Abnormal Blood Cell Morphology

1
Abnormal Blood Cell Morphology
2
Abnormal White Blood Cells

• Neutrophils (AKA PMNs, Polys, Segs)
• Abnormalities in the neutrophil include..
• Greater than 5 bands
• Hypersegmented nuclei (greater than 5 lobes)
• Toxic granulation
• Toxic vacuolization
• Dohle bodies
• Younger stages than the band
• When do you see them in high numbers?
• Bacterial infections
• Inflammation

Norma l
Toxic granulation, vacuolization, Dohle bodies
are seen during bacterial infections, burns,
cancer, and toxic or inflammatory states.
Hyper-segmented
Dohle bodies
Band
Toxic granulation
3
Abnormal White Blood Cells

• Eosinophils (AKA Eos)
• Greater than 3 eosinophils is abnormal
• When do you see them in high numbers?
• parasitic infections
• allergic reactions
• Basophils
• Greater than 1 is abnormal
• When do you see them in high numbers?
• allergic reactions
• inflammatory reactions

Normal
Normal
4
Abnormal White Blood Cells

• Monocyte
• Greater than 10 of WBCs in the
• blood is abnormal
• When do you see them in high numbers?
• bacterial infections
• viral infections
• Lymphocyte
• Greater than 40 in the blood is abnormal
• Some produce and secrete antibodies
• Atypical forms are larger cells with round or
• irregular nucleus and abundant cytoplasm
• When do you see them in high numbers?
• viral infections
• High and atypical form during infectious
  mononucleosis

Normal
Normal
5
Abnormal Platelets

• Platelets (AKA Thrombocytes or PLTs)
• Formed from the fragments of a megakaryocyte
• Megakaryocytes are found in the bone marrow
• Megakaryocytes found in the peripheral blood
• are abnormal
• Many giant platelets are abnormal
• Abnormal platelets are
• Larger than 3 micrometers in diameter
• Giant thrombocytes or giant platelets are seen
  occasionally
• Normal is between 7-20 per field
• Decreased is lt7 per field
• Increased is gt20 per field

6
Abnormal Red Blood Cells

• Red Blood Cells (AKA Erythrocytes of RBCs)
• Can be normal sized (oval or round) 6-8
  micrometers in diameter called normocytic
• Can be smaller than normal lt6 micrometers
  called microcytic
• Can be larger than normal gt8 micrometers called
  macrocytic
• Anisocytosis is when they RBCs vary drastically
  in size
• Poikilocytosis is when the RBCs vary drastically
  in shape
• If the RBC color is normal called normochromic
• If the RBC color is decreased called
  hypochromic
• (larger central pallor)

7
Abnormal Red Blood Cells

• Red Blood Cells (AKA Erythrocytes of RBCs)
• Can be compact RBCs, dark, dense, small called
  spherocytes
• Can be crescent shape and pointed called sickle
  cells (depranocytes)
• Can appear mouth-like called stomatocytes
• Can appear like ovals or elongated called
  ovalocytes or elliptocytes
• Can appear target shaped or bulls eye called
  target cells (Codocytes)

8
Abnormal Red Blood Cells

• Red Blood Cells (AKA Erythrocytes of RBCs)
• Can be spiny called acanthocytes
• Fragmented cells is a broad category and includes
  many different types of cells.
• Schistocytes (Keratocytes) and Helmet cells are
  examples of fragmented cells.
• Nucleated RBCS ? usually found only in the bone
  marrow.
• Can be seen in the peripheral blood in
  severe anemia and in newborns.

9
Abnormal Red Blood Cells

• Common Red Blood Cell Inclusions
• Howell-Jolly bodies
• From left over DNA found in the RBC.
• Appear as round, deep purple circles
• around 2 micrometers in diameter.
• Found in patients after their spleen has
• been removed or when RBC production is
  rushed,
• pernicious anemia and hemolytic anemia.
• Pappenheimer bodies
• Small, light purple, beads, made from iron.
• Located near the periphery of the RBC.
• Need to be stained with Prussian blue to
• determine in they are true Pappenheimer
  bodies.
• Seen in iron loading anemias and hereditary
• hemochromatosis.

10
Abnormal Red Blood Cells

• Common Red Blood Cell Inclusions
• Basophillic stippling
• Remains of RNA and mitochondia.
• Diffuse granules found throughout the cytoplasm.
• Found in patients that have fast RBC growth.
• Found in patients with lead poisoning.
• Heinz bodies
• Denatured hemoglobin
• Large 1-3 micrometers in diameter.
• Located near the periphery of the RBC.
• Special staining with a supravital stain is
  needed to
• visualize Heinz bodies.
• Found in patients with G6PD deficiency and with
• some hemoglobinopathies.