Blood Cell Variations PDF

VARIATION OF CELLS FROM NORMAL MORPHOLOGY RED CELLS VARIATION WHITE CELLS VARIATION PLATELETS VARIATION Variation Hemoglobin Content Erythrocytes contain hemoglobin which stains pink on Wright's stained smears. The degree of central pallor in...

VARIATION OF CELLS FROM NORMAL MORPHOLOGY RED CELLS VARIATION WHITE CELLS VARIATION PLATELETS VARIATION Variation Hemoglobin Content Erythrocytes contain hemoglobin which stains pink on Wright's stained smears. The degree of central pallor in erythrocytes is suggestive of their hemoglobin content. The best method of determining erythrocyte hemoglobin content is using automated instrument indices.  Normochromic Morphology: Erythrocyte with an area of central pallor no more than one- third the diameter of the cell Normochromic RBC Comment: Normochromic red blood cells are seen in healthy patients.  Hypochromic RBCs Morphology: Rbc with an area of central pallor greater than one-third the diameter of the cell. Normochromic RBC Hypochromic red blood cells may be Hypochromic RBC seen in iron deficiency anemia.  Variation in Size The term anisocytosis is used to describe variation in red blood cell size. may be seen in iron deficiency anemia, megaloblastic anemia, and Anisocytosis burn patients.  Anisocytosis Three terms describe the variation in size of RBCs Normocytic Microcytic Macrocytic  Normocytic Morphology: Erythrocyte approximately the same size as the nucleus of a small lymphocyte. Normocytic RBC Normocytic red blood cells are seen in healthy patients. Small lymphocyte  Microcytic Red cells Morphology: Erythrocyte smaller than the nucleus of a small lymphocyte. Microcytes may be seen Small lymphocyte in iron deficiency anemia and thalassemia. Microcytic RBC  Macrocytic Morphology: Erythrocyte larger than the nucleus of a small Macrocytic lymphocyte. RBC Small lymphocyte Macrocytes are commonly seen in anemia due to Vitamin B12 or folate deficiency.  Variation in Shape of RBCs The term poikilocytosis is used to describe variation in red blood cell shape. Poikilocytosis may be seen on peripheral blood smears from sickle cell anemia, severe iron deficiency anemia, and burn patients. Inherited conditions such as HS, Poikilocytosis HE, HPP and SAO(south east asia ovolocytosis). Spherocytes Morphology: spherical, densely staining red blood cells, no central pallor. Spherocytes are commonly seen in hereditary spherocytosis and immune hemolytic anemias. Teardrop Cells Morphology: teardrop shaped red blood cells Tear drop cells (dacrocytes) generally result from marrow replacement by fibrosis or malignancy. Burr Cells Morphology: red blood cells with many, regularly spaced, short projections. Burr cells (echinocytes) are associated with uremia, as seen in chronic renal disease. Stomatocytes Morphology: red blood cell with a rod-shaped area of central pallor Comment: Stomatocytes may be seen in liver disease and acute alcoholism. Schistocytes Morphology: red blood cell fragments, irregularly shaped and variable in size, often with pointed ends Schistocytes (keratocytes) may be seen in disseminated intravascular coagulation and thrombotic thrombocytopenic purpura  Acanthocytes Morphology: red blood cells with multiple, irregularly spaced, blunt projections of varying size Acanthocyte Comment: Acanthocytes (spur cells) are seen in Acanthocyt abetalipoproteinemia and severe liver e disease.  Elliptocytes Morphology: oval or elliptical red blood cells Comment: Elliptocytes are seen in hereditary Elliptocytes elliptocytosis and a variety of anemias.  Sickle Cells Morphology: long, narrow, curved red blood cells with a point on at least one end Sickle cell Comment: Sickle cells (drepanocytes) are seen in sickle cell anemia.  Target Cells Morphology: alternating rings of Target cell pallor and dense staining resembling a target Comment: Target cells Cell Targ et (codocytes) may be seen in thalassemia and liver disease.  Red Blood Cell Inclusions Inclusions in erythrocytes stain red to dark purple on Wright stained smears. Erythrocyte inclusion can be nuclear remnants, iron particles, RNA, or intracellular parasites. They vary in appearance depending upon their Nor mal RBCs and RBCs with inclusions composition.  Basophilic stippling Morphology: uniformly distributed dark blue granules Comment: Basophilic stippling is due to darkly staining aggregates of Basophilic ribosomes stippling may be seen in thalassemia, lead poisoning, and sideroblastic anemia.  Howell-Jolly bodies Morphology: dark purple, dense, round inclusions with distinct borders Comment: Howell-Jolly bodies Howell-Jolly bodies are nuclear fragments often seen in erythrocytes from patients who have had their spleens removed.  Pappenheimer bodies Morphology: small, dark blue, irregularly shaped granules often in clusters Comment: Papenheimmer Pappenheimer bodies bodies are composed of iron may be seen in a variety of disease states including sideroblastic anemia and following splenectomy.  