RATHER WASEEM YOUSUF (MVSc vety clinical medicine)

1. DR.RATHER WASEEM YOUSUF
MVSC VETY CLINICAL MEDICINE
RBC & WBC ABNORMALITIES
AND THEIR INTERPRETATION

2. HEMATOLOGY
 Study of blood and blood forming
tissues
 Key components of hematologic
system are:
Blood
Blood forming tissues
Bone marrow
Spleen
Lymph system

3. WHAT DOES BLOOD DOES
 Transportation
 Oxygen
 Nutrients
 Hormones
 Waste Products
 Regulation
 Fluid, electrolyte
 Acid-Base balance
 Protection
 Coagulation
 Fight Infections

4. Components of Blood
 Plasma
55%
 Blood Cells
45%
Three types
Erythrocytes/RBC
s
Leukocytes/WBCs
Thrombocytes/Pla
telets

5. Erythrocytes/Red Blood Cells
 Composed of hemoglobin
 Erythropoiesis
= RBC production
Stimulated by hypoxia
Controlled by erythropoietin
 Hormone synthesized in kidney
 Hemolysis
= destruction of RBCs
Releases bilirubin into blood stream

6. Leukocytes/White Blood Cells
5 types
Basophils
Eosinophils
Neutrophils
Monocytes
Lymphocytes

7. Types and Functions of Leukocytes
 Granulocytes
 Neutrophil
 Eosinophil
 Basophil
 Agranulocytes
 Lymphocyte
 Monocyte
 Phagocytosis, early phase
of inflammation
 Phagocytosis, parasitic
infections
 Inflammatory response,
allergic response
 Cellular, humoral immune
response
 Phagocytosis; cellular
immune response
TYPE CELL FUNCTION

8. Abnormalities of RBCs
Abnormal erythrocyte
morphology is found in
pathological states that
may be :
- abnormalities in size
(anisocytosis).
- In shape (poikilocytosis).
- In hemoglobin content.
- presence of inclusion
bodies

9. 1-Variation in erythrocyte size
(anisocytosis)
1-Microcytosis:
Morphology:
- Decrease in the red cell size. Red cells are smaller
than normal.
Found in:- Iron deficiency anemia..
- Lead poisoning.
- Anemia of chronic disease.

10. 1-Variation in erythrocyte size
(anisocytosis)
1-Microcytosis:
Morphology:
- Decrease in the red cell
size. Red cells are
smaller than normal.
Found in:- Iron
deficiency anemia..
- Lead poisoning.
- Anemia of chronic
disease

11. 1-Variation in erythrocyte size
(anisocytosis)
2-Macrocytosis:
Morphology:
Increase in the size of a
red cell. Red cells are
larger than normal. May
be round or oval in shape,
the diagnostic
significance being
different.
Found in:
- Foloate and B12
deficiencies (oval)
- Ethanol (round)
- Liver disease (round)
- Reticulocytosis (round)

12. II-Variation in hemoglobin content
1-Hypochromasia:
Morphology:
Increase in the red cells'
central pallor which
occupies more than the
normal third of the red
cell diameter.
Found in:
- Iron deficiency
- Thalassaemia
any of the conditions
leading to Microcytosis

13. II-Variation in hemoglobin content
2- Polychromasia:
Morphology:
Red cells stain shades of blue-gray
as a consequence of uptake of
both eosin (by hemoglobin) and
basic dyes (by residual ribosomal
RNA). Often slightly larger than
normal red cells and round in
shape - round macrocytosis.
Found in:
Any situation with
reticulocytosis - for example
bleeding, hemolysis or
response to haemostatic
factor replacement.

