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Pathologic Red Blood Cell (RBC) Morphologies and Associated Diseases

Acanthocyte (spur cell),  
Basophilic stippling, 
Bite cell,
Red Blood Cell (RBC ... sideroblast, Schistocyte ... cell, Other RBC ... Howell-Jolly bodies #RBC
Red Blood Cell (RBC) Morphology
Microcytic RBC: Pyridoxine deficiency, Thalassemia, Iron deficiency anemia, Chronic disease anemia (sometimes),
Red Blood Cell (RBC ... Morphology Microcytic RBC ... sometimes) Macrocytic RBC ... Schistocyte: Microangiopathic ... Bite Cell RBC: G6PD
Red Blood Cell (RBC) Morphology Atlas
 • Microcytic - Iron-deficiency anemia, Thalassemia, Sideroblastic anemia, Lead poisoning
Red Blood Cell (RBC ... Pulmonary emboli • Schistocytes ... coagulopathy (DIC) #RBC
Warm Antibody Autoimmune Hemolytic Anemia 
1) DIAGNOSE AIHA
 • Anemia: macrocytic > normocytic, ↑ reticulocytes
 •
↑ LDH • Anti-RBC ... Differential → schizocytes
Hemolytic Anemia - Differential Diagnosis Algorithm
 • Sickle cells - Consider sickle cell disease (diverse genotypes):
Hemoglobin H disease • Schistocytes ... hypertension • Unusual RBC ... acanthocytes - Consider RBC
Several artifacts can cause significant and potentially misleading alterations to measured RBC parameters: 
1. Old samples
alterations to measured RBC ... samples cause RBCs ... the tube causes RBCs ... a falsely low RBC ... #Drepanocytes #Schistocytes
Disseminated Intravascular Coagulation (DIC) Overview

Increased Clotting and Consumption of Clotting Factors

Findings:
 • Bleeding
 • Recent history
Peripheral smear: Schistocytes ... studies - PBS: + Schistocytes ... hydration • RBC
Urine Microscopy and Casts - Image Atlas Key

- Squamous Epithelial Casts
- Transitional Epithelial Cells
- Renal Tubular
- Monomorphic RBCs ... - Dysmorphic RBCs ... Granular Casts - WBC ... Cast - RBC Cast
Schistocytes - The arrows point to schistocytes which are fragmented red blood cells. Also called schizocytes,
Schistocytes - The ... arrows point to schistocytes ... Also called schizocytes ... Schistocytes are ... Schistocytes are
Overall Approach to Anemia - Differential Diagnosis Algorithm

Blood Loss
 • Acute Bleed - Normocytic / Normochromic
/ Normochromic RBCs ... TIBC, Hypochromic RBCs ... Decreased RBC ... Thalassemia • RBC ... Disorder • RBC