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,eosinophils
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.