ADDIS ABABA UNIVERSITY COLLEGE OF VETERNARY

MEDICINE

Assignment of Clinical Pathology Group

Title: RBC Abnormalities

Group Member ID
1. JOMEPH GERAMU UGR/7436/13
2. MILKIYAS FIKADU UGR/1544/13
3. BONTU TEMASGEN UGR/9548/13

Submitted to: Mr. Debela Taweya (BSc, MSc, Lecturer)

 Table content Page
1. RED BLOOD CELL ABNORMALITIES............................................. 1
2. Introduction ............................................................................................. 1
3. Definition and types of RBC disorders .................................................... 1
4. RBC Morphologic Abnormalities ............................................................ 1
4.1 Variation in erythrocyte size .................................................... 2
4.2 Variation of RBCs shape .........................................................2
5. Abnormalities in hemoglobin content ...................................................... 7
6. The presence of inclusion bodies in erythrocyte ...................................... 8
7. Importance of studying RBC abnormalities............................................ 10
8. Causes of RBC Abnormalities ................................................................ 10
9. Diagnostic Approaches ........................................................................... 11
10. Implications of RBC Abnormalities ........................................................ 11
11. Referance .................................................................................................12
RED BLOOD CELL ABNORMALITIES
Introduction
RBCs are one of the main components of blood. They are among the most
abundant types of cells. They have the important role of carrying oxygen from
the lungs to the rest of the body and returning carbon dioxide for the lungs to
exhale.

There are many different types of RBC disorders, including conditions that
affect the production, components, and abilities of RBCs. Dysfunction of RBCs
can lead to several issues in the body.

While symptoms can vary depending on the disorder, many conditions share
similar ones. Identifying and treating RBC disorders as quickly as possible may
help to alleviate or manage symptoms and reduce the risk of potential
complications.

In this assignment, we will discuss some of the common RBC disorders.

Definition and types of RBC disorders

RBC disorders are conditions that affect RBCs, which are responsible for
carrying oxygen from the lungs to the rest of the body. There are many types of
RBC disorders, which health experts can categorize by the kind of structure
they affect. Some examples include:

 RBC Morphologic Abnormalities

 Abnormalities in hemoglobin content
 The presence of inclusion bodies in erythrocyte

I. RBC Morphologic Abnormalities

RBC morphologic abnormalities refer to any structural deviations in red blood
cells that can be identified through microscopic examination of blood smears.
These abnormalities can indicate various underlying health issues in animals.

 Abnormal erythrocyte morphology is found in pathological states.

That may be:

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  Abnormalities in size(anisocytosis)
 Abnormalities in shape (poikilocytosis)

A. Variation in erythrocyte size (anisocytosis)

I. Microcytosis:-Decrease in the red cell size. Red cells are smaller
than ± 7 µm in diameter. The nucleus of a small lymphocyte (±8,
µm) is a useful guide to the size of a red blood cell.
Found in:
 Iron deficiency anemia.
 Thalassaemia.
 Leadpoisoning.
 Anemiaofchronicdisease
 Sideroblastic anemia: is a form o anemia in which the bone
marrow Produces ringed sideroblasts der rather than healthy
red blood cells.
II. Macrocytosis: is a term used to describe red blood cells that are
larger than normal.It typically causes no signs or symptoms and is
usually detected incidentally on routine blood tests. Macrocytosis
isn't a specific disease, but it May indicate an underlying problem
that requires medical evaluation.
 Common causes of macrocytosis include:
 VitaminB-12deficiency
 Folatedeficiency
 Liver disease
 Hypothyroidism

B. Variation of RBCs shape (Poikilocytosis)

 RBCs may have different shapes:
1. Spherocytosis: Red cells are more spherical. Lack the central area of pallor
on a stained blood film.

Found in:-

 Hereditary spherocytosis
 Immune haemolytic anemia

Spherocytes are deep red staining, spherical cells that lack central pallor.

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These cells result from loss of cell membrane secondary to partial phagocytosis
by macrophages. This is secondary to the presence of antibodies or complement
on the surface of red blood cells.

