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I.C.1
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Alloimmune hemolytic anemia, Rh incompatibility. Blood film. Note the polychromatophilic macrocytes (reticulocytes), the nucleated red cells, and the ejected erythroblast nuclei. Spherocytes are present. The intense erythroblastosis (nucleated red cells in the blood) is characteristic of Rh-mediated alloimmune hemolysis.

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Alloimmune hemolytic anemia, ABO incompatibility. Blood film. Note the polychromatophilic macrocytes (reticulocytes) and spherocytes, characteristics of a severe spherocytic hemolytic anemia. Nucleated red cells, a striking feature of Rh-mediated alloimmune hemolytic anemia are less prominent in ABO maternal-fetal incompatibility.

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Acanthocytosis. Abetalipoproteinemia. Blood film. Patients with this inherited absence of products of the apolipoprotein B gene characteristically have over 50% acanthocytes, red cells with irregular sharp projections, in the blood. The red cell membrane abnormality is thought to reflect an excess of sphingomyelin in the outer leaflet of the membrane lipid bilayer, leading to excess surface area and sharp spike like folds in the red cell surface. Erythroblasts do not display the abnormality and circulating cells develop it as they age in the circulation.

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Acanthocytosis. Blood film. Spur cell anemia. Acanthocytes are red cells, often contracted in size and hyperchromatic, with irregularly placed, short, pointed projections from the cell surface. They are characteristic of patients with abetalipoproteinemia and may be seen in smaller numbers in a variety of metabolic disorders, such as severe chronic liver or renal disease, in the post-splenectomy state, and in small numbers in a variety of blood cell disorders affecting red cells. This case is an example of spur cell anemia in chronic severe liver disease. Note spherocytes, stomatocytes, and many spheroacanthocytes, the latter are small dense, speculated cells.

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Anorexia nervosa. Blood film. Echinocytes and acanthocytes. Occasional misshapen cells.

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Anorexia nervosa. Blood film. Echinocytes, acanthocytes and echinoacanthocytes.

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Arsenic hydride (arsine gas) poisoning. Blood film. Arsine is a gas formed when metals or ores containing arsenic are exposed to acid. Workers soldering, etching, galvanizing, and lead plating are at risk. This highly toxic gas when inhaled can cause multiorgan injury. The red cells are rapidly hemolyzed as a result of membrane injury. Signs of intravascular hemolysis quickly ensue. The red cells lose hemoglobin and circulating ghost cells may be present. Changes related to oxidant injury may also be present (irregular forms, bitten cells). In this film several red cells are nearly ghosts with very light staining resulting from leakage of ...

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