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Red Blood Cell Abnormalities As Seen with May-Grünwald-Giemsa (MGG) Staining

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Red Blood Cell Abnormalities As Seen with May-Grünwald-Giemsa (MGG) Staining Red blood cell abnormalities as seen with May-Grünwald-Giemsa (MGG) staining Microcyte Macrocyte Megalocyte Microspherocyte Description Description Description Description Ø < 7 µm, in the smear smaller Large red blood cell, Ø 10 µm, Large red blood cell, oval shape, Small red blood cell, Ø < 6 µm, diameter than the nucleus of a central pallor present no central pallor, always hyper- normal volume, no central small lymphocyte, often chromic pallor Incidence hypochromic Reticulocytes are always Incidence Incidence Incidence macrocytes and reflect the Vitamin B12 or Hereditary spherocytosis Iron deficiency regeneration of erythropoiesis. folate deficiency Hypochromic red blood cell Anulocyte Polychromatic red blood cell Echinocyte Description Description Description Description Central pallor > 1/3 of the cell Pronouncedly hypochromic red Blue-tinged red blood cell with Crenated red cell with evenly surface, often microcytic blood cell with small, peripheral remnants of diffusely distributed distributed and uniformly sized ring of haemoglobin, always RNA, often macrocytic spicules Incidence hypochromic Iron deficiency anaemia Incidence Incidence Incidence Reticulocytosis, unspecific with Artefact. In vitro phenomenon Iron deficiency anaemia severe anaemia and in vivo with acidosis and pH hyperosmolarity Acanthocyte Fragmented red cell Sickle cell Pincered cell Description Description Description Description Membrane spikes of irregular Red blood cell with intact con- Red blood cell with pointed Mushroom-shaped red blood size, unevenly distributed vex and damaged concave side, ends, usually crescent shape, cell, no central pallor pointed ends let the cell appear apparently hyperchromic Incidence as helmet cell Incidence Hepatopathy, Incidence Hereditary spherocytosis, post splenectomy Incidence In peripheral blood only observed band 3 gene defect, Red blood cell fragmentation with homozygous HbS disease, MCHC > 36 g/dL syndrome, findings of ≥ 5 ‰ and sickling in heterozygous disease marked thrombocytopenia can only under oxygen deficiency in point to thrombotic-thrombocy- cell suspension topenic purpura (TTP). This result is a lab emergency and should be communicated by phone. Elliptocyte (ovalocyte) Target cell Stomatocyte Teardrop cell Description Description Description Description Elongated shape with round Round, central Hb concentration Central pallor appears slit-like, Teardrop or pear shape ends, normal central pallor due to dome-shaped hernia of straight or mouth-like Incidence the membrane, followed by an Incidence Incidence Extramedullary haematopoiesis empty zone, then peripheral Hb Hereditary elliptocytosis, Hepatopathy, hereditary with primary myelofibrosis ring two types: haemolytic, non- stomatocytosis haemolytic Incidence Thalassaemia, post splenectomy Basophilic stippling Pappenheimer body Howell-Jolly body Cabot ring Description Description Description Description Numerous small, coarse, blue Dark blue, granular, mostly Round residual nucleus of Round to oval or loop-like, granules, unevenly distributed, irregularly shaped, solitary or purple-brown colour, circular, fine, red-purple inclusion; due to denatured ribosomes multiple inclusions found at cell not refractive, eccentrically point of origin: remnants of (RNA) periphery, Ø max. 1 µm, fre- placed, frequently associated mitotic spindle quently associated with Howell- with acanthocytes, target cells, Incidence Incidence Jolly bodies, biochemically: iron Pappen heimer bodies Unspecific in severe anaemia, Unspecific, with severe protein complexes especially with MDS, AML – Incidence anaemia, e. g. thalassaemia especially in FAB AML-M6, per- Incidence Post splenectomy, severe anae- nicious anaemia, lead poisoning, Post splenectomy mia with intact spleen function, hereditary pyrimidine 5'-nucleo- e. g. pernicious anaemia, MDS tidase deficiency Plasmodium falciparum inclusions Erythroblast Rouleaux Normocytic red blood cell Description Description Description Description Ring type: brown nucleole, ring- Erythroblasts (E) in peripheral Linear arrangement of red Diameter: 7 µm, equals the shaped blue cytoplasm, infested blood of adults are always patho- blood cells simulating a ‘stack diameter of the nucleus of a red blood cell not enlarged, no logical (physiological only in of coins’ small lymphocyte. Colour: granulation or pigmentation, first month of life). In the blood haemoglobin colour (pink – red); Incidence multiple parasites common smear, E are not included in WBC shape: round or oval, central Hypergammaglobulinaemia, differential but counted on top pallor 1/3 of the cell surface; Incidence monoclonal and polyclonal, per 100 WBC. no inclusions. Malaria tropica, > 5 % parasite hyperfibrinogenaemia infestation = severe malaria Incidence Incidence tropica. Plasmodium falciparum Associated with diseases show- Physiological red blood cell must be detected in the blood ing increased erythro- and hae- smear! matopoiesis and in extramedul- lary haematopoiesis Abbreviations: Ø – diameter, RNA – ribonucleic acid, DNA – deoxyribonucleic acid, MDS – myelodysplastic syndrome, AML – acute myeloid leukaemia, BM – bone marrow, Hb – haemoglobin, WBC – white blood cells © Copyright 2015 – Universitätsklinikum Aachen AÖR, Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammzelltransplantation Authors: Reinhild Herwartz, Prof. Dr. med. Roland Fuchs, Medizinische Klinik IV, Uniklinik RWTH Aachen Sysmex Europe GmbH Bornbarch 1, 22848 Norderstedt, Germany · Phone +49 40 52726-0 · Fax +49 40 52726-100 · [email protected] · www.sysmex-europe.com In cooperation with: Universitätsklinikum Aachen Klinik für Hämatologie, Onkologie, Hämostaseologie und Stammzelltransplantation Pauwelsstraße 30, 52074 Aachen, Germany · Phone +49 241 80-0 · [email protected] · www.ukaachen.de You will find your local Sysmex representative’s address under www.sysmex-europe.com/contacts ZE000791.EN.N.10/15.
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