This document describes various abnormal red blood cell morphologies seen in different hematological conditions. It discusses ovalocytes seen in megaloblastic anemia, spherocytes in hereditary spherocytosis and membrane defects, elliptocytes associated with iron deficiency anemia and thalassemia, echinocytes in renal and liver diseases, burr cells and acanthocytes seen in various conditions. It also summarizes target cells, schistocytes, keratocytes, dacrocytes, sickle cells and other abnormal RBC shapes and their clinical associations.

1. CATEGORY OF BLOOD
VARIATION IN SHAPE
“POIKILOCYTOSIS”
PRINCESS ALEN AGUILAR

3. OVAL
MACROCYTES
(OVALOCYTES)
• Inc. MCV
• CS=
Megaloblas
tic Anemia
most
popular for
this cell
• No cental
pallor

5. SPHEROCYTES
 Dec. surface volume to ratio
 Defects on RBC membrane CHONs
 Spectrin deficiency
 CS= Hereditary spherocytosis, AIHA, G6PD, ABO-HDN,
RC ENZYME DEF.
 Microcytic Hyperchromic anemia

6. ELLIPTOCYTES
“ciggar shape cell”
 CS= IDA, Pernicious Anemia, Hereditary elliptocytosis,
Myelofibrosis w/ myeloid dysplasia, Megaloblastic
Anemia, SCA, Thalassemia, Congenital disorder of
diserythropoiesis

7. ECHINOCYTES (CRENATED RBC)
 Short equally spaced projections, regular spicules
 Present in prolonged standing artifacts
 Resembles to Burr Cells
 CS= pyruvate kinase def. , uremia, hepatic therapy, renal
insufficiency, suddend change in pH

8. Burr cells “sea urchin”
 Irregular spicules, less pointed
 Also seen in Renal failure and uremia

9. Acanthocytes
“Spur cells or thorn cells”
 Very spiny irregular projections
 CS= Abetalipoproteinemia, cirrhosis, HUS, post
splenectomy, HA, PKD
 Lysine: Sphingomyosin def.

10. Stomatocytes “Mouth Cell”
 w/ slit like or mouth like central pallor
 CS=Rh null Disease, Renal Dse, Liver Dse
 Due to osmotic changes

11. TARGET CELLS/CODOCYTES
 MEXICAN HAT CELLS, LEPTOCYTES, PLATYCYTES,
BULL’S EYE, GREEK HELMET CELLS
 INC. VOLUME RATIO
 CS= Liver Dse, Hemoglobinopathies, Thalassemia, IDA

13. SCHISTOCYTES
“Fragmentocytes or Egg shells”
 Cell fragments
 CS= Microangiopathic anemia, thermal injury, renal
transplantation rejection, G6PD def, heart valve
replacement, HA, severe burns, mechanical destruction due
to TTP or DIC
 Fragmenting/disintegrating RBC

14. KERATOCYTES (HELMET CELLS)
Horn like
projections
Red cell caught in
fibrin strands
Triangle cell,
keratocytes of
Bessis
Fragile
CS= Hemolytic
Anemia

15. DACROCYTES (TEAR DROP)
 Round cell wth elongated tail
 Cells are squeezed into small opening
 CS= Myelofibrosis, Megaloblastic Anemia,
Thalassemia, Pernicous Anemia

16. MICROSPHEROCYTES/
PYROPOIKILOCYTES
 Occurs in severe burns
 Low MCV
 2-3um

18. SICKLE CELL/ DREPANOCYTES/
MENISCOCYTES
 THIN, ELONGATED, POINTED ENDS,
 APPEAR CRESCENT SHAPE RBC
 LACK CENTRAL PALLOR
 Hgbinopathies SS, SC, SD

19. Hgb CC Crystal
 Rhomboid, tetragonal or rod shaped, crystals of dense
staining
 After splenectomy
 CS= Homozygous Hb SC Dse

20. BLISTER CELL
 Red cell w/ single or multiple vacuoles or
markedly thinned areas at the periphery
 Pre-cursor of helmet cells
 Microangiopathic Hemolytic Anemia

21. DEGMACYTE (BITE CELL)
 Drug-induced anemias
 G6PD Def., Thalassemia,
 Happened due to passing through the blood
vessels of the spleen some parts of the cell
remains

22. BASOPHILIC STIPPLING
 Fine= Inc. polychromatophilia
 Blueberry bagel appearance
 CS= Lead poisoning (Plumbism), Impaired Hgb
synthesis, MA
 Remnants of RBC RNA

