– Repeated loss of membrane fragments resulting in gradual decrease in surface/volume – Normal aging process* intrinsic defect (HS) – Immune hemolysis caused by splenic “pitting” – Thermal injury – Fibrin strands catches RBC, reseals and forms spherocyte
Spherocytes seen in:
– Immune hemolytic anemia – post-transfusion DIC, burns – Heinz body hem anemia – hemoglobinopathies
Hereditary Spherocytosis (HS)
- genetically-transmitted (autosomal dominant) form of spherocytosis an auto-hemolytic anemia characterized by the production of red blood cells that are sphere-shaped rather than bi-concave disk shaped (Donut-Shaped), and therefore more prone to hemolysis. - Howell-Jolly bodies may be seen.
Morphologic types Normal oval or elliptical – Hereditary ovalocytosis (or elliptocytosis) – Thalassemias Hypochromic – Iron deficiency anemia Macro-ovalocytes – Megaloblastic anemia
– Increase in membrane lipids resulting in condensation of Hgb . Liver disease – Decrease Hgb synthesis . Abnormal globin chains . Thalassemia . Iron deficiency anemia
Schistocytes -irregularly shaped fragmented red cells – Causes of schistocyte formation . Red cells are torn by fibrin strands in DIC, septicemia, TTP . Spectrin is denatured by heat in burn victims . Heart valves traumatize red cells causing fragmentation – Helmet cells/bite cells
How To Do A WBC Differential with RBC Morphology and PLT Estimate?
- Perform WBC Estimate-Verify with WBC count (#WBC/10 fields) - Perform100 cellWBC Differential(40x or 100x) - Assess RBC morphology (100x) - Perform PLT Estimate in 10 fields - Record using qualitative remarks and check to see if it verifies with PLT count (#PLT/10 x 20,000)
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