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.
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.
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.
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.
Anorexia nervosa. Blood film. Echinocytes
and acanthocytes. Occasional misshapen cells.
Anorexia nervosa. Blood film. Echinocytes,
acanthocytes and echinoacanthocytes.
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 hemoglobin through pores in damaged membranes.