A Laboratory Guide to Clinical Hematology A Laboratory Guide to Clinical Hematology A Laboratory Guide to Clinical Hematology VALENTIN VILLATORO AND MICHELLE TO EDMONTON A Laboratory Guide to Clinical Hematology by Michelle To is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted. Please be aware that the content for the entirety of this eBook is subject to a creative common license: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) You are free to: Share — copy and redistribute the material in any medium or format Adapt — remix, transform, and build upon the material The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. 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Contents Authors & Editors ................................................................................................................................... xii Creative Commons License and Citation ............................................................................................... xiii Contact Information and Feedback ......................................................................................................... xv Acknowledgements and Funding ........................................................................................................... xvi ERA: Education and Research Archive ................................................................................................. xvii How To Use This eBook ....................................................................................................................... xviii Common Abbreviations Used .................................................................................................................. xx Red Blood Cells: Normal Morphology .................................................................................................... 21 Red Blood Cell Maturation .............................................................................................................. 22 Red Blood Cell Indices, Colour, and Size ......................................................................................... 32 Red Blood Cells: Abnormal RBC Morphology ......................................................................................... 44 Poikilocytosis ................................................................................................................................... 45 Acanthocytes (Spur Cells) ................................................................................................................ 47 Agglutination ................................................................................................................................... 49 Bite (Keratocyte) & Blister (Helmet) Cells ...................................................................................... 52 Dimorphic Population ...................................................................................................................... 55 Echinocytes (Burr Cells) .................................................................................................................. 57 Elliptocytes & Ovalocytes ................................................................................................................ 59 Pyknocytes ....................................................................................................................................... 62 Rouleaux .......................................................................................................................................... 64 Schistocytes ..................................................................................................................................... 66 Sickle Cells (Drepanocytes) ............................................................................................................. 68 Spherocytes ..................................................................................................................................... 70 Stomatocytes ................................................................................................................................... 73 Target Cells (Codocytes) .................................................................................................................. 75 Tear Cells (Dacrocytes, Teardrops) ................................................................................................. 77 Red Blood Cells: Abnormal RBC Inclusions ............................................................................................ 79 Basophilic Stippling ......................................................................................................................... 80 Cabot Rings ...................................................................................................................................... 82 Heinz Bodies .................................................................................................................................... 84 Hemoglobin H (Hb H) ...................................................................................................................... 86 Hemoglobin C Crystals .................................................................................................................... 88 Hemoglobin SC Crystals .................................................................................................................. 89 Howell-Jolly Bodies .......................................................................................................................... 90 Pappenheimer Bodies (Siderotic Granules) ..................................................................................... 92 Bacteria & Fungi ............................................................................................................................. 95 Malaria ............................................................................................................................................. 97 Babesia .......................................................................................................................................... 100 Trypanosomes ................................................................................................................................ 101 Red Blood Cells: Hypochromic, Microcytic Anemias ............................................................................ 103 Iron Deficiency Anemia (IDA) ........................................................................................................ 104 Anemia of Chronic Inflammation/Disease (ACI/ACD) .................................................................... 106 Sideroblastic Anemia ..................................................................................................................... 108 Thalassemia ................................................................................................................................... 110 Iron Studies ................................................................................................................................... 117 Red Blood Cells: DNA Metabolism Abnormalities & Bone Marrow Failure ......................................... 119 Megaloblastic Anemia .................................................................................................................... 120 Non-Megaloblastic Macrocytic Anemia ......................................................................................... 125 Aplastic Anemia ............................................................................................................................. 128 Red Blood Cells: Introduction to Hemolytic Anemias ........................................................................... 130 Introduction to Hemolytic Anemias ............................................................................................... 131 Red Blood Cells: Hemoglobinopathies .................................................................................................. 135 Normal Hemoglobin Structure ...................................................................................................... 136 Sickle Cell (Hemoglobin SS) Disease ............................................................................................ 137 Sickle Cell Trait (Hemoglobin AS) ................................................................................................. 140 Hemoglobin C (Hb CC) Disease ..................................................................................................... 142 Hemoglobin SC Disease ................................................................................................................. 144 Red Blood Cells: Extrinsic Defects Causing Hemolytic Anemias ......................................................... 146 Microangiopathic Hemolytic Anemias (MAHAs) ........................................................................... 147 Macroangiopathic Hemolytic Anemias .........................................................................................