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RBC Clin Med I

RBC Differential/Morphology

RBC Maturation Stages 1. Stem Cell (nucleated) 2. Rubriblast (nucleated) 3. Prorubricyte (nucleated) 4. Rubricyte (basophilic & polychromatic) 5. Metarubricyte (nucleated) 6. Reticulocyte (anucleated) 7. Mature RBC (anucleated)
Reticulocytes Large, young RBCs which appear bluish when stained with Diff-Quik When stained with New Methylene Blue (NMB) they have dots, strings or clumps of basophilic material (DNA/RNA)
Mature RBCs Normal, mature RBCs: biconcave disks. Central pallor. Dog RBCs are ~ 7um and live ~ 100 days Cat RBCs ~5-6 um and live ~60 days Dogs exhibit an area in the middle of the cell which is more pale than surrounding cell. Cats much less pallor.
What am I looking for with a differential, in regards to RBCs? Morphology RBC: formation shape size color (chromia) inclusions (abnormal like fiber, bacteria, viruses
Agglutination Precipitation of RBCs out of blood Occurs as WBCs attack RBCs as if foreign Can suggest an autoimmune disease
Rouleax Formation RBCs stacked like coins RBC arrangement due to blood smear technique
Poikilocytosis Abnormally shaped RBCs Can be abnormally small, contain protusions or appear as a fragment
Types of Poikilocytes Acanthocytes (spur cells) Echinocytes (burr cells) Schistocytes Spherocytes Keratocytes Codocytes/Leptocytes (target cells) Stomatocytes Anulocytes Dacrocytes
Acanthocytes (spur cells) RBCs with cell membrane abnormalities Sort, irregular, unevenly spaced protusions Seen with hemangiosarcoma, a blood vessel tumor Blood moved thru intravascular tumor at high speed
Echinocytes (burr cells) Sharp, evenly spaced projections Can be drying artifact (crenation) Seen with renal disease and lymphosarcom... polydipsia/polyuria, dehydration, kidney pain
Schistocytes RBC fragments due to internal trauma, RBCs pushed thru fibrin strands Associated w hemangiosarcoma, (blood vessel that bleeds and clots repeatedly) Disseminated intravascular coagulopathy(DIC)... pet beins to spontaneously clot blood in ve
Spherocytes Smaller RBCs w no central pallor Appear as small, dense RBCs Associated with AIHA, autoimmune hemolytic anemia, where WBCs attack own RBCs RBCs decrease in size as WBCs attack
Keratocytes (helmet, blister or bite cells) Associated w hemangiosarcoma, neoplasia, glomerulonephritis, intravasular trauma and various hepatic diseases May contain pseudovacuole due to fibrin strands causing bisection and reconnection
Codocytes/Leptocytes Take a variety of shapes with different names: Target cells Folded cells aka Stomatocytes Barr cells aka knizocytes - rare
Anulocytes Bowl-shaped RBCs Due to loss of membrane flexibility that does not allow RBC to return to normal shape after passing thru capillary May be seen in any acute disease
Dacrocytes Tear-drop shaped Can be an artifact or seen in myeloproliferative diseases (spinal cord or bone marrow) If artifact, "tails" point in same direction
Poikilocytes Anisocytosis Anisochromia
Anisocytosis Abnormal variation in size of RBCs Macrocytosis=abnormally large RBCs, macrocytes Microcytosis=abnormally small RBCs, microcytes Normocytosis=normal sized RBCs
Anisochromia Hypochromia-hemoglobin deficiency; insufficient color Hyperchromia-hemoglobin excess; overabundance of color Normochromia-normal hemoglobin; normal color Polychromatophilia-RBCs w many colors If many reticulocytes do reticulocyte smear
RBC Inclusions Small bodies that are "included" in RBCs Presence indicates toxicity, RBC parasite, viral infection or disease
RBC Inclusions we will cover: Heinz bodies - feline and canine Hollow Jolly Bodies Basophillic Stippling Distemper Viral Inclusions Mycoplasma Haemofelis/canis Ehrlichia Babesia from brown dog tick
Heinz Bodies Small round projection from RBC surface Usually represents oxidation and denaturation of Hgb Seen in cats w DM, lymphoma and hyperthyrodism Looks blue when using NMB, clear w Diff-Quik Seen in dogs after eating onions, toxic drugs, acetamin
Howell Jolly Bodies Small fragments on nonfunctional nucleus that were not extruded as cell left marrow. Normally removed from blood by pitting action of spleen Appear as on dark staining body per cell Seen w regenerative anemia, pts on corticosteroids, splenect
Basophillic Stippling Round, dark blue granules in RBCs Granules are precipitated ribosomes and mitochondria Seen w toxic injury to bone marrow (lead poisoning), severe anemia, drug toxicity, severe burns or septicemia
Distemper Viral Inclusions Large aggregates of viral particles can form in cytoplasm of RBCs, WBCs and epithelial cells in many tissues during acute phase of infection
Mycoplasma Haemoncanis Rare in dogs Usually seen in splenectomy or immuno-suppressed pts Commonly appear as chain of small cocci or rods that stretch across the RBC surface Chains may branch
Mycoplasma Haemonfelis Fairly common bacterial parasite of cat RBCs AKA hemobartonellosis or feline infectious anemia Appear as small round, rod or ring-shaped structures that stain dark purple Most commonly appear as short rods on RBC periphery
Ehrlichia Type of rickettsial organism w many species Tick borne disease that affect WBCs and platelets Transmitted by brown dog tick Appears as small clusters called morulae in the cytoplasm Can result in neutropenia, thromocytopenia and anemia
Created by: mfjasp