Abnormal Morphology of Blood Cells

Adhi Kristianto Sugianli

Objectives

The type of abnormalities

Erythrocyte (RBC)
Leukocyte (WBC)
Thrombocyte (Platelet)
Review
Normal hematology cell
Normal or Abnormal ?
Define Blood Smear Abnormalities

Define the blood smear area

2/3 from head
2 criteria :
In every field to be examined
Pathologic and not artificially induced
Morphology of RBC

Shape
Poikilocytosis
Type of shape abnormal
Size
Anisocytosis
Macrocytic
Microcytic
Color
Hypochromia
Hyperchromia
Distribution
Agglutination
Rouleaux
Inclusion bodies
RBC

Anisocytosis Poikilocytosis
5% of all area = normal; more than 5% = abnormal
Size
Macrocytic
9 m in diameter (MCV > 100 fL)
Megaloblastic macrocytic
Impaired DNA synthesis
Macroovalocyte, Hypersegmentation
Non megaloblastic macrocytic
Accelerated erythropoiesis
Round polychromatophilic macrocytes
Microcytic
Diameter < 7 micrometer (MCV < 80 micrometer)
Impaired Hb synthesis
Decreased/defective globin synthesis
With hypochromia : Thalassemia
Without hypochromia : Sideroblastic anemia
Color

Hypochromia
Central pallor > 3 micrometer
Grade : +1 up to +4
Hyperchromia and Polychromasia
Hyperchromia
Resulting from the increased volume of Hb and the
decreased surface area
Polychromasia
Represents effective erythropoiesis
Grade : +1 up to +4
Shape

Target cell
Excess membrane cholesterol and phospholipid and
decreased cellular Hb
Spherocyte
Reduced surface to volume ratio that results in a cell
with no central value
Ovalocytes and Ellyptocytes
Mechanical weakness or fragility of the membrane
skeleton
Stomatocytes
Membrane defect associated with abnormalities in
red cell cation permeability
Changes in red cell volume
Shape

Achantocytes
Excess of cholesterol and an increased cholesterol to
phospolipid ratio
Fragmented cells
Schistocytes, burr cells, helmet cells
Loss from the cell of a piece of membrane that may
or may not contain hemoglobin
Tear drops
Exact physiologic mechanism is unknown
Distribution

Agglutination
If an erythrocyte antibody is present in a patients
plasma and a corresponding erythrocyte antigen is
represented

Rouleaux
The result of elevated globulin or fibrinogen in the
plasma
This abnormal plasma appear as stacks of coin
 Agglutination

Rouleaux
Inclusion Bodies

Howell Jolly Bodies

Nuclear remnants containing DNA

Basophilic Stippling
Contain ribosomes can potentially form stippled cells

Siderotic granules - Pappenheimer bodies

Resulting from an excess of available iron throughout
the body
Inclusion Bodies

Heinz bodies
Result of denatured or precipitated hemoglobin

Cabot rings
Contain arginine-rich histone and non hemoglobin
iron
WBC

White blood cells may exhibit several morphological

changes
The neutrophils are the cell type primarily affected.

Most of these neutrophilic changes originate in the

cytoplasm in response to various pathologic
processes.
Toxic granulation
Toxic vacuolization, or
The presence of Dohle Bodies
WBC Variation

Number of cells
Mild infections
Slight leukocytosis, with or without the shift to the left.
Severe bacterial infections
Moderate leukocytosis and a shift to the left in
granulocytosis
Shift to the left
Shift to the right
Granule
Toxic granulation
Cytoplasm
Toxic vacuolization
Nucleus
Hypersegmentation
Platelet

Normal
2 to 4 micrometer
discoid shape
blue granules dispersed throughout a light blue
cytoplasm
Platelet Variation

Number of cells
Increase platelet count
Thrombocytosis
Size
Large platelet (giant thrombocyte)
Increased platelet turnover
Shape & Color
Blue or gray agranular discs
Extremely large
Show tailing or streaming of the cytoplasm
 Further Reading

Denise Harmening, Clinical Hematology and

Fundamentals of Hemostasis,
Publisher: FA Davis Company

Shiro Miwa, Atlas of Hematology (Blood cell)

Thank You