ISSUE21ISSUE

January2022

This issue
Last Month’s Slides P.1
Monthly Case study P.1-2
Red Cell Morphology part 2 P.2-3
Cell Quiz P.2

LastMonth’sSlides
Slide 1
Patient on ICU.
Monocytosis, large blasts
with large nuclei.

Monthly Digital Case study
December 2021 Slide 5

Presentation

Slide 2Male, aged 66

Anisocytosis, Echinocytes,Monocytosis

FBC Results

Slide 3NADSlide 4
Anaemia. NAD

Slide 5
See Slide Review

Slide 6
No clinical information.
NADWBC 10.5 (10^3/mm3)
RBC 2.3 (10^6/mm3)
HGB 8.0 (g/dL)
HCT 23.8 (%)
MCV 103 (fL)
MCH 34.2 (pg)
MCHC 33.8 (g/dL)
PLT
264 (0^3/mm3)
Neutrophils 85.2 %Lymphocytes 7.4 %Monocytes 7.4%
Eosinophils 0.0 %Basophils
0.0 %Metamyelocytes %Red cells show rouleaux pattern, stacked up likepenny's.

Slide review
Patient in intensive care. Anaemia.

Rouleaux pattern formation of red blood cells.
Rouleaux formation is a term describing groups of red blood cells that form stacks,
resembling stacks of coins. The formation is due to the unique discoid shape of redcells. The flat surface of the discoid RBCs gives them a large surface area to allowing
them to contact and stick to each other; thus, forming a rouleau.
Rouleaux occurs when the plasma protein concentration is high,specifically, gamma proteins in Multiple Myeloma.

Cell Quiz:

Slide 5 Review continued

Name the cells highlighted in
the film below:

There is an alteration in the electrostatic charges of the red cells, which results inthe cells stacking on top of each other, instead of repelling. This is a non-specificindicator of the presence of disease.
Possible follow-up tests:
ESR if not already would be increased. Urine screen Bence-Jones urine test is often
used in suspected Multiple Myeloma cases.

Red Cell Morphology Terminology part 2
Variation in shape

Last Month’s Cell
Quiz:
What is the name of the cells
highlighted in red box:

Normal red cells are biconcave discs which, when viewed microscopically, appear as
small disc shaped cell with a diameter of 6-8 um. The biconcave shape allows thered cell to easily traverse through the circulation. Normal red cells showing uniformshape.

If red cells are displaying a degree of abnormal shape, then they are described as
showing Poikilocytosis e.g.
A) AcanthocyteB) DacrocyteC) SchistocyteD) Drepanocyte

Answer:A Dacrocyte is a type ofpoikilocyte, shaped like a teardrop. Hence, the common
name teardrop poikilocytosis.
Dacrocytes occur when theBM is infiltrated with fibrosis,
granulomatous infiltration or
haemopoietic
metastatic neoplasm. They
may be seen in megaloblastic
anaemia and splenic
abnormalities (the numbers
will decrease post
splenectomy).

Slight Poikilocytosis on its own is not very specific and can be caused by productionof abnormal cells by the bone marrow or from damage to normal cells whilst in thecirculation.

Elliptocytes are a specific form of Poikilocyte where the red cells elongated oval
shaped red cells with the long axis more than twice the short axis.

Elliptocytes can be seen in hereditary elliptocytosis, megaloblastic anaemia, irondeficiency (see below regarding Pencil cells), post chemotherapy and thalassaemia.

RBC Terminology continued…

QSP 2.0

Pencil Cells: are very similar to elliptocytes, apart from the fact that their length ismore than 4 times their width, they are hypochromic and are considered a more
specific finding in cases of iron deficiency.

Available as a single use
license and a site license
which allows up to 50
concurrent users.
To find out more, contactus.

Echinocyte is a red cell which is covered with regularly distributed equally sizedrounded projections

Bibliography

Echinocytes are associated with numerous disorders such as in-vitro artefact fromstorage (sometimes called red cell crenation), liver disease, Pyruvate Kinase
deficiency, burns, and renal failure.
Acanthocytes are red cells, which unlike Echinocytes, have irregularly distributed
variably sized pointy projections. Causes of severe acanthocytosis can behereditary abetalipoproteinemia, McLeod red cell phenotype, high red cell
membrane phosphatidylcholine haemolytic anaemia or acquired infantile
pyknocytosis, Liver disease, hyposplenism.
Schistocytes are fragments of red cells from which part of the cytoplasm has beenlost. They are seen in thrombotic thrombocytopenia purpura (TTP) and HaemolyticUraemic Syndrome (HUS), and as such the presence of schistocytes is a very
important early diagnostic factor. A count of the number of schistocytes present isoften requested in such patients and expressed as a percentage from a count of noless than 1000 red cells. Schistocytes can also be caused by structural/mechanicalabnormalities of red cells e.g. malfunctioning prosthetic heart valve, metastatic
cancer, and HELLP.

ISCH recommendations
for identification,
diagnostic value, andquantification ofschistocytes
https://doi.org/10.1111/j.
1751-553X.2011.01380.xBlood Cells – A PracticalGuide, Barbara J Bain
Red Cell Morphology
International Journal ofHaematology
https://doi.org/10.1111/ij
lh.12082

Editorial Team
Kelly Duffy
Andrew Fisher

About us

Schistocytes may be differentiated into:
Keratocytes (or horned cells): have a single pair of spicules (sometime between 4-6pairs).
Bite Cells (or Bitten out cells): appear as if the red cell has a bite taken out of it,with the edges tending to be smooth and rounded. These cells are formed when
the spleen removes an aggregate of haemoglobin (Heinz Body) produced
secondary to oxidant drug injury (Dapsone). Other causes of Bitten out cells are
G6PD deficiency NADPH deficiency and thalassemia.
Helmet Cells: they tend to have a linear edge and have the appearance of an army
type helmet.

Keratocyte (Horn Cell)

Helmet Cell

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