Sickled cells sickle cell disease

■ Hypersegmented neutrophils (folat:e/B1? deficiency) a Hypochromic and microcytic RBCs (iron deficiency) a Basophilic stippling (lead poisoning)

« Heinz bodies (G-6-PD deficiency)

■ "Bite cells" (hemolytic anemias)

* Howell--Jolly bodies (asplenic patients)

■ iron inclusions in RBCs of bone marrow (sideroblastic anemia)

■ Teardrop-shaped RBCs (myelofibrosis)

■ Sclnstocytes, helmet cells, and fragmented RBCs (intravascular hemolysis) »Spherocytes and elliptocytes (hereditary spherocytosis/elliptocytosis)

■ Acanthocytes/spur cells (abetalipoproteioemia)

■ Target cells (thalassemia, liver disease)

■ Echinocytes and burr cells (uremia)

■ Polychromasia (from reticulocytosis-; should alert you to possibility of hemolysis) a Rouleaux formation (multiple myeloma)

a Parasites inside RBCs (malaria, babesiosis)

Reticulocyte index (RI) should be > 2% with anemia; otherwise, the marrow is not responding properly. A reticulocyte index > 3% should, make you think of hemolysis as the cause (the marrow is responding properly, so it is not the problem). With these three parameters, you can make a reasonable differential diagnosis if the cause is not obvious.


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