RBC Morphology Guide
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This document discusses the examination of red blood cell (RBC) morphology from a blood smear. RBC morphology provides diagnostic information for physicians and quality control for lab tests. RBCs normally appear as biconcave disks under the microscope; their shape allows flexibility to pass through small blood vessels. To accurately assess RBC morphology, the feathered edge of the smear where cells are randomly distributed should be examined. Abnormalities in size, shape, color, distribution, and inclusions can provide clues to underlying conditions.
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RBC Morphology Guide
- 4. Examination of RBC morphology Why?? • Differentiating normal morphology from abnormal and artificial morphology. • Provide valuable diagnostic information to the physician. • Provide a quality control mechanism to verify red cell indices values as determined by automated or manual methods.
- 5. Erythrocytes Red cell morphology can be defined as the appearance of the erythrocytes on a rowmanowsky stained smear. Erythrocytes are shaped like biconcave disks approximately 7 to 8 µm in diameter. The biconcave disk shape gives red blood cells (RBCs) the flexibility to squeeze their way through capillaries and other small blood vessels. Viewed under the microscope, RBCs look like a circle with a central hole, or central pallor, which is approximately one-third the diameter of the cell.
- 6. How? Assess RBC morphology by examining the smear in the feathered (thinner) edge where the RBC are randomly distributed and, for the most part, lie singly, with occasional doublets. The size of normal erythrocyte is approximately equal to the size of the nucleus of small lymphocyte.
- 7. Ideal area Once the correct area has been located on low power, switch to oil immersion Notice the red cells are lying singly with occasional doublets.
- 8. Too thin (tail) The area shown in this field is too thin for accurate red cell morphology evaluation. The cells have large spaces between them, show no central pallor and many are somewhat square.
- 9. Too thick (head) should not be used for red cell morphology assessment. Some of the cells appear to be stacked like coins because of the large number of cells present in this section of the slide.
- 10. The morphology seen in the too thin and too thick areas of the smear is referred to as artificial morphology.
- 12. Variations of erythrocyte morphology Size Shape Color (Hb content) Distribution Inclusions
- 15. Microcyte: have a diameter of less than 7 microns and an MCV of less than 76 fl.
- 16. Macrocyte: diameter of >8 microns and MCV greater than 96 fl
- 17. Anisocytosis: red cells of normal size, microcytes and macrocytes are present in the same field.
- 19. Central pallor Erythrocytes, when spread on a glass slide, show varying degrees of central pallor. This central pallor is related to the hemoglobin concentration present in the red cells. The central pallor in normal erythrocyte is approximately 1/3 of the cell.
- 20. A decreased amount of haemoglobin is referred to as hypochromasia or hypochromia. Hyperchromasia and hyperchromia, refer to a hypothetical situation rather than an actual occurrence. Cells located in the "too thin" portion of the smear often appear to be "hyperchromic".
- 21. Normochromic
- 22. Hypochromic
- 24. Polychromasia (or Polychromatophilia) refers to red blood cells of multiple colours, particularly gray-blue
- 26. Crenated RBC (Burr cell)
- 27. Target cell
- 28. Acanthocyte
- 29. Blister cell
- 30. Elliptocyte
- 32. Microspherocytes
- 34. Stomatocyte
- 36. Variation in red cell distribution
- 38. RBC inclusions • Inclusion bodies are usually nuclear or cytoplasmic aggregates of stainable substances.
- 40. Cabot ring
- 43. Malaria parasite
- 45. Leucocyte shift to left
- 46. Leukocyte shift to right: Hypersegmented neutrophil
- 49. Giant platelet
- 52. Questions???