Bite Cells (cells with a smooth semicircle extracted): Bite Cells are due to
spleen phagocytes that have removed Heinz bodies consisting of denatured
Hgb. They are found in hemolytic anemia due to glucose-6-phosphate
dehydrogenase deficiency.
Spherocytes (round, dense cells with an absent central pallor): Spherocytes are
seen in immune hemolytic anemia and hereditary spherocytosis.
Sickle Cells (sickle-shaped cells): Sickle cells are due to polymerization of Hgb
S. This occurs from the substitution of a valine for glutamic acid as the sixth
amino acid of the beta globin chain, which produces a hemoglobin tetramer
(alpha2/beta S2) that is poorly soluble when deoxygenated. They are found in
sickle cell disease but not in sickle cell trait.
Target Cells (cells with extra hemoglobin in the center surrounded by a rim of
pallor; “bull’s eye appearance”): Target cells are due to an increase in the ratio
of cell membrane surface area to Hgb volume within the cell. They have a
central spot of Hgb surrounded by a ring of pallor from the redundancy in the
cell membrane. They are found in liver disease, post splenectomy, and in
hemoglobinopathies.
Nucleated red cells: These are not normally found in the peripheral blood. They
appear in hypoxemia and myelofibrosis or other myelophthisic conditions, as
well as with sever hemolysis.
Heinz bodies: (inclusions seen only on staining with violet crystal): Heinz
bodies represent denatured Hgb and are found in glucose-6-phosphate
dehydrogenase after oxidative stress
Parasites: A variety of parasites, including malaria and babesiosis, may be seen
with red blood cells
Rouleaux (red cell aggregates resembling a stack of coins): Rouleaux is due to
the loss of normal electrostatic charge-repelling red cells due to coating with
abnormal paraprotein, such as multiple myeloma.
Coagulation Cascade