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RED CELL ABNORMALITIES

Red Cell Size

Red Cell Type Morphologic Appearance Defect or Change Associated Conditions
Normocytic Normal sized biconcave disc NA NA
RBCs, 6-8 um

Microcytic Smaller RBCs, less than 6 um Abnormal size due to the failure Iron deficiency anemia
MCV <80 fl of hemoglobin synthesis Thalassemia

Macrocytic Larger RBCs Impaired DNA syn. Megaloblastic anemia

MCV > 100 fL Stress erythropoiesis Liver disease
Excess surface membrane Alcoholism

Red Cell Hemoglobin Content

Red 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 Conditions
Hypochromic Central pallor exceed 1/3 of the Reduced hemoglobin content Iron deficiency anemia
diameter of the cell (MCHC) Thalassemia

Hyperchromic No central pallor Greater than normal MCHC Spherocytosis

Red Cell Shape

Red Cell Type Morphologic Appearance Defect or Change Associated Conditions
Acanthocyte Spheroid with 3-12 irregular Increased ratio of cholesterol to End stage liver disease
spikes lecithin Pyruvate kinase deficiency
Abetalipoproteinemia

Echinocyte Regular 10-30 scalloped short Depletion of ATP Uremia

projections Exposure to hypertonic solution Cirrhosis
Artifact in drying Hepatitis
Chronic renal disease
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Red Cell Type Morphologic Appearance Defect or Change Associated Conditions
Codocyte Peripheral rim of hemoglobin Excess surface membrane to Hemoglobinopathies
surrounded by clear area and volume ratio Thalassemia
central hemoglobinized area Post-splenectomy
(bull’s eye)

Dacryocyte Teardrop or pear-shaped with Squeezing and fragmentation Myeloid metaplasia

single elongated point or tail during splenic passage Hypersplenism

Drepanocyte Crescent shape cell that lacks Polymerization of deoxygenated Sickle cell anemia
zone of central pallor hemoglobin

Elliptocyte Rod or cigar shaped Polymerization of hemoglobin Hereditary elliptocytosis

Schistocyte Fragments of RBCs varying in Extreme fragmentation produced Disseminated intravascular

size and shape by damage of RBCs by fibrin, coagulation (DIC)
altered vessel walls and Microangiopathic hemolytic
prosthetic heart valves anemia

Red Cell Type Morphologic Appearance
Spherocyte Smaller in diameter than normal
RBC with concentrated
hemoglobin content
No visible central pallor
Stomatocyte Normal sized cell with slit like
area in center
Red Cell Inclusions
Red Cell Type Morphologic Appearance
Howell-Jolly bodies Coarse round densely stained
purple 1-2 um granules
eccentrically located on periphery
of membrane
May be single or double
Cabot ring Rings, loops or figure of eight; red
to purple
Defect or Change
Lowest surface area to volume
ration
Defective membrane
Known to have increased
permeability to sodium
Defect or Change
Nuclear remnants containing
DNA
Remnants of microtubules of
mitotic spindle
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Associated Conditions
Hereditary spherocytosis
Immune hemolytic anemia
Hereditary stomatocytosis
Rh null disease
Associated Conditions
Megaloblastic anemia
Accelerated erythropiesis
Dyserythropoiesis

Red Cell Type Morphologic Appearance
Heinz bodies Deep purple irregular shaped
inclusions 2 to 3 um
Found on RBC inner surface of
membrane
Supravital stain
Basophilic stippling Round dark blue granules
uniformly distributed
Pappenheimer bodies Small 2 to 3 um irregular
basophilic inclusions that
aggregate in small clusters near
periphery with Wright’s stain
Ringed sideroblast Nucleated RBC that contains
nonheme iron particles arranged
in ring form
BM smear, iron stain
Defect or Change
Represent precipitated,
denatured hemoglobin due to
oxidative injury
Represents impaired
erythropoiesis
Unused iron deposites
Excessive iron overload in
mitochondria of normoblasts
Due to defective heme synthesis
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Associated Conditions
Hereditary defects in hexose
monophosphate shunt
G6PD deficiency
Unstable hemoglobins
Lead poisoning
Pyrimidine-5-nucleotidase
deficiency
Sideroblastic anemia
Defective erythropoiesis
Sideroblastic anemia
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Red Cell Type Morphologic Appearance Defect or Change Associated Conditions
Siderocyte Non-nucleated cell containing iron Same as above Same as above
granules

Miscellaneous RBC abnormalities

Red Cell Type Morphologic Appearance Defect or Change Associated Conditions
Autoagglutination Clumping of RBCs Presence of antibody Cold agglutinin
Autoimmune hemolytic anemia

Rouleaux Alignment of RBCs linear Caused by increased Multiple myeloma

appearing as stack of coins concentration of globulin Waldenstrom’s
macroglobulinemia
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WBC ABNORMALITIES

Abnormalities Associated with Granulocytes

Description Morphologic Appearance Defect or Change Associated Conditions
Alder-Reilly granules Large purple-black coarse Accumulation of Alder-Reilly anomaly
cytoplasmic granules mucopolysaccharides Hunter’s syndrome

Auer rods Pink or red rod shaped Fused primary granules AML
cytoplasmic structures Found in myeloid and monocytic
series only

Chediak-Higashi granules Giant red, blue to grayish round Large cytoplasmic inclusions of Chediak-Higashi syndrome
inclusions in cytoplasm fused primary granules that are Albinism
deficient in enzymes for
phagocytosis
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Description Morphologic Appearance Defect or Change Associated Conditions
Hypersegmented 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 Three factors needed to produce Lupus erythematosus
homogenous round inclusion with LE cell: antinuclear antibodies,
nucleus wrapped around cell nuclei, phagocytes with
ingested material

Döhle bodies Single or multiple blue Aggregates of free ribososmes of Severe infections
cytoplasmic inclusions in rough endoplasmic reticulum Toxic states
neutrophil
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Description Morphologic Appearance Defect or Change Associated Conditions
Toxic granules Large purple to black azurophilic Primary granules Infections, toxic states
granules

Toxic vacuoles Large empty white areas within Represent end stage Septicemia
cytoplasm phagocytosis Severe infections
Toxic states

Abnormalities Associated with Lymphocytes/Plasma cells

Description Morphologic Appearance Defect or Change Associated Conditions
Basket cell Degenerated nucleus or ruptured Lymphocytes that are fragile and Chronic lymphocytic leukemia
cell in form of smudge or basket break upon smearing Small numbers are artifact

Hairy cell Lymphocyte with hair-like Thought to be of B cell origin Hairy cell leukemia
cytoplasmic projections
surrounding nucleus

Description Morphologic Appearance
Seźary cell Round lymph cell with nucleus
that is grooved or convoluted
Flame cell Plasma cell with red to pink
cytoplasm
Grape cell Plasma cell that contains small
colorless vacuoles
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Defect or Change Associated Conditions
Represents leukemic phase of Seźary
mycosis fungoides Mycosis fungoides
T-cell characteristics
Associated with increase in IgA Multiple myeloma of IgA nature
Large protein globules giving the Multiple myeloma
appearance of grapes
SOURCE: SAUNDERS MANUAL OF CLINICAL LABORATORY SCIENCE
LEAH MARCH2009