RED CELL ABNORMALITIES

Red Cell SizeRed Cell Type Morphologic Appearance Defect or Change Associated Conditions

Normocytic Normal sized biconcave disc RBCs, 6-8 um

NA NA

Microcytic Smaller RBCs, less than 6 umMCV <80 fl

Abnormal size due to the failure of hemoglobin synthesis

Iron deficiency anemiaThalassemia

Macrocytic Larger RBCsMCV > 100 fL

Impaired DNA syn.Stress erythropoiesisExcess surface membrane

Megaloblastic anemiaLiver disease Alcoholism

Red Cell Hemoglobin ContentRed Cell Type Morphologic Appearance Defect or Change Associated Conditions

Normochromic Normal in color NA NA

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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsHypochromic Central pallor exceed 1/3 of the

diameter of the cellReduced hemoglobin content (MCHC)

Iron deficiency anemiaThalassemia

Hyperchromic No central pallor Greater than normal MCHC Spherocytosis

Red Cell ShapeRed Cell Type Morphologic Appearance Defect or Change Associated Conditions

Acanthocyte Spheroid with 3-12 irregular spikes

Increased ratio of cholesterol to lecithin

End stage liver diseasePyruvate kinase deficiencyAbetalipoproteinemia

Echinocyte Regular 10-30 scalloped short projections

Depletion of ATPExposure to hypertonic solutionArtifact in drying

UremiaCirrhosisHepatitisChronic renal disease

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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsCodocyte Peripheral rim of hemoglobin

surrounded by clear area and central hemoglobinized area (bull’s eye)

Excess surface membrane to volume ratio

HemoglobinopathiesThalassemiaPost-splenectomy

Dacryocyte Teardrop or pear-shaped with single elongated point or tail

Squeezing and fragmentation during splenic passage

Myeloid metaplasiaHypersplenism

Drepanocyte Crescent shape cell that lacks zone of central pallor

Polymerization of deoxygenated hemoglobin

Sickle cell anemia

Elliptocyte Rod or cigar shaped Polymerization of hemoglobin Hereditary elliptocytosis

Schistocyte Fragments of RBCs varying in size and shape

Extreme fragmentation produced by damage of RBCs by fibrin, altered vessel walls and prosthetic heart valves

Disseminated intravascular coagulation (DIC)Microangiopathic hemolytic anemia

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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsSpherocyte Smaller in diameter than normal

RBC with concentrated hemoglobin contentNo visible central pallor

Lowest surface area to volume rationDefective membrane

Hereditary spherocytosisImmune hemolytic anemia

Stomatocyte Normal sized cell with slit like area in center

Known to have increased permeability to sodium

Hereditary stomatocytosisRh null disease

Red Cell InclusionsRed Cell Type Morphologic Appearance Defect or Change Associated Conditions

Howell-Jolly bodies Coarse round densely stained purple 1-2 um granules eccentrically located on periphery of membraneMay be single or double

Nuclear remnants containing DNA

Megaloblastic anemiaAccelerated erythropiesis

Cabot ring Rings, loops or figure of eight; red to purple

Remnants of microtubules of mitotic spindle

Dyserythropoiesis

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Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsHeinz bodies Deep purple irregular shaped

inclusions 2 to 3 umFound on RBC inner surface of membrane

Represent precipitated, denatured hemoglobin due to oxidative injury

Hereditary defects in hexose monophosphate shuntG6PD deficiencyUnstable hemoglobins

Basophilic stippling Round dark blue granules uniformly distributed

Represents impaired erythropoiesis

Lead poisoningPyrimidine-5-nucleotidase deficiency

Pappenheimer bodies Small 2 to 3 um irregular basophilic inclusions that aggregate in small clusters near periphery with Wright’s stain

Unused iron deposites Sideroblastic anemiaDefective erythropoiesis

Ringed sideroblast Nucleated RBC that contains nonheme iron particles arranged in ring form

Excessive iron overload in mitochondria of normoblastsDue to defective heme synthesis

Sideroblastic anemia

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BM smear, iron stain

Supravital stain

Red Cell Type Morphologic Appearance Defect or Change Associated ConditionsSiderocyte Non-nucleated cell containing

iron granulesSame as above Same as above

Miscellaneous RBC abnormalitiesRed Cell Type Morphologic Appearance Defect or Change Associated Conditions

Autoagglutination Clumping of RBCs Presence of antibody Cold agglutininAutoimmune hemolytic anemia

Rouleaux Alignment of RBCs linear appearing as stack of coins

Caused by increased concentration of globulin

Multiple myelomaWaldenstrom’s macroglobulinemia

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WBC ABNORMALITIES

Abnormalities Associated with GranulocytesDescription Morphologic Appearance Defect or Change Associated Conditions

Alder-Reilly granules Large purple-black coarse cytoplasmic granules

Accumulation of mucopolysaccharides

Alder-Reilly anomalyHunter’s syndrome

Auer rods Pink or red rod shaped cytoplasmic structures

Fused primary granules AMLFound in myeloid and monocytic series only

Chediak-Higashi granules Giant red, blue to grayish round inclusions in cytoplasm

Large cytoplasmic inclusions of fused primary granules that are deficient in enzymes for phagocytosis

Chediak-Higashi syndromeAlbinism

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Description Morphologic Appearance Defect or Change Associated ConditionsHypersegmented neutrophil >5 lobes Abnormal DNA synthesis Megaloblastic anemia

Pelger-Huet Single or bilobed nucleus Decreased segmentation Pelger-Huet anomaly

LE cell Neutrophil with large purple homogenous round inclusion with nucleus wrapped around

Three factors needed to produce LE cell: antinuclear antibodies, cell nuclei, phagocytes with ingested material

Lupus erythematosus

Döhle bodies Single or multiple blue cytoplasmic inclusions in neutrophil

Aggregates of free ribososmes of rough endoplasmic reticulum

Severe infectionsToxic states

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Description Morphologic Appearance Defect or Change Associated ConditionsToxic granules Large purple to black azurophilic

granulesPrimary granules Infections, toxic states

Toxic vacuoles Large empty white areas within cytoplasm

Represent end stage phagocytosis

SepticemiaSevere infectionsToxic states

Abnormalities Associated with Lymphocytes/Plasma cellsDescription Morphologic Appearance Defect or Change Associated Conditions

Basket cell Degenerated nucleus or ruptured cell in form of smudge or basket

Lymphocytes that are fragile and break upon smearing

Chronic lymphocytic leukemiaSmall numbers are artifact

Hairy cell Lymphocyte with hair-like cytoplasmic projections surrounding nucleus

Thought to be of B cell origin Hairy cell leukemia

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Description Morphologic Appearance Defect or Change Associated ConditionsSeźary cell Round lymph cell with nucleus

that is grooved or convolutedRepresents leukemic phase of mycosis fungoidesT-cell characteristics

SeźaryMycosis fungoides

Flame cell Plasma cell with red to pink cytoplasm

Associated with increase in IgA Multiple myeloma of IgA nature

Grape cell Plasma cell that contains small colorless vacuoles

Large protein globules giving the appearance of grapes

Multiple myeloma

SOURCE: SAUNDERS MANUAL OF CLINICAL LABORATORY SCIENCE

LEAH MARCH2009

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