Malformed red blood cells

Introduction Red blood cell malformation is clinically suggestive of glomerulonephritis. Morphological examination of urinary red blood cells is a widely used method in clinical application in the past decade. The basic principle is that glomerular-derived red blood cells are affected by mechanical damage of the glomerular basement membrane and/or intra-osseous osmotic gradient, and the morphology is often distorted. The urinary red blood cell morphology of non-glomerular hematuria is generally absent. The above changes occur and show a uniform positive shape. This can help distinguish between glomerular hematuria and non-glomerular hematuria.

Cause

(1) Urine osmotic pressure: a series of changes in osmotic pressure of renal tubules, which are important factors influencing the production of malformed red blood cells. When the red blood cells leaking from the glomerulus pass through the renal tubules, the osmotic pressure environment changes rapidly. The red blood cells will undergo hemolysis changes under low osmotic pressure. The amount of hemoglobin in red blood cells varies from normal to red blood cells, and the red blood cell membrane can occur. When the rupture occurs, the components in the red blood cells are excreted outside the cells, and spore-like protrusions or vacuoles appear; the red blood cells are prone to shrinkage and shrinkage under hypertonic conditions. Urine red blood cells have undergone different environments such as hypotonic, isotonic, hypertonic, etc. in the renal tubules, resulting in typical pleomorphic characteristics of the cells.

(2) pH: The effect of pH change of renal tubule fluid on the morphology of urinary red blood cells is also highly valued. Studies have found that as the pH decreases, red blood cells gradually tend to increase and swell. When the pH value is less than 4.0, the red blood cells are swollen and partially dissolved, and typical shadow red blood cells appear. When the pH value is greater than 9.0, the red blood cells shrink and appear pure zigzag red blood cells. The influence of other factors on the morphology of red blood cells The formation of abnormal red blood cells is still affected by other factors, especially in clinical analysis and diagnosis.

an examination

Related inspection

Nephropathy, routine urine, routine urine, blood pH (pH), renal function test

More than 80% of malformed red blood cells are glomerular hematuria, more than 80% of abnormal red blood cells are non-glomerular hematuria, malformed red blood cells >20%, 50%), and homogeneous red blood cells (>50%) Mixed type.

Differential diagnosis

It should be differentiated from the following categories of red blood cell malformations:

1 Yeast-like red blood cells: There are vesicles protruding in the outer membrane of the red blood cells or the cells are spore-like changes.

2 fried bread rolls like red blood cells: red blood cell membrane is obvious inside and outside two circles, surrounded by hypertrophy, shaped like fried bread rolls.

3 ancient money-like red blood cells: shaped like Chinese ancient coins.

4 membrane defects red blood cells: erythrocyte membrane is incomplete, part of hemoglobin (Hb) is lost.

5 large red blood cells: the cell body is enlarged, the center is light, and there is no double disc depression.

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