14. Anemia Classifications
 Microcytic, hypochromic
 Microcytic, normochromic
 Normocytic, normochromic
 Macrocytic, normochromic

15. NORMOCYTIC, NORMOCHROMIC
ANEMIA
 MCV normal
 MCHC normal
 Examples:
acute blood loss
aplastic anemia
most leukemia's
bone marrow infiltration

16. MICROCYTIC, HYPOCHROMIC ANEMIA
 MCV decreased
 MCHC decreased
 Examples:
iron deficiency
thalassemia
lead poisoning
anemia of chronic disease

17. MICROCYTIC, NORMOCHROMIC ANEMIA
MCV decreased
MCHC normal
Examples:
mid-stage iron deficiency
thalassemia

18. MACROCYTIC, NORMOCHROMIC
ANEMIA
 MCV increased
 MCHC normal
 Examples:
folate deficiency
vitamin B12 deficiency
pernicious anemia

19. III- Variation of red cells shape
(Poikilocytosis)
RBCs may have different
shapes:
1- Spherocytosis:
Morphology:
Red cells are more spherical.
Lack the central area of pallor
on a stained blood film.
Found in:
- Hereditary spherocytosis
- Immune haemolytic anemia
- Zieve's syndrome
- Microangiopathic haemolytic
anemia

20. III- Variation of red cells shape
(Poikilocytosis)
2-Target Cells:
Morphology:
Red cells have an area of
increased staining which
appears in the area of
central pallor.
Found in:
-Obstructive liver disease
-Severe iron deficiency
- Thalassaemia
- Haemoglobinopathies
- Post splenectomy

21. III- Variation of red cells shape
(Poikilocytosis)
3- Ovalocytes:
Morphology:
oval shape red blood
cell
Found in:
- Thalassaemia major.
- Hereditary ovalocytosis.
- Sickle cell anemia

22. III- Variation of red cells shape
(Poikilocytosis)
4- Elliptocytosis:
Morphology:
The red cells are oval or
elliptical in shape. Long
axis is twice the short axis.
Found in:
- Hereditary elliptocytosis
- Megaloblastic anemia
- Iron deficiency
- Thalassaemia
- Myelofibrosis

23. III- Variation of red cells shape
(Poikilocytosis)
5- Tear Drop Cells:
Morphology:
Red cells shaped like a
tear drop or pear
Found in:
- Bone marrow fibrosis
- Megaloblastic anemia
- Iron deficiency
- Thalassaemia

24. III- Variation of red cells shape
(Poikilocytosis)
6- Blister cell:
Morphology:
Have accentric hallow
area.
Found in:
Microangiopathic
hemolytic anemia

25. III- Variation of red cells shape
(Poikilocytosis)
7- Schistocytosis:
Morphology:
Fragmentation of
the red cells.
Found in:
- DIC
- Micro angiopathic
haemolytic anemia
- Mechanical haemolytic
anemia

26. III- Variation of red cells shape
(Poikilocytosis)
8- Stomatocytosis:
Morphology:
Red cells with a central
linear slit or stoma. Seen
as mouth-shaped form in
peripheral smear.
Found in:
- Alcohol excess
- Alcoholic liver disease
- Hereditary
stomatocytosis
- Hereditary spherocytosis

27. III- Variation of red cells shape
(Poikilocytosis)
9- Burr (crenation )
cell:
Morphology:
Red cell with uniformly spaced,
pointed projections on their
surface.
Found in:
- hemolytic anemia
- Uremia.
- Megaloblastic anemia

28. III- Variation of red cells shape
(Poikilocytosis)
10- Keratocytes
(horn cell):
Morphology:
Part of the cell fuses back
leaving two or three horn-
like projections. The
keratocyte is a fragile cell
and remains in circulation
for only a few hours.
Found in:
- Uraemia
- Severe burns
- EDTA artifact
- Liver disease

29. III- Variation of red cells shape
(Poikilocytosis)
11- Acanthocytosis:
Morphology:
are red blood cells with
irregularly spaced
projections, these
projections very in width
but usually contain a
rounded end
Found in:
- Liver disease
- Post splenectomy
- Anorexia nervosa and
starvation

30. III- Variation of red cells shape
(Poikilocytosis)
12- Sickle Cells:
Morphology:
Sickle shaped red
cells
Found in:
Hb-S disease

31. III- Variation of red cells shape
(Poikilocytosis)
13- Rouleaux Formation:
Morphology:
Stacks of RBC's
resembling a stack of
coins.
Found in:
-Hyperfibrinogenaemia
-Hyperglobulinaemia

32. III- Variation of red cells shape
(Poikilocytosis)
14- Red cell-
agglutination:
Morphology:
Irregular clumps of red
cells
Found in:
- Cold agglutinins
- Warm autoimmune
hemolysis

33. III- Variation of red cells shape
(Poikilocytosis)
15- Nucleated red blood
cells.
These red blood cells are
released from the bone
marrow early into the
blood stream, due to the
need for oxygen. Normal
red blood cells do not
contain a nucleus on a
peripheral smear.

