POIKILOCYTES SECONDARTY TO MEMBRANE ABNORMALITIES

1. Spherocytes Round cells

Lack central pallor
Increased staining intensity
Smaller volume
Stereoscan microscope: slight concavity
Hereditary: Spectrin deficiency; fairly uniform in
size; density of decreased membrane surface:
volume ratio; MCV normal/deceased; MCHC
increased
Acquired: Immunohemolytic anemia; Banked
blood
2. Elliptocytes and Ovalocytes Egg-shaped or slightly oval
Sausage, rod or pencil
Hb: concentrated at the two ends of cell
Normal central pallor
Hereditary (Elliptocytes): Defect in the
cytoskeleton; Defect in the skeletal membrane
protein 4.1; Increased heat sensitivity of spectrin
Acquired (Ovalocytes): Iron-deficiency anemia;
Megaloblastic anemia; Myelophthisic anemia
Megaloblastic anemia: ovalocytes; lack central
pallor
3. Echinocytes and Burr cells Echinocytes
Evenly distributed; uniform-size blunt spiculesor
bumps
Crenated cells
Anticoagulated blood several hours old; Release of
basic substances from glass slides; Depletion of
ATP
In vitro: REVERSIBLE; In vivo: IRREVERSIBLE
Transformation: Moist saline w/ elevated pH
Burr cells
Anemia with renal insufficiency
Increased BUN
REVERSIBLE
Irregular spicules
4. Acanthocytes Small
Densely stained
Spicules: Irregulary spaced; Pointed; Thorn-like of
various lengths and widths; Club-like
IRREVERSIBLE
Changes in the ration of plasma lipids (lecithins
and sphingomyelins)
Alcoholic cirrhosis
Spur cells
Abetalipoproteinemia
5. Stomatocytes Central pallor: Elongated or slit-like; Mouth-
shaped
Stereoscan microscope (moist prep): Bowl-
shaped
Heridetary: numerous stomatocytes but mild
+ +
anemia; Increased Na ; Decreased K ; Increased
rate of active cation transport
May retain in spleen
Acquired: Alcoholism, cirrhosis, obstructive liver
disease, and Rh null disease
6. Codocytes Target cells
Mexican hat cell
Central area of Hb surrounded by a relatively
colorless ring and a peripheral ring of Hb
Scanning electron microsope: bell or tall hat
shape; thin walled; concave
ALWAYS ACQUIRED
Membrane loaded with cholesterol and
phospholipids
Great osmotic resistance; Increase in
surface:volume ratio
 POIKILOCYTES SECONDARTY TO TRAUMA
1. Schistocytes Schizocytes
Cleavage and fragmentation
Develops a blister
Result from membrane damage
NOT HEREDITARY
Helmet, triangular with few pointed extremities
Microangiopathic anemia; Traumatic haemolytic
anemia
March hemoglobinuria (feet of individuals with long
walking expeditions)
2. Keratocytes A schistocyte with one or more hornlike
projections
Normal volume
Central pallor
Erythrocyte caught on a fibrin strand
Vacuolike area (blister cell)
Remain in circulation for more than a few hours
3. Dacrocytes Teardrops
Pear-shaped with a blunt pointed projection
Red cell with inclusion (Heinz body)
Myelofibrosis with myeloid metaplasia
4. Microspherocytes and Pyropoikilocytes Small, round cells
Thermal damage to the cell membrane
Severe burns
Hereditary hemolytic anemia
Abnormality in spectrin
Greatly increased when heated in vitro @ 45C
Extremely low MCV
5. Semilunar bodies Half-moon cell
Crescent cell
Large; Pale-pink staining ghost of red cell
Large as leukocytes
ALWAYS ACQUIRED
Malaria
 POIKILOCYTES SECONDARTY TO ABNORMAL HEMOGLOBIN CONTENT
1. Drepanocytes
2. Hemoglobin CC crystals
3. Hemoglobin SC crystals
Sickle cells
Changed by the long rod-shaped polymers
Inherited abnormal Hb S
Lost its nucleus and completely hemoglobinized
Thin and elongated with pointed ends are well filled
with Hb
Curved or straight
S, V, or L shapes
IRREVERSIBLE
Homozygous S disease (Hb SS)
Homozygous C disease
Hexagonal with blunt ends
Stain darkly
Cell membrane: invisible
Free crystals
More frequent after splenectomy
Hb SC disease
Dark-hued crystals of condensed Hb
a.) Crystalline projection: Straight with parallel
sides and one blunt, pointed, protruding end
Washington monument shape
b.) Multiple crystals that protrude in different
directions as fingerlike projections from a common
crystalline center
Pale area at the opposite end