Changes in the morphology of erythrocytes
The morphology of erythrocytes varies with many hematological diseases and syndromes, which is manifested by a decrease in size, a change in the shape of red blood cells, the intensity and nature of their staining, and the appearance of pathological inclusions. The morphology of erythrocytes is judged by examining stained blood smears using an immersion microscope system.
Size changes
Microcytosis - prevalence in blood smears of erythrocytes with a diameter of 5-6.5 microns - observed with hereditary spherocytosis, iron deficiency anemia, thalassemia. All these cells have a reduced volume and a smaller amount of Hb. At the heart of changes in the size of red blood cells is a violation of the synthesis of Hb.
Macrocytosis - the presence in blood smears of erythrocytes more than 9 μm in diameter - is revealed in macrocytic anemia, liver diseases, vitamin B12 deficiency and folic acid, anemia of pregnant women, in patients with malignant tumors, hypothyroidism, leukemia.
Megalocytosis - the appearance in blood smears of erythrocytes 11-12 microns in diameter, hyperchromic, without enlightenment in the center, oval shape. The presence of megalocytes in blood smears is characteristic for anemia caused by a deficiency of vitamin B12 and folic acid, anemia in helminthic invasions.
Anisocytosis - the presence in blood smears of erythrocytes, differing in size: with the predominance of small-size erythrocytes - microanisocytosis, with predominance of large-diameter erythrocytes - macroanizo-cytosis. Anisocytosis is an early sign of anemia, isolated, without other morphological changes in erythrocytes, develops with mild forms of anemia.
Changes in the form of
Poikilocytosis - changes in the different degree of expression of red blood cells, which becomes distinct from discoid. This is the most important sign of pathological changes in erythrocytes. In contrast to anisocytosis, it develops with severe anemia and is a more unfavorable sign.
Only a few types of erythrocyte forms are specific for specific pathologies. These include microspherocytes, specific for hereditary microspherocytosis( Minkowski-Schoff-ra disease);sickle cells characteristic of sickle-cell anemia. Other changes in the shape of erythrocytes - target cells, acanthocytes, stomatocytes, ellipocytes, dacryocytes, etc., may appear with various pathological conditions.
Color changes
The most commonly observed pale color of erythrocytes with a wider unpainted central part is hypochromia, which is caused by low saturation of the erythrocyte Hb. Hypochromia of erythrocytes, usually in combination with microcytosis, is a characteristic sign of iron-deficient anemia. Hypochromia is possible with lead poisoning, thalassemia and other hereditary erythrocyte damage.
Reinforced erythrocyte staining - hyperchromia - is associated with increased saturation of red blood cells Hb. It is observed much less frequently, in combination with macrocytosis and megalocytosis. These changes are typical for patients with a deficiency of vitamin B12 and folic acid( with Addison-Birmer anemia, diphyllobothriasis, malignant tumors of the stomach, intestines, alcoholism).
Polychromatophilia( erythrocytes of grayish color) is due to the ability of immature red blood cells( due to insufficient saturation of Hb) to stain with acidic and basic dyes. Normally, single polychromatophilic erythrocytes are detected. Their amount increases with increased erythropoiesis( posthemorrhagic anemia, hemolytic anemia after a crisis).
Inclusions in erythrocytes
Inclusions in erythrocytes are represented by elements of pathological regeneration of the bone marrow.
Rings of the Kebot - the remains of the nuclear shell of the megaloblast, look like a ringlet, eight, are painted red. Quota rings are found with dyseritropoiesis, in particular with megaloblastic anemias( vitamin B12 and folic deficiency), thalassemia, acute erythromyelosis.
Taurus Jolly - small violet-red inclusions, present on 2-3 in one erythrocyte, are the remains of the megaloblast core. Normally, Jolly's bodies are found only in the blood of the newborn. They are constantly found in blood smears after splenectomy. Taurus Jolly can be detected by poisoning with hemolytic poisons, anemia of various origins.
Basophilic granularity is an aggregated basophilic substance in the form of blue granules, it is better revealed when the color is methylene blue. The appearance of basophilic granularity in erythrocytes is characteristic for
lead( formed by aggregates of ribosomes and iron-containing mitochondria), but also possible with sideroblastic and megaloblastic anemia, thalassemia.
Heinz-Ehrlich's Heifer - single or multiple inclusions formed from denatured Hb, which are detected when stained with methyl violet. The Heinz-Ehrlich Taurus is the first sign of an upcoming hemolysis, they are detected by poisoning with hemolytic poisons, anemias caused by deficiency of glucose-6-phosphate dehydrogenase, glutathione reductase.
Nucleated cells of erythrocyte series
For various pathological conditions in the peripheral blood, one can detect basophilic, polychromatophilic and oxyphilic normoblasts( normocytes).A large number of normoblasts is characteristic of hemolytic anemia. They can appear in blood smears during posthemorrhagic anemia, Addison-Birmer's anemia( in remission), acute leukemia( sometimes), metastases of tumors in the bone marrow, leukemoid reactions in malignant neoplasms, after splenectomy, with severe heart failure.