This document provides information on various types of red blood cell morphologies seen on blood smears, including normal and abnormal shapes and inclusions. It describes normocytic and normochromic red blood cells as well as variations such as microcytic, macrocytic, poikilocytes (variations in shape), anisocytosis (variation in size), and polychromasia (variation in color). Specific abnormal red blood cells and inclusions are defined such as sickle cells, target cells, Howell-Jolly bodies, basophilic stippling, malaria parasites, and reticulocytes. Causes and disorders are provided for each abnormal finding.

1. DIPLOMA IN MEDICAL LABORATORY
TECHNOLOGY
HAEMATOLOGY DIAGNOSTIC II (SBD 0153)
NAME : NUR FATHIYAH BINTI MOHD.
ID
: 012012111311.
LECTURER’S NAME :MDM SHUHADA
DATE OF SUBMISSION : 03
DECEMBER 2013

2. NORMOCYTIC (NORMAL SIZE)
 biconcave shape , no nucleus
SIZE
 7.2 X 2.1 µm



NORMOCHROMIC
Hemoglobin content in rbc.
Normal colour : pinkish red
(wright / leishman staining).
Pale central area -1/3 of total
surface

4. normocytic
microcytic
marcocytic

5.  MCV < 90 fl
 Defect in nuclear maturation /
stimulated erythrocytes.
Disorder : Folate and vitamin B12
deficiency , reticulocytosis.

6. m
i
c
r
o
c
y
t
i
c
 Low in hemoglobin
synthesis.
 MCV > 80 fl
 Disorder : iron
deficiency anaemia ,
thalassemia and
hemoglobinopathies ,
malabsorption syndrome.

7. Tear drop cell
(dacryocytes)
Sickle cell
(drepanocytes)
Target cell
(codocytes)
Thorn cell
(acanthocytes)
Helmet cell
(schizocytes)
Shape
variation
Burr cell
(echinocytes)
Blister
cell
Spherocytes
Ovalocytes /
elliptocytes
Stomatocytes

8. Sickle cell
(drepanocytes)
Usually forming the shape
of a cresent or banana.
No central pallor
Dense hemoglobin
(dark red to light
purple)
Disorder : sickle
cell anemia

9. Target cell
(codocytes)
About the same size
as normal RBC
Disorder : liver
disease , thalassemia
Bull’s eye appearance
(resembles the target sign)
Due to excess membrane
cholesterol or low haemoglobin
content

10. Thorn cell (acanthocytes)
Multiple thorny , spikes.
No central
pallor
Also known as spur cell
Rare thorn cell may be
seen in a blood smear
which may be due to the
very old RBC’s
Disorder : cirrhosis , neonatal
hepatitis and post-splenectomy

11. Causes : decrease deformability which leads
to increasing cell rigidity and premature
destruction.
Disorder : bleeding in gastric
ulcers , peptic ulcer and
gastric carcinoma.
Evenly
distributed ,
uniformly sized
spicules
BURR CELL
(ECHINOCYTES)

12. Due to underlying
RBC membrane
defect.
Compact and
round shape
“slit-like” or
“mouth-like “
central pallor.
Disorder : alcoholism ,
thalassemia minor ,
hereditary spherocytosis.
STOMATOCYTES

13. Usually
longer and
narrower
than normal
RBC.
OVALOCYTES /
ELLIPTOCYTES
Disorder : thalassemia
, hemolytic anemia ,
iron deficiency
anemia.
Usually has
a central
pallor

14. Doughnut
shaped
No central
pallor
SPHEROCYTES
MCV may be normal of
slightly decreased
Due to loss of
membrane due to
aging , antibody
coating or genetic
defect.
Disorder : autoimmune
hemolytic anemia , transfusion
reaction

15. BLISTER
CELL
Vacuoles may
ruptured
Thinner area at periphery / outer
membrane of cell membrane.
Disorder : pulmonary
emboli in sickle cell
anemia , microangiopathic
hemolytic anemia

16. An army helmet
features with short
straps.
Remains after
rupturing of
blister cell
HELMET CELL
(SCHIZOCYTES)
Disorder : emboli ,
G6PD deficiency ,
hemolytic anemia

17. TEAR DROP CELL
(DACRYOCYTES)
Unipolar tapered
end with a blunt tip
Increase number of
tear drop RBC is a clue
to a possible
underlying marrow
process.
Disorder : thalassemia , severe
anemia , megaloblastic anemia ,
mylefibrosis.

