13 Diseases affecting erythrocytes

Microcytic/hypochromic anemia

Iron deficiency anemia

FIGURE 13–1A Severe iron deficiency anemia (peripheral blood [PB] ×500).

FIGURE 13–1B Iron deficiency anemia (PB ×1000).

FIGURE 13–1C Iron deficiency anemia (bone marrow [BM] ×1000; showing shaggy cytoplasm).

Peripheral blood:

Erythrocytes are hypochromic and microcytic; large variation in size; possible thrombocytosis

Note:

Small lymphocyte depicted for size comparison.

Bone marrow:

Erythrocyte precursors are smaller and more numerous than normal and have shaggy cytoplasm. There is nuclear cytoplasmic asynchrony, with cytoplasmic maturation lagging behind that of the nucleus.

β-thalassemia minor

β/β⁺ β/β⁰ β/δβ⁰ β/δβ^lepore

FIGURE 13–2A β-Thalassemia minor (PB ×500).

FIGURE 13–2B β-Thalassemia minor (PB ×1000). The presence of basophilic stippling (arrow) is common in thalassemia minor but not in iron deficiency anemia.

Peripheral blood:

Microcytosis, slight hypochromia, target cells, basophilic stippling

β-thalassemia major

β⁰β⁰ β⁺β⁺ β⁰β⁺ δβ^lepore/δβ^lepore

FIGURE 13–3A β-Thalassemia major (PB ×500).

FIGURE 13–3B β-Thalassemia major (PB ×1000).

Peripheral blood:

Marked variation in size and shape, numerous nucleated erythrocytes, microcytes, hypochromia, target cells, basophilic stippling, tear drop cells, schistocytes, polychromasia

α-thalassemia*

Hemoglobin h

−−/−α

Peripheral blood:

Microcytes, hypochromia, marked poikilocytosis, target cells, polychromasia (see Figure 12-5, C).

Hemoglobin bart hydrops fetalis syndrome

−−/−−

Peripheral blood:

Numerous nucleated erythrocytes, marked variation in size, hypochromia, variable polychromasia, macrocytes

FIGURE 13–4A Bart hemoglobin (PB ×500).

FIGURE 13–4B Bart hemoglobin (PB ×1000).

Macrocytosis

Nonmegaloblastic

FIGURE 13–5A Macrocytic (nonmegaloblastic) (PB ×500).

FIGURE 13–5B Macrocytic (nonmegaloblastic) (PB ×1000).

Peripheral blood:

Round macrocytes, leukocyte and platelet counts usually normal

Bone marrow:

No megaloblastic changes

Associated with:

Normal newborn, liver disease, chronic alcoholism

Megaloblastic anemia

FIGURE 13–6A Megaloblastic anemia (PB ×500).

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