34. IV -Erythrocyte inclusion bodies
1- Howell-Jolly Bodies:
Morphology:
Small round cytoplasmic
red cell inclusion with
same staining
characteristics as nuclei
Found in:
- Post splenectomy
- Megaloblastic anemia

35. IV -Erythrocyte inclusion bodies
2- Siderotic Granules
(Pappenheimer
Bodies)
RBCs which contain no
hemoglobin iron granules.
They appear as dense blue,
irregular granules which
are unevenly distributed in
Wright stained RBCs.
Pappenheimer bodies can
be increased in hemolytic
anemia, infections and
post-splenectomy.

36. IV -Erythrocyte inclusion bodies
3- Basophilic stippling:
Morphology:
Considerable numbers of
small basophilic inclusions
in red cells.
Found in:
- Thalassaemia
- Megaloblastic anemia
- Hemolytic anemia
- Liver disease
- Heavy metal poisoning.

37. IV -Erythrocyte inclusion bodies
4- Heinz Bodies:
Represent denatured
hemoglobin
(methemoglobin - Fe+++)
within a cell. With a
supravital stain like crystal
violet, Heinz bodies appear
as round blue precipitates.
Presence of Heinz bodies
indicates red cell injury and
is usually associated with
G6PD-deficiency.

38. IV -Erythrocyte inclusion bodies
5- Cabot Rings:
Reddish-blue threadlike rings
in RBCs of severe
anemia's. These are
remnants of the nuclear
membrane and appear as a
ring or figure 8 pattern.
Very rare finding in patients
with Megaloblastic anemia,
severe anemia's, lead
poisoning, and
dyserythropoiesis.

39. IV -Erythrocyte inclusion bodies
6- Parasites of Red
Cell:
are protozoan parasites
which occur in many
species of birds and are
the cause of avian
malaria. Transmitted by
mosquitoes, infection
with Plasmodium can be
a cause of hemolytic
anemia

40. Erythrocyte inclusion bodies
Depiction of red blood
cell morphologies that
may appear on a
peripheral smear,
showing:
(A)Basophilicstippling
(B) Howell-Jolly bodies
(C)Cabot'sringbodies
(D) Heinz's bodies.

41. Leukocytes (White Blood Cells)
 The leukocytes, or white blood cells,
constitute only 1% of the total blood
volume.
 They originate in the bone marrow and
circulate throughout the lymphoid
tissues of the body.
 There they function in the
inflammatory and immune processes.
 They include:
 the granulocytes
 Neutrophils – 55-65%
 Eosinophils – 1-4%
 Basophils – 0-1%
 the lymphocytes – 20-40%
 the monocytes – 3-8%

42. Differential Count
Neutrophil
50 – 75 %
Eosinophil
0 – 3 %
Basophil
0 – 1 %
Lymphocyte
20 – 40 %
Monocyte
2 – 6 %

43. Abnormalities of WBCs(quantative)
 Leucocytosis – substantial increase in the
WBC count.
- Physiologic increase (no trauma/injury)
- Pathologic increase (trauma/pathology)
 Leucopenia – substantial decrease in the
WBC count.
 N.V. = 5,000 – 10,000/cu mm

44. Neutrophilia Neutropenia
 Infections,
Inflammation,
Metabolic disorders
 Acute hemorrhage,
corticosteroids
 Stress, post-surgery,
burns, HDN
 Lithium drugs,
neoplasms
 Decreased production
- Inherited/acquired stem cell
disorder
- Benzene toxicity, cytotoxic
drugs
 Increased destruction
- Immune mechanism,
sequestration
 BM depression, IM, varicella,
Typhoid
 SLE, hepatitis or any viral
infections
NEUTROPHILLS

45. Eosinophilia Eosinopenia
 Allergic disorders
(asthma)
 Parasitic infections
(nematodes)
 Skin disease (eczema)
 Hodgkin’s disease
 Scarlet Fever
 Pernicious anemia
 Stress due to
trauma or shock
 Mental distress
 Cushing’s
syndrome
 ACTH
administration
EOSINOPHILLS