18. Normal erythrocytes
: pinkish red with
lighted coloured
centre.
Hypochromia : central pallor
exceed 1/3 of the cell membrane.
Anisochromia : uneven
coloration of erythrocytes.
Hyperchromia :
erythrocytes is
intensively coloured.
Polychromatophilia :
cytoplasm is greyishorange in colour.
VARIATION IN RED CELL
COLORATION

19. AGGLUTINATION
Irregular overlapping
aggregate of RBC’s.
Seen in cold antibody
syndrome
Reaction of antibodies with
antigens on erythrocytes
ROULEAUX FORMATION
Caused by concentration of
fibrinogen or immunoglobulin
Arrangement of
erythrocytes in groups
that resembles stacks of
coins
Seen in multiple myeloma ,
inflammation
VARIATION IN RED CELL
DISTRIBUTION

20. C
crystal
Howelljolly
bodies
Malaria
parasites
RBC
inclusion
Basophilic
stippling /
punctate
basiphilia
Pappenheimer
bodies
(siderocytes)
Reticulocytes
Cabot
ring
Heinz
bodies
H
inclusion

21. Nuclear / cytoplasmic
aggregates of stainable
substances , usually protein.
condition
 formed if there is the
abnormalitiy
 invoved virus infection
 classified according to staining

22. May be centrally
located or sometimes in
the periphery
Staining :
Romanowsy (eosinmetilena blue)
Composed of
fragments of DNA
Caused by
acceleration /
ineffective
erythropoiesis in
which chromosome
fragments are left
in the cytoplasm
Disorder : splenectomy and in thalassemia
, hemolytic anemia
HOWELL-JOLLY BODIES

23. BASOPHILIC STIPPLING /
PUNCTATE BASOPHILIA
Staining : romanowsy
(eosin-metilena blue
Artifactual caused by
precipitation of RNA
during staining
Composed of
ribosomes
Very small blue /
blue-gray
granules
distributed
throughout the
cytoplasm of
RBC’s
Disorder : defective /
accelerated heme synthesis
, lead poisoning anf
thalassemia

24. PAPPENHEIMER BODIES
(SIDEROCYTE)
Staining : prussian blue
Caused by excess
available iron
throughout the body
Purplish irregular aggregates of
granules composed of ferric iron
Disorder : sideroblastic
anemia , thalassemia ,
asplenism

25. H INCLUSION
Stain with supravital
stain four drops of blood
is incubated with 0.5ml
of brilliant cresyl blue
for 20 minutes at 37°c
Blue-green dots
can be seen in
the red blood
cell
Composed of precipitated chains of
beta-hemoglobin
Can be seen in HbH disease
because of the deposit of the
unstable hemoglobin red blood
cell,HbH.

26. Purple-blue inclusions visible only after
supravital stain
Composed of
denatures hemoglobin
HEINZ
BODIES
Seen in alpha thalassemia ,
G6PD deficiency and
unstable hemoglobin
syndromes

27. CABOT RING
Purplish ring-shaped , figure-8 /
loop shaped structure composed
of nuclear membrane remnants
Exact mechanism
unknown
Staining : romanowsky
Rarely seen
Disorder : pernicious
anemia , lead
poisoning ,
homozygous
thalassemia and
post-splenectomy

28. Round to oval ringshaped intracellular
parasite in RBC’s
MALARIA
PARASITES
Found in malaria
Usually <2 micrometer in
young trphozoites

29. C
CRYSTAL
Hexagon shaped /
rhomboid shaped
crystalline structures
in RBC’s.
Variable sized RBC
crystalline dark bluepurple inclusions.
Disorder : hemoglobin C
, hemoglobin SC

30. RETICULOCYTES
Young red blood cells that
contains ribonucleic acid
and ribosomes
Seen As dark
blue granule or
filament
Staining : Supravital stains (such as brilliant
cresyl blue, as used here) clump RNA and
mitochondria and permit easy identification
of reticulocytes, as compared to mature RBC