Blood Film

    Table of contents

    .

    Source: MKSAP

    Blood Film

    Cell Morphology

     

    Name Conditions Photo

    Microcytosis

     

    Anisocytosis (abn.  size)

     

    poikilocytosis (abn. shape)

     

    anisopoikilocytosis (both)

    - Iron Deficiency microaniso.jpg
    Pencil Cells - Iron Deficiency Anemia pencilCells.jpg
    Macrocytosis

    - Vit B12 or folate deficiency;

    - myelodysplasia, use of antimetabolites

     

    Target Cells

    (Actually look like vases)

    Hemoglobinopathy

    (Classically Thalassemia)

    - Liver disease

    - Splenectomy

    targetCells.jpg
    Rulleoux

    Coin-like stacking of RBCs.

    High plasma proteins (such as antibodies)

    causing RBCs to stick to each other.

     

    - Paraproteinemia

       Multiple Myeloma (classic)

     

    rulleoux.jpg

    Tear Drop Cells

    (aka Dacryocytes)

    - Bone marrow infiltration

       Myelofibrosis (also see nucleated RBCs)

       Marrow Granuloma

       Other infiltration

    tearCell.jpg

    Basophilic Stippling

    of Erythrocytes

    Non-specific

    - Lead Toxicity

    - Megaloblastic anemia

    - Sideroblastic anemia

    - others...

    basoStippling2.jpg

    Hypersegmented 

    neutrophils/PMNs

     

    ≥6 nuclear lobes

    OR

    >20% of PMNs having

    5 lobes.

    - Megaloblastic anemia (folate, B12, etc) B12DefSmear2.png

    Echinocytes

    (aka "Burr Cells")

    - Classically in Kidney Disease

    - Also see with many chronic conditions.

    Burr Cells.jpg

    Acanthocytes

    (aka "Spur Cells")

    - Severe Liver Disease acanthocytes.jpg
    Spherocytes

    - Classically: Congenital Spheocytosis

    - Also: Warm Autoim. Hemolytic Anemia

     

    (Lose their biconcave shape)

    spherocytosis.jpg

    Schistocytes

    (aka "Helmet Cells)

     

    Bite Cells

    Scistocytes:

    -  Microangiopathy (TTP, HUS, DIC)

          (Often say "scistocytes")

     

    "Bite Cells:"

    - Acute G6PD hemolysis (fava beans)

    biteCells.jpg
    Nucleated Erythrocytes - Marrow Stress (Hemolysis, Hypoxia)  
    Elliptocytes - Hereditary elliptocytosis  
    Sickle cells (drepanocytes) - Sickle Cell Anemia  
    Stomatocytes - Hereditary stomatocytosis, artifact  

     

     

    Inclusions

    Name Conditions Photo

    Basophilic Stippling

    of Erythrocytes

    Non-specific

    - Lead Toxicity

    - Megaloblastic anemia

    - others...

    basoStippling2.jpg

    Hypersegmented 

    neutrophils/PMNs

     

    ≥6 nuclear lobes

    OR

    >20% of PMNs having

    5 lobes.

    - Megaloblastic anemia (folate, B12, etc) B12DefSmear2.png

    Nucleated RBC

    - Marrow Stress (Hemolysis, Hypoxia)  
    Howell-Jolly Bodies

    (Small nuclear remnants)

    - Post-splenectomy, hyposplenism

      (sickle cell)

    - Neonates

    - Megaloblastic anemia

     
    Sideroblasts

    - Erythrocytes with iron containing

      granules on cytoplasm

     
    Heinz Bodies

    (Denatured/precipitated hemoglobin)

    - G6PD deficiency exposed to oxidant

    - thalassemia

     
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