Red Blood Cell (RBC):- Part 2 – Peripheral blood smear, Normal Picture and RBC Morphology
Sample
- To assess RBC morphology make fresh smears and smears from the blood in EDTA.
Precautions
- A well-made smear is needed.
- A well-stained smear is also important.
- Otherwise, the analysis of cell morphology may be greatly distorted by poorly made and poorly stained smears.
Indications
- This is done to see the morphology of RBC as variation and abnormality in size, shape, structure, Hb contents and, staining characteristics.
- Can diagnose the type of Anaemia.
- Can diagnose Thalassemia.
- Also, can find other abnormalities like hemoglobinopathies.
- This also helps to see the effect of chemotherapy and radiation.
- Special stains can find infections, infestation, leukemia, and other diseases.
Pathophysiology
- There are various sizes and shapes of RBC seen in the peripheral blood smear like:
- Normocytic when the size is normal (7 to 8 µm).
- Normochromic when the color is normal.
- Microcytic when the size is smaller than normal RBC and these are less than 6 µm.
- In iron deficiency anemia and thalassemia and hemoglobinopathies.
- Macrocytic when the size is larger than > 8 µm.
- Found in liver diseases, alcoholism, and oval in megaloblastic anemia.
- Anisocytosis is an abnormal variation in size from the normal diameter of 6 to 8 µm, seen in severe anemia like iron deficiency, hemolytic anemia, and hypersplenism.
- Hypochromasia when the RBCs are pale with decreased Hb concentration.
- Poikilocytes when RBCs have variation in shapes.
- Spherocytes when RBCs are round without the central pale area.
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- Elliptocytes are oval or elongated RBC.
- Found in hereditary elliptocytosis.
- Elliptocytes are oval or elongated RBC.
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- Sickle cell is a crescent-shaped RBC seen in sickle cell anemia.
- The target cell is RBC with a dark central area and clear space between this dark area and periphery.
- Found in iron deficiency anemia, liver disease, post-splenectomy, and hemoglobinopathies.
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- Schistocytes or helmet shape RBCs Are irregularly contracted cells or fragmented RBCs.
- Burr cells are RBCs with spinous processes.
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- Acanthocytes are RBCs with small cells with thorny projections.
- found in liver disease, renal failure, and abetalipoproteinemia.
- Acanthocytes are RBCs with small cells with thorny projections.
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- Teardrop cell is RBCs with a tear like an appearance.
- The nucleated cell is RBCs with the presence of a nucleus. These are normoblast or megaloblastic cells.
- In the peripheral smears also note for Inclusion:
- Howell-Jolly bodies. These are spherical purple bodies within RBCs, these are nuclear debris.
- Heinz inclusion bodies. These are small round inclusion of denatured hemoglobin, seen with supravital stain or under phase microscopy.
- Siderocytes are the RBCs containing siderotic granules which stain blue with Prussian blue stain.
- Basophilic stippling is the presence of punctate stippling seen with Wright stain.
- Reticulocytes are also seen. These are RBCs containing RNA and stain pinkish-blue in color. With methylene blue show a reticular network.
- Rouleaux formation is the pilling of RBCs on each other or aggregated RBCs.
Red Blood cell rouleaux
Normal cells in the Peripheral blood
- Band form neutrophils = 2 to 6%
- Neutrophils = 50 to 70%
- Eosinophils = 1 to 5%
- Basophils = 0 to 2%
- Lymphocytes = 20 to 44%
- Monocytes = 2 to 10%
Interpretation of the peripheral blood smear:
- Screen the slide and note any of the abnormalities present in the smear as regards RBCs.
- Also, it can evaluate the number or any abnormality of white cells.
- Also, the number of platelets can be evaluated.
- So the peripheral smear gives the following information.
- Any abnormality of RBCs.
- Any abnormality in white cells.
- can assess the number of platelets.
- One can see the following picture in various types of anemia :
- In hemolysis, or hemorrhage or in increased erythropoiesis. There are basophilic or polychromatophilic macrocytes
- Megaloblastic anemia shows oval macrocytes with an increased number of lobules in the neutrophils.
- Hemoglobinopathies anemia there are target cells e.g. in thalassemia and Hb C.
- Target cells are also seen in iron- deficiency anemia and liver diseases.
- Thalassemia and lead poisoning show microcytes with stippling.
Red blood cells morphology and their etiology:
- Note please see more information on CBC and peripheral blood smear.
very informative. thank you
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Good article. Shapes of some abnormal RBC type are missing that must be added.
Please, thanks for the comments. Can you specify missing abnormal cells?
very well
Thanks.