By Irma Pereira MT (ASCP) SH, Tracy I. George MD, Daniel A. Arber MD
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Extra resources for Atlas of Peripheral Blood: The Primary Diagnostic Tool
3 Large three-dimensional RBC aggregates are readily visible at low power and indicate the presence of cold autoagglutinins. in affected neonates and infants who may present with hydrops fetalis, jaundice, splenomegaly, and severe hemolytic anemia requiring transfusions. PK deficiency is distinguished as one of the nonspherocytic hemolytic anemias. Cases with echinocytes, acanthocytes, bite cells, and microspherocytes have all been documented. The reticulocyte count is markedly increased in these patients (Fig.
Occasional teardrop-shaped RBCs are present. Ovalocytes are not prominent. a chains are affected and presents as a mild microcytic hypochromic anemia (Fig. 5). 2). If three a chains are affected, this is called hemoglobin H disease due to the presence of unstable hemoglobin H (tetrameric b chains). Tetrameric g chains are also present (hemoglobin Barts). These two unstable hemoglobins result in poor oxygen delivery to tissues due to the higher affinity for oxygen characterized by these hemoglobins.
Instance, hemoglobin Bristol induces hemoglobin precipitation resulting in more severe red cell destruction, whereas hemoglobin Seattle produces only mild, sporadic hemolytic anemia. DNA sequencing specifically identifies the unstable hemoglobin. 19 Hemoglobin Köln. This unstable hemoglobin shows oxidative changes with bite cells, irregularly contracted erythrocytes, polychromatophilic red cells, and some hypochromia. 20 The isopropanol stability test is used to detect unstable hemoglobins. Unstable hemoglobins have reduced stability when exposed to alcohol denaturation, compared with the stability of normal hemoglobins.