23. HOWELL JOLLY BODIES
 Single: nuclear chromatic remnants, MA, HA
 Double: MA, Abnormal Erythropoiesis
 Large single inclusions
 Related to DNA remnants

24. PAPPENHEIMER BODIES
 SIDEROTIC GRANULES
 SMALL DARK BLUE PURPLE
 PRUSSIAN BLUE= Staining non-heme iron granules
 WRIGHTS STAIN= Faint blue
 Granules clumped together
 CS= Sideroblastic anemia, Hgbinoathies, Thalassemia,
MA, myelodysplatic syndrome

25. CABOT RINGS
 Ring shape, figure of 8
 Double or several concentrics
 Microtubules remnants or mitotic spindle
 Rarely seen in PA, lead poisoning
 Abnormal erythropoiesis

26. HEINZ BODIES
 Denatured Hgb
 Residues of oxidized Hgb
 Presence in indicative of RBC injury
 w/ alcoholism
 G6PD def, unstable Hgb

27. Hb H INCLUSIONS
“GOLF BALL
DENTS”
Multiple blue
green spherical
inclusins
stained with
Brilliant Cresyl
Blue (BCB)

28. MALARIAL INCLUSIONS

30. Toxic granulation
 Dark blue-black cytoplasmic granules in neutrophil
 Thought as primary granules
 Show inc.alkaline phosphatase activity
 Found in: acute infections
drug poisoning
burns

31. Dohle Bodies
 Single or multiple light blue or gray areas in cytoplasm of
neutrophils
 RER & represent failure of cytoplasm to mature
 Found in: infections
poisoning
burns
following chemotherapy

32. Hypersegmented Neutrophils
 Neutrophils with six or more lobed nucleus
 Represents an abnormality in maturation of neutrophil
 Acquired(in megaloblastic erythropoiesis) or
inherited(Undritz anomaly)
 Found in: pernicious anemia
folic acid deficiency
chronic infections

33. Barr Body
 Sex chromatin
 Represents the second X chromosome in females (2-3%
of neutrophils in females)
 Small,well-defined,round projection of nuclear chromatin
 These cells are not found in normal males.

34. Degenerated Neutrophil w/
pyknotic nucleus
 Result from condensing of
nuclear chromatin into a solid
structure mass with no pattern
 Not counted in differential cell
count

35. Vacuolated neutrophil
 Degeneration of cytoplasm begins to acquire holes or as
result of active phagocytosis
 May reflect increased lysosomal activity
 Found in: septicemia
severe infection

36. Giant Neutrophils
 Can be seen occasionally in normal peripheral blood
smear
 Larger than normal neutrophils and genrally
hyperlobulated
 Found in frequency of 1 in every 20,000 neutrophils but
increase in disease states

37. Pelger-Huet Anomaly
 Indicates failure of
neutrophil to segment
properly
 Bi-lobed nucleus; chromatin
is coarsely clumped
 May be inherited or
acquired (as in leukemias)
 Heterozygous for this
char.shows numerous bi-
lobed (dumbell shape);
homozygous-round
neutrophil

38. Chediak-Higashi Syndrome
(Autosomal recessive disorder)
 Rare,fatal disprder found in
children
 Inherited as an autosomal
recessive char.
 Contain very large,reddish-
purple or greenish-gray
staining granules in the
cytoplasm of granulocytes
 In monocytes & lymphocytes,
stain bluish-purple
 These granules represent
abnormal lysosomes
 Found in: anemia
neutropenia
thrombocytopenia

39. Alder-Reilly anomaly
 Heavy,coarse blue-black
granules of BEN & sometimes
lymphocytes & monocytes
 Inherited condition
 Associated with Hurler’s
syndrome & Hunter’s
syndrome

40. May-Hegglin Anomaly
 Inherited anomaly affecting neutrophils and platelets
 Larger than usual Dohle-like bodies
 Giant bizarre platelets is present & function may be
abnormal

41. Auer rods
 Rod-like bodies representing
aggregated primary granules
that stain reddish purple
 Found in : cytoplasm of
myeloblast, monoblast and
promyelocytes in acute
monocytic or acute
myelogenous leukemia and
eythroleukemia

42. Smudge or Basket cell
 Disintegrating nucleus of ruptured WBC

43.  Platelets encircling the peripheral borders of neutrophils
 This phenomenon is thought to be due to a serum factor
which reacts in the presence of EDTA.