Activity 6: Hematology Nucleus - The spoke-like pattern of the chromatin accentuates the nuclear

membrane and the nuclear pores.

Niña Manlangit
Cytoplasm - color is now a blue/gray rather
12-Silver
than the deep midnight blue of the basophilic
1. ATLAS OF THE BLOOD CELLS pronormoblast stage.

Pronormoblast
Size - 20–25 μm
Nucleus - round to oval with one or two nucleoli.
The chromatin is open and contains few, if any in
clumps
Normal Values – 5-10%
Cytoplasm - does not have the fine background grittiness found in the
myeloblast. A pronormoblast typically has a round, centrally-located nucleus,
unlike a myeloblast that typically has an eccentric nucleus.
Orthochromic Normoblast
Size – slightly larger than mature red blood
cells. They have small, round nuclei and dense,
pyknotic chromatin.
Nucleus - the nucleus in the early stages of
extrusion/elimination from the cell. Once the nucleus has
been extruded, the slight blue color, also known as
polychromasia, will begin to fade and the now non-
nucleated RBC will be indistinguishable from any other
circulating RBC.

Normal Values – 50%

Basophilic Normoblast
Cytoplasm - color approaches the color of a peripheral
Size - slightly smaller in size than the RBC as it becomes fully hemoglobinized.
pronormoblast

Nucleus – more condensed chromatin and lower

nuclear-cytoplasmic ratios
Reticulocyte
Normal values – 15-20%
Size - the reticulocytes are abnormal in size (> 105 fl or < 85 fl), the physician
Cytoplasm - deep blue, and a pale perinuclear
should ask what abnormality has been
halo may present. unmasked by the therapy

Nucleus - Like mature red blood cells,

Polychromatic Normoblast in mammals, reticulocytes do not have
a cell nucleus.
Size – 12 μm
Normal Values – 0.5-1.5%
Cytoplasm - The reticulocytes are the cells with the dark blue dots and curved Cytoplasm - immature blood cell, found in bone marrow, that gives rise to white
linear structures (reticulum) in the cytoplasm. blood cells of the granulocytic series (characterized by granules in the cytoplasm,
as neutrophils, eosinophils, and basophils), via an intermediate stage that is called
a myelocyte.

Promyelocyte
Erythrocyte
Size - 0-20 µm
Size - 7.2 um in average diameter 2.1 um in thickness
Nucleus - The nucleus of a promyelocyte
Nucleus - They lack a cell nucleus and most organelles, to accommodate is approximately the same size as a
maximum space for hemoglobin; they can be viewed as sacks of hemoglobin, myeloblast but their cytoplasm is much
with a plasma membrane as the sack. Approximately 2.4 million new erythrocytes more abundant.
are produced per second in human adults.
Cytoplasm - promyelocytes have a
Normal Values – 30% cytoplasm heavily loaded with azurophilic
granules, which are often coarser and more
Cytoplasm- The cytoplasm of erythrocytes is numerous than the ones seen in normal
rich in hemoglobin, an iron-containing promyelocytes.
biomolecule that can bind oxygen and is
responsible for the red color of the cells and the
blood. ... The cells develop in the bone marrow
and circulate for about 100–120 days in the body
before their components are recycled by
macrophages.

Myelocyte

Size - 10-18 µm
Nucleus – (to round) slightly indented
Myeloblast nucleus; reddish-blue and slightly
granular chromatin; nucleoli may or may
Size - 10–20 µm not be present; moderate bluish pink
cytoplasm; primary and specific granules
Nucleus - they are characterized by a large (fine and pale).
round to oval nucleus with a small basophilic
cytoplasm with no evident granules. Cytoplasm - The cytoplasm contains
striking azurophilic granules or primary
granules. These granules contain
myeloperoxidase, acid phosphatase, and esterase enzymes. Normally no
promyelocytes are seen in the peripheral blood. At the point in development when
secondary granules can be recognized, the cell becomes a myelocyte.
Metamyelocyte
Size - 10-18 µm
Nucleus - Note the indented nucleus (kidney bean);
Cytoplasm - light blue-purple and granular chromatin; no nucleoli are present;
moderate clear pink cytoplasm;
specific granules are obvious.
Basophilic metamyelocytes are very
rare.
Band cell
Size - 15-µm
Nucleus - It is characterized by having a curved but not lobular nucleus.
Normal Values - Band neutrophils
normally account for approximately 5-
10% of peripheral blood leukocytes.
Basophil
Size - 14-16 µm
Nucleus - Basophils contain large
cytoplasmic granules which obscure the
cell nucleus under the microscope. However, when unstained, the nucleus is
visible and it usually has 2 lobes.
Cytoplasm - cytoplasmic granules that have an affinity for basic dyes. These
granules are numerous and unevenly distributed, with colors varying from deep
purplish-blue to dark purple-red. They contain heparin, histamine, and other
chemicals.
Eosinophil
Size - 12 μm
Nucleus - This proinflammatory white blood
cell generally has a nucleus with two lobes
(bilobed) and cytoplasm filled with
approximately 200 large granules containing
enzymes and proteins with different (known
and unknown) functions.
Cytoplasm - Their cytoplasm is packed with
large rounded granules which stain red-
orange with Romanowsky stains.
Neuthrophil
Size - diameter between 9 and 15 micrometres.
Nucleus - A mature neutrophil exhibits a segmented nucleus with three to five Nucleus - The nucleus has coarsely granular chromatin and multiple lobes which
distinct lobes which are connected extend through much of the cell.
by thin filaments.
Cytoplasm - possess abundant pale-staining cytoplasm and numerous azurophilic
Cytoplasm - The cytoplasm of cytoplasmic granules.
neutrophils contains numerous
purplish granules called azurophilic
or primary granules that contain
microbicidal agents. Neutrophils
also contain smaller, secondary
granules that house lysozyme,
gelatinase, collagenase and many
other enzymes.

