Evaluation of RBC morphology is a critical step in thorough blood smear evaluation and can aid in identifying many different metabolic disorders, indicate oxidative damage, or help localize a disease process. There are four features of red blood cell morphology that should be evaluated: color, size, shape, and inclusions. Patients with iron deficiency anemia can develop hypochromasia. Since iron is necessary for heme synthesis, erythrocytes from patients with iron deficiency can have decreased hemoglobin content. Basophilic stippling represents the spontaneous aggregation of ribosomes and polyribosomes in RBC. In Romanowsky-stained samples, affected RBCs contain uniformly distributed punctate, basophilic structures. Basophilic stippling may be seen in cattle and other ruminants as a part of the regenerative response to anemia.
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