The morphology of Blood

cells
 Composition of the blood

The circulating blood is composed of plasma

and cells.
The cells are red cells (or erythrocytes), white
cells (or leucocytes) and platelets.
Blood cells can be identified in blood films
stained with a mixture of basic and acidic
dyes.
Normal white cells are divided into
polymorphonuclear leucocytes (or
granulocytes) and mononuclear cells.
White blood cells
There are three types
of granulocyte named
according to their
staining
characteristics in
blood films. They are
neutrophils,eosinophil
s and basophils.
Mononuclear cells are
divided into
lymphocytes and
monocytes.
Neutrophils

The neutrophils in
the circulating
blood are mainly
mature
segmented
neutrophils.
Band form Neutrophils
There are smaller
numbers of cells of
neutrophil lineage with
non-segmented nuclei.
They are referred to as
neutrophil band cells or
band forms. They are
less mature than
segmented neutrophils.
An increased number
of band cells is referred
to as a'left shift'.
Eosinophil

One eosinophil -
mature. Normal
blood - 100X.
Orange colour
granules.
Bi-lobed nucleus.
Basophil

One mature
basophil.
Blackish granules
overlying the
nucleus.
Normal lumphocytes
Lymphocytes are
the smallest WBC.
They have large
condensed
nucleus, with a
scanty bluish
cytoplasm.
Normal monocyte
Monocytes are the
largest WBC.
The nucleus is
slightly indented .
The cytoplasm is
abundant, sky blue
in colour.
Some have
vacuoles in the
cytoplasm.
Red cells
Normal red cells or
erythrocytes show
only slight
variation in size
and shape. The
blood film should
be examined in the
area where the red
cells are touching
but not often
overlapping.
Red cells
. In this area many
red cells have an area
of central pallor
which may be up to a
third of the diameter
of the cell. This is
consequent on the
shape of a normal red
cell, which resembles
a disc that is thinner
in the centre.
Platelets
Normal platelets
are also apparent.
They are small
anuclear
fragments
between the red
cells containing
small purple-
staining granules.
Platelet ribbon
A string of platelets or
Platelet Ribbon. This is
the appearance of
normal platelets when
being shed by a
megakaryocyte into
the marrow sinus. The
ribbon then breaks up
into numerous small
platelet fragments.
Normal blood - 100X
Platelet aggregates
Platelet aggregates
may be
composed of
apparently intact
platelets, degranulated
pale grey platelets or a
mixture of both, as in
this example. If the
platelet count is low it
is essential to examine
the blood film carefully
for platelet aggregates.
Platelet satellitism
Platelet satellitism
describes the
phenomenon of
adherence of platelets
to white cells.
It is an in vitro
phenomenon of no
clinical significance.
However it is important
that it is detected since
the platelet count will
be factitiously low.
Nucleated epithelial cells
Extraneous non-
haemopoietic cells are
sometimes seen in blood
films. These include
epithelial cells which are
readily identified from their
abundant sky-blue
cytoplasm and small
central nucleus. They are
more often seen
if capillary blood is
obtained by percutaneous
puncture than when a film
is made from venous blood.
Endothelial cells
Endothelial cells are very
occasionally seen in films
prepared from venous
blood samples. They have
rather pleomorphic oval
nuclei with a grooved
surface. The cytoplasm is
scanty and the cell outline
is irregular. They tend to
occur in clumps. It is
important not to confuse
normal endothelial cells
with carcinoma cells which
are also very occasionally
seen in the circulating
blood.
Artefacts
Fixation artefact is the
term used for the
artefact that occurs
when there is water in
the methanol used for
fixation of the blood
film.This leads to
refractile rings in red
cells and makes it quite
impossible to assess
red cell morphology.
Heat artefact
Inadvertent heating of a
blood
sample, for example during
transport in a hot car, can
lead to a heat artefact.
Red cells bud off vesicles
and microspherocytes seen.
White cells disintegrate
and
proteins coagulate,
producing weakly basophilic
particles, which are similar
in size to platelets.
Storage artefact
Prolonged storage of blood
before making the blood film,
particularly storage at room
temperature,leads to storage
artefact.
White cells become fragile
and may form smear cells
[deep red arrow].
Neutrophil nuclei round up
and form homogeneous round
masses or a single mass [blue
arrow].These cells have a
resemblance to NRBC.
Red cells undergo an
echinocytic change or
crenation.