 Spherocytes are related to immune mediated hemolytic anemia.

In such case, it is not unusual to observe microscopic agglutination
as well. Spherocytes are also reported after blood transfusions,
snake envenomation, bee stings, and zinc toxicity. Because of the
small size of catred blood cells and the lack of central pallor,
spherocytes are difficult to detect in this species.

2. Echinocytes:
 Echinocytes,or crenated erythrocytes,are speculated erythrocytes.
 The Surface projections are numerous,evenly distributed and of
similar size.
 It is mostly considered an artifact secondary to slow drying of the
blood smear or as a result of prolonged sample storage before
slide preparation.
 This has also been related to snake envenomation,underlying
neoplasia (such as lymphoma and mast cell tumor) and glomerulo-
nephritis.This is by far the most common RBC pathology observed
on microscopic examination. Most of the time, this is a non-
significant finding.

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3. Poikilocytosis
 Poikilocytosis is a general term for “abnormally shaped
erythrocytes”.
 Its significance is mostly related to the presence of multiple red
blood cell pathologies simultaneously.
 The most frequent simultaneous anomalies noted are acanthocytes,
schistocytes, and echinocytes, poikilocytosis can be related to
liver disease (hepaticlipidosisincats), disseminated intravascular
coagulation glomerulo-nephritis and hemangiosarcoma in dogs.

4. Codocytes
 Codocytes,or target cells,are cells with a bull’s-eye appearance on
blood film.These result from increased red blood cell membrane
cholesterol to phospholipid ratio.
 Although these cells are a common and mostly non-significant
finding, they can be related to liver disease. The presence of a
large numbers of such cells should prompt a liver enzyme panel.

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 5. Schistocytes
 Schistocytes are erythrocytes fragments .They result from shearing
of the erythrocytes secondary to intravascular trauma. These cells
are mainly noted in dogs and are associated with disseminated
intravascular coagulation, hemangiosarcoma, glomerulonephritis,
hemophagocytic histiocytic disorders, iron-deficiency anemia.
 In case of hemangiosarcoma in dogs, it is not unusual to notice the
presence of acanthocytes as well.
 Fragmentation in iron-deficiency anemia could be secondary to
oxidative injury to the red blood cell membrane.

6. Acanthocytes
 Acanthocytes, or spur cells, are erythrocytes covered by irregularly shaped
unevenly distributed surface projections.This erythrocyte anomaly results
from alteration in cholesterol or phospholipid concentration in the red blood
cell membrane.

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 This can be associated with liver disease in companion animals, and is a
common finding in cats suffering from hepatic lipidosis.

This has also been related to erythrocytes fragmentation secondary to

disseminated intravascular coagulation,hemangiosarcoma, and
glomerulonephritis.

7. Ovalocytes:
 oval shape red blood cell,
 Found in: -
 Thalassaemia major.
 -Sickle cell anemia
 Hereditary ovalocytosis.

8. Rouleaux Formation:
 Stacks of RBC's resembling a stack of coins.
 Found in: - Hyperfibrinogenaemia and Hyperglobulinaemia.

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9. Nucleated red blood cells.
These red blood cells are released from the bone marrow early into the blood
stream, due to the need for oxygen.

Normal red blood cells do not contain a peripheral smear.

II. Variation in hemoglobin content

i. Hypochromasia:
Hypochromia is characterized by an increase in central pallor. It is said to
be Present when greater than 1/2 of the cell diameter has central pallor.
Hypochromia is caused by a deficiency in the production of
hemoglobin,which is usually the result of iron deficiency caused by
chronic hemorrhage.
ii. Polychromasia:
Polychromasia is a disorder where there is an abnormally high number of
immature red blood cells found in the blood stream as a result of being
prematurely released from the bone marrow during blood formation.

Poly-refers to many,and-chromasia means color. Polychromasia is

usually a sign of bone marrow stress as well as immature red blood cells.

Three types are recognized,with types (1)and (2) being referred to as 'young red
blood cells' and type (3) as 'old red blood cells'. Giemsa stain is used to
distinguish all three types in blood smears.