Megakaryocyte

Megakaryoblast
Size – 20-30 mm
Nucleus - have a single large
oval, kidney-shaped or lobed
nucleus with several nucleoli, a
very high nucleus to cytoplasm
ratio and deeply basophilic
agranular cytoplasm.
Cytoplasm – deep blue
Size - 100 μm
Nucleus - Megakaryocytes are bone marrow platelet progenitors, which undergo
endomitosis rather than mitosis
and cell division.
Megakaryocytes are extremely
large cells (generally 50 to 150
µm), which have a single
nucleus with multiple lobes (2–
16).
Cytoplasm – pink

Promegakaryocyte

Size - 70 µm

Platelets
Size – 2-4 um in diameter

Nucleus - Platelets are irregularly shaped, have no nucleus, and typically

measure only 2–3 micrometers in diameter. Platelets are not true cells, but are
instead classified as cell
fragments produced by
megakaryocytes. Because they
lack a nucleus, they do not
contain nuclear DNA.

Cytoplasm - Platelets have no

cell nucleus; they are fragments of
cytoplasm that are derived from
the megakaryocytes of the bone
marrow, which then enter the
circulation.

Abnormalities of RBC Morphology

Red Cell Type Morphologic appearance Defect or Change Associated condition

 Red cells are smaller than
7μm in diameter.
Microcytosis
Increase in the size of a red
cell. Red cells are larger
than 9 μm in diameter.
Macrocytosis
Iron deficiency is the most
likely cause of microcytic
anemia, but iron
deficiency is uncommon to
rare in horses, especially
adult horses. Iron deficient
erythrocytes are usually
also hypochromic, and
poikilocytosis (variability
in erythrocyte shape) may
be present. Copper
deficiency is a potential
cause of microcytosis.
Macrocytosis is a term
used to describe red blood
cells that are larger than
normal. Also known as
megalocytosis or
macrocythemia, this
condition typically causes
no signs or symptoms and
is usually detected
incidentally on routine
blood tests.
Iron deficiency anemia.
Thalassaemia., sideroblastic
anemia, led poisoning anemia
chronic disease.
- Folate and B12
deficiencies (oval)
- ethanol (round)
- liver disease (round)
- reticulocytosis (round)
- Hypothyroidism
- A side effect of certain
medications, such as
those used to treat
cancer, seizures and
autoimmune disorders

Hypochromic means that - Iron Deficiency

Erythrocytes that
Hypochromic demonstrate a central pale
area that becomes larger
and paler as the
hemoglobin content
diminishes.
the red blood cells have - Sideroblastic Anaemia
less hemoglobin than - Thalassaemia
normal. Low levels of
hemoglobin in your red
blood cells leads to appear
paler in color. In
microcytic hypochromic
anemia, your body has low
levels of red blood cells
that are both smaller and
paler than normal.
 Erythrocytes that are Hormones cause cellular - Liver Disease
thinner than normal which changes by binding to - Hemoglobinopathies
show a peripheral rim of receptors on target cells. - Thalassaemia
hemoglobin with a dark The number of receptors - Sideroblastic anemia
central hemoglobin- on a target cell can
containing area. A pale increase or decrease in
Target Cells (Codocytes) unstained ring containing response to hormone
less hemoglobin separates activity. Hormones can
the central and peripheral affect cells directly
zones and gives the cell a through intracellular
target appearance. hormone receptors or
indirectly through plasma
membrane hormone
receptors.
Are nearly spherical A condition that affects - Hemolytic anemia
erythrocytes which are red blood cells. People - Post transfusion
nearly spherical with this condition - Hereditary
erythrocytes which usually typically experience a sphercocytosis
Spherocytes have a diameter smaller shortage of red blood cells
than normal. They lack the (anemia ), yellowing of the
central pale area due to eyes and skin (jaundice),
their spherical shape. and an enlarged spleen
(splenomegaly).