46. BASOPHILIA BASOPENIA
 Chronic
myelocytic
leukemia.
 Polycythemia.
 Hodgkin’s
disease.
 Hyperthyroidism.
 Pregnancy.
Basophil

47. Lymphocytosis Lymphopenia
 Viral infections
(German measles )
 Infectious
Mononucleosis
(kissing dis.)
 Mumps (parotitis),
pertussis
 Tuberculosis, syphilis,
thyrotoxicosis
 Congestive heart
failure, SLE
 Renal failure
 Advanced
Tuberculosis
 High levels of
adrenal
corticosteroids
LYMPHOCYTES

48. MONOCYTES
 SBE, Syphilis,
Tuberculosis
 Protozoan infections
 Mycotic or fungal
infections
 Malaria, Systemic lupus
erythematosus
 Rheumatoid arthritis
 Monocytosis  Monocytopenia
 Lymphocytic
leukemia
 Aplastic anemia

49. Abnormalities of WBCs(qualitative)
 Morphologic abnormalities involving
either the nucleus or cytoplasm
 Functional abnormalities
 Inherited or Acquired

50. Toxic Granulation
Morphology
Increased granulation. Granulation
more basophilic and larger than
normal.
Found in
 Severe bacterial infection.
 Non specific finding - seen in
tissue damage of various types.
 Normal pregnancy.
 Therapy with cytokines

51. Dohle Bodies
Morphology
Small pale blue cytoplasmic
inclusions, often in the periphery
of the cell.
Consist of ribosomes and
endoplasmic reticulum
Found in
 Infective and inflammatory
states.
 Severe burns
 Tuberculosis
 Post chemotherapy
 Pregnancy
 May-Heggling Anomaly

52. Russell bodies
Morphology
are eosinophilic, large,
homogenous immunoglobulin-
containing inclusions usually.
Found in
a plasma cell undergoing excessive
synthesis of immunoglobulin; the
Russell body is characteristic of the
distended endoplasmic reticulum
This is one cell variation found
in multiple myeloma.

53. Hypersegmentation or right shift of
neutrophil nuclei
Morphology
Average lobe count increased OR
increased % of neutrophils with
5 - 6 lobes OR > 3% neutrophils
with 5 lobes or more.
Found in
 Megaloblastic anaemia
 Iron deficiency
 Chronic infection
 Liver disease
 Uraemia

54. Hypogranulation
Morphology
Reduced granulation in
neutrophil cytoplasm.
Found in
 Myelodysplastic syndromes

55. Phagocytosed Parasites
Morphology
Malaria - Plasmodium
falcifarum
Found in
 Severe malaria infection

56. Macro Neutrophils
Morphology
Twice the size of a normal
neutrophil with tetraploid DNA
content.
Found in
 Occasionally in the blood of
healthy subjects.
 Inherited
 Administration of G-CSF
 Megaloblastic anaemia
 Chronic infection

57. Shift To The Left
Morphology
Presence of precursor of
granulocytes in the peripheral blood
Found in
 Normal in pregnancy or neonate.
 Infections.
 Bone marrow fibrosis.
 Bone marrow infiltration by
malignancies

58. Pseudo Pelger Huet Anomaly
Morphology
Bilobed neutrophils with more
condensed chromatin
Found in
 Inherited Myelodysplastic
syndromes.
 Idiopathic myelofibrosis.
 Chronic granulocytic leukemia.
 Therapy with colchicine,
ibuprofen.
 Infectious mononucleosis,
malaria, myxedema.
 CLL

59. Neutrophil aggregation
Morphology
Small clumps of neutrophils.
Happens in vitro if EDTA
anticoagulated blood is allowed
to stand. May lead to incorrect
WBC.
Found in
 In vitro finding.
 Infectious mononucleosis.
 Bacterial infections.
 Auto immune disease.

60. Atypical Lymphocytes
Morphology
Pleomorphic. Large with diameter
of 15 - 30 µm. Abundant, strongly
basophilic cytoplasm. Basophilia
may be confined to the cytoplasmic
margins.
Found in
 Viral infections - EBV, CMV,
Hep A, Measles.
 Bacterial infections - brucella,
tuberculosis.
 Protozoa – malaria.
 Immunization.
 SLE.