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III. Erythrocyte inclusion bodies
1. Howell-Jolly Bodies:
 Small round cytoplasmic red cell inclusion with same staining
characteristics as nuclei

 Found in:
o Post splenectomy and
o Megaloblastic anemia

2. Siderotic Granules (Pappenheimer Bodies)

 RBCs which contain no hemoglobin iron granules. They appear as
dense blue, irregular granules which are unevenly distributed in
Wright stained RBCs.
 Pappenheimer bodies can be increased in hemolytic anemia.
infections and post-splenectomy.

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 3. Basophilic stippling:
 Considerable numbers of small basophilic inclusions in red cells.
 Found in:
o Hemolytic anemia Liver disease and
o Heavy metal poisoning.

4. Heinz Bodies:
 Represent denatured hemoglobin (methemoglobin - Fe+++)
within a cell. With a supravital stain like crystal violet,

 Heinz bodies appear as round blue precipitates.

Presence of Heinz bodies indicates red cell injury and is usually associated with
G6PD-deficiency.

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 5. Parasites of Red Cell:
 are protozoan parasites which occur in many species of birds and
are the cause of avian malaria.
Transmitted by mosquitoes, infection with
Plasmodium can be a cause of hemolytic anemia

Importance of studying RBC abnormalities in Veterinary

Clinical Pathology
Identifying and understanding RBC abnormalities is crucial in veterinary
medicine. They can aid in the

 diagnosis,
 prognosis, and
 monitoring of various medical conditions

Causes of RBC Abnormalities

 Immune-mediated Hemolytic Anemia
Immune-mediated destruction of red blood cells can lead to the
presence of spherocytes and other RBC morphologic changes.

 Infectious Diseases Impacting RBCs

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 Various infectious diseases, including hemotropic mycoplasma,
rickettsial diseases, babesiosis, and cytauxzoonosis, can impact
the morphology of red blood cells.
 Inherited Red Cell Membrane Disorders
Certain inherited red cell membrane defects can result in
abnormal RBC shapes and size, which can be detected through
laboratory analysis

Diagnostic Approaches
 Blood Smear Examination Techniques
o Careful examination of a properly prepared blood smear is crucial for
identifying and characterizing RBC morphologic abnormalities.
 Correlating Clinical History with RBC Findings
o Integrating the patient's clinical history and presenting signs with the
observed RBC abnormalities can aid in the diagnostic process.
 Integration of Laboratory Test Results
o Combining the RBC morphologic findings with other laboratory test
results, such as complete blood count and biochemistry profiles, can
provide a more comprehensive understanding of the underlying
condition.

Implications of RBC Abnormalities

 Clinical Significance in Diagnosing Underlying Conditions
Identifying and interpreting RBC morphologic abnormalities
can be crucial in the diagnostic process, helping to uncover the
underlying cause of various medical conditions.
 Prognostic Value in Veterinary Medicine
The presence and severity of RBC abnormalities can have
prognostic implications, influencing the veterinarian's
treatment approach and the patient's expected outcome.

 Monitoring Treatment and Response to Therapy

Ongoing monitoring of RBC morphology can help assess the
effectiveness of treatment and guide adjustments in the
management of the patient's condition.

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Referance:
 Fundamentals of Veterinary Clinical Pathology by Duncan and Prasse,
first edition

 Da Costa L, Galimand J, Fenneteau O, et al. Hereditary spherocytosis,

elliptocytosis, and other red cell membrane disorders. Blood Rev. 2013
May 9; doi:pii: S0268-960X(13)00019-2 10.1016/j.blre.2013.04.003.
Epub ahead of print. [PubMed] [Google Scholar]

 Perrotta S, Gallagher PG, Mohandas N. Hereditary spherocytosis. Lancet.

2008; 372:1411–26. [PubMed] [Google Scholar]

 Fundamentals of Veterinary Clinical Pathology,by Steven L.

Stockham (DVM, MS); Michael A. Scott (DVM, PhD)

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