DIAGNOSIS OF BLOOD DISORDERS | RED AND WHITE BLOOD CELL ABNORMALITIES

Characteristic red blood cell abnormalities are anaemia, sickle cell anaemia and spherocytosis. Sometimes the microscopic investigation of the red cells can be essential to the diagnosis of life – threatening disease e.g. TTP.

ANAEMIA: this is the most significant in red cell abnormalities. Here the oxygen carrying capacity of blood is decreased in respect to patient's age, sex, environmental factors and climatic factor (WHO DEFINITION). The causes of anaemia are varied, and most of them are expressed as changes in RBC morphology. Therefore, morphological examination of red cells using blood film is very helpful in evaluating and determining the cause of anaemia. Normal red blood cells stained with a Romanowsky stain are nearly uniform in size , shape and colour. Each cell appears as a pink disc, about 7 microns in diameter, with a rim of hemoglobin and a clear central area called central pallor. The central pallor generally occupies less than one-third of cell. The red cells having normal size and normal colour are said to be normocytic and normochromic, respectively. Blood disorders may be indicated microscopically by changes in the shape of red cells or by presence of inclusion body (Hoffbrand and Moss, 2011). 

Blood Film Showing Normal Blood
 
Abnormal Blood
a.      Anisocytosis (variation in size)
 

b.   Poikilocytosis (irregularities in shape)
 

c.   Variation in colours

Hypochromia: Ring staining of cells due to poor hemoglobin

SPHEROCYTOSIS: small dense red cells due to cell membrane abnormalities cells show increased osmotic fragility. (loss of biconcavity) (Bacus, 2001)
ABNORMALITIES ASSOCIATED WITH HEMOGLOBINOPATHIES  
SICKLE CELLS: severe distortion of red cells due to aggregation of abnormal hemoglobin molecules in reduced stage.

TARGET CELLS: cells showing central area of density with surrounding pallor (thin cells with central bulge).

Red cell inclusion bodies

Nucleated

WHITE BLOOD CELL DISORDERS: white blood cells are classified according to their propensity to stain with particular substances, the shape of the nuclei and the granular inclusions.
In examination of blood film for white blood cell estimation, these white cell are seen
a.      Neutrophil granulocytes: usually make up to 80% of the white cell count.
b.      Eosinophil granulocytes
c.      Basophile granulocytes : these are seen occasionally
d.      Lymphocytes: having very little cytoplasm and large nucleus 

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