitions:
Spherocytes: are nearly spherical erythrocytes which are
nearly spherical erythrocytes which usually have a diameter
smaller than normal. They lack the central pale area due to their
spherical shape.
Normocytic Spherocytes

13. Definitions:
Target Cells: are erythrocytes that are thinner than normal
which show a peripheral rim of hemoglobin with a dark central
hemoglobin-containing area. A pale unstained ring containing
less hemoglobin separates the central and peripheral zones and
gives the cell a target appearance.
Normocytic Target Cells

14. Definitions:
Schistocytes: are fragmented red cell segments that are the
result of some hemolytic process. These segments can be a
variety of shapes but helmet cells and triangularly-shaped cells
are particularly characteristic.
Normocytic Schistocytes

15. Definitions:
Sickle cells (drepanocyes, menisococytes): are
interchangeable terms used to indicate sickle-like forms of
erythrocytes (crescent-shaped, irregular spines, filaments, holly-
leaf appearance) noted when RBC containing HbS are
subjected to reduction in oxygen tension or pH.
Normocytic Sickle cells

16. Definitions:
Acanthocytes: are irregularly shaped red cells with spiny or
torny projections and dark centers.
Normocytic Acanthocytes

17. Definitions:
Burr cells: are uniformly shrunken red cells with uniform
irregular, wrinkled cell membranes. Their presence is an artifact
of storage and all red cells in the field are usually affected. (By
contrast, ecinocytes are intermixed with normal red cells).
Normocytic Burr cells

18. Definitions:
Ecinocytes: are irregularly shaped red cells with spiny
projections and preserved central pallor. While their presence is
usually an artifactual phenomenon.
Normocytic Ecinocytes

19. Definitions:
Rouleaux formation: describes an aggregation of
erythrocytes that are aligned one upon the other, resembling
stacks of coins.
Normocytic Rouleaux formation

20. Definitions:
Agglutination of red cells: is caused by agglutinins and
resembles Rouleaux but is more irregular with round clumps
rather than linear Rouleaux.
Normocytic Agglutination of red
cells

21. Definitions:
Hemoglobin C crystals: are hexagonal crystals that may
be found in individuals with HbC syndromes. The crystals may
intracellular or extra-cellular.
Normocytic Intracellular HbC / extra-
cellular HbC

22. Definitions:
Basophilic Stripling: is the term used to indicate the
presence of irregular basophilic granules in the cytoplasm of
erythrocytes. The granules are composed of unstable RNA and
may be fine of coarse.
Normocytic Basophilic Stripling

23. Definitions:
Pappenheimer Bodies: are intracellular inorganic iron-
containing granules that may be ob-served on Wright’s stained
peripheral blood smears.
Normocytic Pappenheimer Bodies

24. Definitions:
Howell-Jolly Bodies: are intracellular particles which are
smooth, round remnants of nuclear chromatin (DNA. Usually,
only one per cell is seen but, occasionally, there may be more
than one.
Normocytic Howell-Jolly Bodies
multiple

25. Some more Morphologies:
Teardrop Cells Heinz Bodies
Cabot Rings

26. Hope now you can ID abnormally
shaped RBC:

27. Hope now you can ID abnormally
shaped RBC:

28. Summary of Red Blood Cell
(RBC) Morphology

30. Abnormal RBC are differentiated and
identified as part of the “diff”.
Changes in size, shape, hemoglobin content, and/or appearance of
cellular inclusions may occur as a result of disease process. Such
changes are noted as part of the “diff”.

31. Are nucleated red blood cells
normally seen in peripheral blood?
Immature nucleated red blood cells (NRBC) are not normally seen
in
adults blood,. However, they may be seen normally in newborns
and
abnormally in disease.
Properythroblast Basophilic erythroblast
Polychromatophilic Orthochromatic
erythroblast erythroblast

32. End of Red Blood Cell
(RBC) Morphology

33. Disease that may be associated
with abnormal Red Blood Cell
(RBC) Morphology

34. Summary of Abnormal Red Blood Cell Morphologies and Disease
States That May Be Associated with these abnormal Morphologies
•Hypochromic:
Iron Deficiency
Sideroblastic Anaemia
Thalassaemia
Microcytosis:
Found with Hypochromic
Macrocytosis:
Megaloblastic Anaemia
High reticulocytes count
Liver disease
Mylodysplastic syndrome
Target Cells:
Liver Disease
Hemoglobinopathies
Thalassaemia
Sideroblastic anemia
Spherocytes:
Hemolytic anemia
Post transfusion
Hereditary
sphercocytosiss
•Tear-Drop Cells:
Severe Anaemia
Myloproliferative disorders
Elliptocytes:
Hereditary elliptocytosis
Iron-deficiency anaemia
Thalassaemia
Stomatocytes:
Acute alcoholism
Malignancies
Helmet Cells:
G6PD deficiency
Pulmonary emboli
Schistocytes:
Disseminated intra-vascular coagulopathy
(DIC)
Thrombotic Thrombocytopenia purpura
(TTP)
Hemolytic uremic syndrome
•Sickle cells:
Sickle cell anaemia
Sickle thalassaemia
Acanthocytes:
Congenital
abetalipoproteinemia
Vitamin E deficiency
Alcohol intoxication
Post-splenectomy
Burr Cells:
Liver disease
Renal disease
Severe burns
Bleeding gastric ulcers

35. Summary of Abnormal Red Blood Cell Morphologies and Disease
States That May Be Associated with these abnormal Morphologies
•Howell-Jelly:
Megaloblastic anaemia
Mylodysplastic
Basophilic
Stippling:
Lead Poisoning
Thalassaemia
Significant anaemia
Dyserythropoiesis
Rouleaux
formation:
High level of circulating
acute-phase proteins.
with High ESR rate.
autoimmune conditions
myeloma

36. Thank you!