Hemolytic disease of the newborn from Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions, presented by MediaLab

Erythrocyte Disorders: Smear Case 1: Jaundice and the Peripheral Smear

Hemolytic disease of the newborn

Jaundice was recognized in a day-old infant. Notice particularly the size variation (anisocytosis) of the erythrocytes on the infant's peripheral smear.
What does this observation mean? Does it provide immediate information that might serve as guidance in expediting diagnosis and treatment?
Note that normal-sized red blood cells, microcytes, microspherocytes, macrocytes, and nucleated red blood cells are all present. Red cell variations are expected findings in healthy neonates, but the variations here are exaggerated. Hyposplenic functional features may appear, including acanthocytes, spherocytes, and possibly Howell-Jolly bodies, especially if hemolysis is particularly vigorous. A high (3-7%) reticulocyte count is not unusual during the first three or four days after birth, however, the marrow in this jaundiced infant is proliferating vigorously in response to hemolysis.
A call for more red cells is urgent. Immature red cells (in the form of nucleated red cells) and red cells with stippling of RNA (basophilic stippling) are readily identified.
Red cell maturation sequence has not been totally processed in the marrow nor is all residual red cell debris removed by the spleen.
In the lower photograph are reticulocytes stained by supravital stain (new methylene blue).
Basophilic stippling (specks of RNA) stains with both supravital stains and with routine Wright-Giemsa stain.

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