RBC Morphology Description Clinical Conditions

A. Poikilocytosis
*Secondary to Abnormal
Hemoglobin Content
1. Sickle Cell -crescent shaped with -Sickle cell Anemia
pointed projections at the -Sickle cell trait
terminal end
- may be curved, straight,
S, V or L shaped
*Secondary to Membrane -spheric (ball-shaped) red -Hereditary spherocytotic
Abnormality cells that have diminished anemia
1. Spherocytes
WBC Morphology diameter, at times
Description Associated -Malaria
Conditions
A. Nuclear Changes reduced to 4 um , and a -Hyperplenism or Post-
1. Hyper segmented central
-neutrophils
thickened
withportion
more *seen splenectomy
in megaloblastic
Neutrophil than
instead5 nuclear
of thelobes
normaland -Heinz
processes
body hemolytic
such as:
with many
palor.reddish -Pernicious
anemiaAnemia
-compared granules.
to normal cells -Post-Folic
Tranfusion
Acid decifiency
reaction
their surface area are -Autoimmune
-Vitamin B12 deficiency
Hemolytic
markedly reduced. -Chronic
Anemia Anemia
2. Target cell -Mexican Hat - Obstructive and Chronic
-Down Syndrome
2. Basket cells / appearance;
-squashed/ruptured
bulls eye -Chronic
Liver Disease
lymphocytic
Smudge cells appearance
leukocytes leukemia
-Thalassemia
(if >/=25%)
-RBC -network
has a peripheral
appearance ring -Familial LCAT deficiency
of hemoglobin
-results fromwithpartial
dark -Post-Splenectomy
breakdown
stained central
of the -Hemoglobinopathies
immature
hemoglobin and area
fragile
3. Eliptocyte -Cigar shape, sausage,
leukocytes -Hereditary Elliptocytosis
3. Pyknotic Cells/ -WBCs without pencilchromatin -Myelophthisic
-infections
anemia
Twinning deformity bridges between the -Aging cells
nuclear lobes -Pernicious Anemia
-tetraploid neutrophils with -Myeloproliferative
4. Ovalocyte -Oval shaped,
diploid egg-
nucleus -Hereditay Ovalocytosis
disorders
-twice the shaped
size of normal -Megaloblastic anemia
neutrophils -Thalassemia
B. Cytoplasmic
Changes
1. Alder-Reilly -presence of dark course,
5. Granulation
Echinocyte -RBC
dark membrane
azurophilic have
granules -Uremia
uniformly
in spacedof
the cytoplasm and
all -Post-splenectomy
distributed blunt /
WBC cell linesknobby -Malabsorption state
spicules -Pyruvate kinase
-crenated red blood cells deficiency
6. Burr cell
2. Chediak-Higashi -irregularly contracted
-neutrophils show giantred -Uremia
-seen in Albinism
Anomaly cells with prominent
green-gray granules -Gastric cancer
(rare,autosomal) spicules -Bleeding peptide ulcer
-Renal insufficiency
-Acute Blood loss
-Pyruvate kinase
deficiency
7. May-Hegglin
3. Acanthocyte -RBCcytoplasm
-WBC membranecontains
have -Severe
-BleedingLiver disease
tendencies
Anomaly irregularly
irregularlyspaced pointed
sized, multiple -Alcoholic Anemia(w/
orspicules or thorny
single blue or pink hemolytic anemia)
projections that have -
various lengths and Abetalipoproteinimia(rare)
widths(bulbous -Pyruvate kinase
 inclusions

4. Dohle Bodies / -contains ribosomal RNA -May-Hegglin Anomaly

Amatobodies -round, palae bluish-gray -severe infections
structure that ranges from -burns
1-5 um, located near the -poisoning
cytoplasmic membrane -after chemotherapy
-pregnancy

-rod or spindle-shaped -Myelogenous Leukemia

5. Auer Rods cytoplasmic inclusions
-reddish-purple, 1-6u long,
less than 1.5u thick

6. Toxic Granulation -excessive granulation, in -toxic states

amount and intensity with
more prominent granules.
The granules have a much
more vivid blue-black
coloration
-Severe infections and
burns
-chemical poisoning

7. Toxic Vacuolation -usually occurs in *Physiologic:

segmented neutrophils but
occur in monocytes also
-2 types:
a. Physiologic: small/large
uniformly placed vacuoles
b. Pathologic: large
unevenly distributed
vacuoles (in fresh sample)
-delayed obs preparation
-prolonged storage of
samples
-prolonged exposure of
blood to sulfonamide or
chloroquine
*Pathologic
-sepsis of serious infection
-poisoning
-cells with long exposure
to Heller and Paul Oxalate

C. Hereditary White
Blood Cell
Disorder
1. Pelger-Huet -neutrophils are hypo
Anomaly (fairly segmented
common) -
HETEROZYGOTES=nucleus
is seen as peanut-shaped,
dumb-bell shaped, or
pince-nez shaped
 -HOMOZYGOTES=nucleus
is spherical without
lobulations (w/prominent
nuclear clumping)
D. Others
1. Atypical -very large, up to 20u -Infectious Mononucleosis
Lymphocytes -oval to kidney shaped -can be seen in normal
nucleus with blue to dark individuals
blue vacuolated cytoplasm
which gives a foamy
appearance

2. LE Cell -a phagocyte(neutrophil) -Systemic Lupus

with an engulfed Erythematosus (SLE)
degenerated -Rheumatoid Arthritis (RA)
material(nucleus)
-formation is induce by LE
Factor (gamma globulin)
-ingested material is a soft
and silky purple mass
without definite nuclear
pattern
3. Tart Cells -a monocyte that have -unknown significance
engulfed another cell or a
nucleus
-the engulfed material
retains its nuclear
pattern/structure
(homogeneous ingested
material)
4. Human Ehrlichiosis HME = Human Monocytic Common to both:
Ehrlichiosis -low white vlood cell count
-caused by the -thrombocytopenia
rickettsia-like Ehrlichia -extremely elevated liver
chafeensis enzymes
-patients show an initial -diagnostic = presence of
flu-like presentation berry-like inclusions
(difficult to detect & not
HE = Human Granulocytic present in some cases)
Ehrlichiosis
-caused by the
rickettsia-like Ehrlichia
phagocytophilia
-patients show an acute
onset of high fever, chills,
and headache

References
1. Color Atlas of Hematology : Practical Microscopic and Clinical Diagnosis 2 nd revised
edition
H. Theml et. al.
pg 142-146, 153
2. Hematology In Practice
Betty Ciesla
pg 41-47, 97-108, 143-150
3. Modern Hematology : Biology and Clinical Management 2 nd edition
R. Munker et. al.
pg. 101, 142
4. Henrys Clinical Diagnosis and Methods by Laboratory Management 22 nd edition
pg. 523