Abnormal Blood Cell Morphology

Abnormal White Blood Cells

• Neutrophils (AKA: PMNs, Polys, Segs) — Abnormalities in the neutrophil include…..1. Greater than 5% bands2. Hypersegmented nuclei (greater than 5 lobes)3. Toxic granulation4. Toxic vacuolization5. Dohle bodies6. Younger stages than the band

• When do you see them in high numbers?— Bacterial infections— Inflammation

Band

Norma l

Hyper-segmented

Toxic granulation

Dohle bodies

Toxic granulation, vacuolization, & Dohle bodies are seen during bacterial infections, burns, cancer, and toxic or inflammatory states.

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

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

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 <7 per field— Increased is >20 per field

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 <6 micrometers = called microcytic

—Can be larger than normal >8 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)

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 bull’s eye = called target cells (Codocytes)

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.

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.

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.