Heinz bodies Morphology: round bodies within red blood cells (supravital stain) Comment: Heinz bodies are composed of denatured hemoglobin Heinz body Usually visualized using supravital staining in Heinz body patients with G6PD deficiency or unstable haemoglobins.  Malaria parasites Morphology: malaria ring forms are seen intracellularly Comment: Malaria is a Malarial parasites parasitic disease (ring form) caused by any of four different species of Plasmodium.  Neutrophil- Mature Key features Size: 10 - 15 microns in diameter Nucleus: 3 to 5 lobes joined by thin filaments very coarse chromatin Filament nucleoli absent Lobe Cytoplasm: pale pink fine, pink-purple granules Eosinophil- mature Key features Size: 10 - 15 microns in diameter Nucleus: 2 to 3 lobes very coarse chromatin nucleoli absent Cytoplasm: abundant numerous red-orange granules  Basophil Key features Size: 10 - 15 microns in diameter Nucleus Granule Nucleus: 2 to 3 lobes very coarse chromatin nucleoli absent Cytoplasm: dark blue-black granules granules often overlie nucleus some granule stain loss is common  Granulocytes Variations Variations in granulocytes appearance may be caused by maturation defects, inflammation, and infections. Maturation defects are due to Toxic neutrophil genetic or metabolic disorders. Bacterial infections can cause 'toxic' changes to neutrophils.  Hyposegmentation Morphology: granulocytes with one or two poorly Hyposegmented segmented nuclear lobes eosinophil Comment: Hyposegmented Hyposegmented neutrophils may be seen in neutrophil patients with Pelger-Huёt anomaly or myelodysplastic syndrome. Hyposegmented neutrophil  Hypersegmentation Morphology: neutrophil with six or more nuclear Hypersegmented segments neutrophil Comment: Hypersegmented neutrophils are seen in patients with anemia due to Vitamin B12 or folate deficiency.  Auer rods Morphology: pink, rod- shaped inclusions in myeloblast cytoplasm Comment: Auer rods may be seen in myeloblasts Auer Rod from patients with acute myelogenous leukemia. Toxic granulation Morphology: Toxic granulation neutrophil with increased dark granules in its cytoplasm Comment: Toxic granulation is seen in patients with severe bacterial infections.  Toxic vacuolation Morphology: round, clear spaces within granulocyte cytoplasm Vacuole Toxic vacuolation in neutrophils may be seen in patients with Vacuole severe bacterial infections.  Döhle bodies Morphology: pale blue, irregularly shaped inclusion in neutrophil cytoplasm Döhle bodies consist of Döhle body Döhle body ribosomes and /or rough endoplasmic reticulum and are seen in severe bacterial infections.  Lymphocytes Variations The majority of lymphocytes are located in extravascular sites, such as lymph nodes, the gastrointestinal tract, and spleen. When activated by contact with antigens, lymphocytes undergo morphological changes. Reactive lymphocyte The specific morphological change is related to the specific lymphocyte's function. Reactive lymphocyte Morphology: lymphocytes with abundant cytoplasm often indented by surrounding red blood cells Reactive lymphocyte Reactive lymphocytes (atypical lymphocytes) are Reactive lymphocyte associated with viral infections. Large granular lymphocyte Morphology: lymphocytes with abundant cytoplasm containing prominent granules Large granular lymphocytes may be associated with viral infection or neutropenia.  Cleaved lymphocytes Morphology: lymphocytes with large nuclear clefts Lymphocytes with a Cleaved Lymphocytes cleaved nucleus are associated with pertussis (whooping cough) in children.  Plasma cells Morphology: blue Perinuclear cytoplasm, eccentric clearing nucleus, prominent perinuclear clearing Plasma cells are rarely seen in the peripheral blood except in cases of severe inflammation or end stage multiple myeloma.  Monocytes The bone marrow is the primary site of monocyte maturation. The majority of monocytes reside in tissue and are called macrophages. Monocyte Monocytes migrate to the tissues via the peripheral blood.  Monocyte Key features Size: 12 - 24 microns in diameter Nucleus: folded or indented Nucleus sieve-like chromatin nucleoli absent Vacuole Cytoplasm: abundant, gray-blue vacuoles commonly present few granules may be present  Platelets- mature Key features Platelet Round or oval Size: 1.5 - 4 microns in diameter Nucleus: absent Platelet Cytoplasm: pale blue purple granules  Platelets Variations Platelets normally vary slightly in shape, size, and staining characteristics. Normal and abnormal platelets usually vary significantly in morphology. Morphologically abnormal platelets are usually associated with disease states. Normal and abnormal platelets  Large forms Morphology: large platelets greater in size than a normal red blood cell are termed 'giant' platelets Large platelets are associated with disease states having an Giant platelets increased rate of platelet production.