Elliptocytes, also known - Hereditary

as ovalocytes, are elliptocytosis
abnormally shaped red - Iron-deficiency
blood cells that appear anaemia
Interchangeable terms used oval or elongated, from - Thalassaemia
to indicate ovalshaped slightly egg-shaped to rod
Elliptocytes and erythrocytes. or pencil forms. They have
Ovalocytes normal central pallor with
the hemoglobin appearing
concentrated at the ends of
the elongated cells when
viewed through a light
microscope
 Are interchangeable terms
used to indicate sickle-like
forms of erythrocytes
(crescent-shaped, irregular
spines, filaments, holly-leaf
Sickle cells appearance) noted when
(drepanocyes) RBC containing HbS are
subjected to reduction in
oxygen tension or pH.
Is the term used to indicate
the presence of irregular
basophilic granules in the
cytoplasm of erythrocytes.
The granules are composed
of unstable RNA and may
Basophilic Stippling be fine of coarse.
Abnormalities of WBC
Description Morphologic appearance
Sickle cells, also referred - Sickle cell anaemia
to as drepanocytes, are - Sickle thalassaemia
formed as a result of the
presence of hemoglobin S
in the red cell. As the red
cell ages, it becomes rigid
as it passes through the
low oxygen tension
atmosphere of the small
capillaries in the body.
Basophilic stippling is a - Lead Poisoning
frequent manifestation of - Thalassaemia
hematologic disease in the - Significant anaemia
peripheral blood, and it is - Dyserythropoiesis
also observable in bone
marrow aspirates. It is
implicated in cases of lead
poisoning but can be an
indicator of various heavy
metal toxicities.
Defect or Change Associated condition
 Large purple-black coarse Accumulation of Alder-Really anomaly
cytoplasmicgranules mucopolysaccharides Hunter’s syndrome

Alder – Reilly granules

Pink or red rod shaped Fused primary granules AML

cytoplasmic structures Found in myeloid and
monocytic series only

Auer rods

Giant red, blue to grayish Large cytoplasmic inclusions Cheidak – Higashi

round inclusions in of fused primary granules syndrome
cytoplasm that are deficient in enzymes Albinism
for phagocytosis

Chediak – Higashi
granules
 Neutrophil with large purple
homogenous round inclusion
with nucleus wrapped around
LE cell
Single or bilobed nucleus
Pelget - Huet
Single or multiple blue
cytoplasmic inclusion in
neutrophil
Döhle bodies
Three factors needed to Lupus erythematosus
produce LE cell: antinuclear
antibodies, cell nuclei,
phagocytes with ingested
material
Decreased segmentation Pelger – huet anomaly
Aggregates of free ribosomes Severe infections
of rough endoplasmic Toxic states
reticulum
 >5 lobes Abnormal DNA synthesis Megaloblastic anemia

Hypersegmented
neutrophil

Large purple to black Primary granules Infections, toxic states

azurophilic granules

Toxic granules

Large empty white areas Represent end stage Septicemia

within cytoplasm phagocytosis Severe infections
Toxic states

Toxic vacoules
 Degenerated nucleus or Lymphocytes that are fragile Chronic lymphocytic
ruptured cell in form of and break upon smearing leukemia
smudge or basket Small numbers are artifact

Basket cell

Lymphocyte with hair – like Thought to be of B cell Hairy cell leukemia

cytoplasmic projections origin
surrounding nucleus

Hairy cell
Anemia: Classification Systems - Red cell membrane disorders (cytoskeletal membrane disorders, lipid
membrane disorders, etc.)
- Red cell enzymes defects (pyruvate kinase, glucose-6-phospate
dehydrogenase deficiency, etc.)
Pathophysiologic characteristics - Porphyrias (congenital erythropoetic and hepatoerythropoietic porphyrias,
etc.)
I. Absolute anemia ( Red cell volume )
a. Red cell Production c. Blood loss and blood redistribution
1. Acquired - Acute blood loss
- Pluripotential hematopoietic stem cell failure - Splenic sequestration crisis
(Autoimmune, anemia of leukemia etc.)
- Erythroid progenitor cell failure (pure red cell II. Relative anemia (plasma volume)
Aplasia, endocrine disorders etc.)
- Macroglobulinemia
- Functional impairment of erythroid and other
- Pregnancy
Progenitors from nutritional and other causes
- Athletes
( megaloblastic anemias, iron deficiency anemia etc.)
- Postflight astronauts
2. Hereditary
- Pluripotential hematopoietic stem cell failure
(Fanconi anemia etc.)
- Erythroid progenitor cell failure (diamond-Blackfan
Syndrome etc.)
- Functional impairment of erythroid and other progenitors
From nutritional and other causes (megaloblastic anemias, disorders
Of iron metabolism, Thalassemias etc.)

b. Red cell Destruction

1. Acquired
- Mechanical macroanglopathic, microanglopathic (DIC,
TTP, etc.) Parasites and microorganism (Malaria, etc.)
- Antibody mediated (warm type autoimmune hemolytic
Anemias, cryopathic syndromes etc.)
- Hypersplenism
- Red cell membrane disorders
- Chemical injury and complex chemicals (arsenic, cupper,
Spider, scorpion, and snake venom, etc)
- Physical injury (heat, oxygen, etc.)

2. Heredity
- Hemoglobinopatheis (sickle cell disease, unstable hemoglobins)