Abnormal Blood Cell Morphology Abnormal White Blood Cells

Abnormal Blood Cell Morphology

Abnormal White Blood Cells • Neutrophils (AKA: PMNs, Polys, Segs) — Abnormalities in the neutrophil include…. . 1. Greater than 5% bands 2. Hypersegmented nuclei (greater than 5 lobes) 3. Toxic granulation Norma l 4. Toxic vacuolization 5. Dohle bodies 6. Younger stages than the band • When do you see them in high numbers? — Bacterial infections — Inflammation Band Toxic granulation, vacuolization, & Dohle bodies are seen during bacterial infections, burns, cancer, and toxic or inflammatory states. Hyper-segmented Dohle bodies Toxic granulation

Abnormal White Blood Cells • Eosinophils (AKA: Eos) — Greater than 3% eosinophils is abnormal Normal • 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

Abnormal White Blood Cells • Monocyte —Greater than 10 % of WBCs in the blood is abnormal Normal • 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

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 ü From left over DNA found in the RBC. ü Appear as round, deep purple circles around 2 micrometers in diameter. ü Found in patients after their spleen has been removed or when RBC production is rushed, pernicious anemia and hemolytic anemia. — Pappenheimer bodies ü Small, light purple, beads, made from iron. ü Located near the periphery of the RBC. ü Need to be stained with Prussian blue to determine in they are true Pappenheimer bodies. ü Seen in iron loading anemias and hereditary hemochromatosis.

Abnormal Red Blood Cells • Common Red Blood Cell Inclusions — Basophillic stippling ü Remains of RNA and mitochondia. ü Diffuse granules found throughout the cytoplasm. ü Found in patients that have fast RBC growth. ü Found in patients with lead poisoning. — Heinz bodies ü Denatured hemoglobin ü Large 1 -3 micrometers in diameter. ü Located near the periphery of the RBC. ü Special staining with a supravital stain is needed to visualize Heinz bodies. ü Found in patients with G 6 PD deficiency and with some hemoglobinopathies.