14-20 micrometers wide

7:1 nucleus to cytoplasm ratio

2-5 nucleoli in a large oval or round nucleus that is lacey and fine due to loose chromatin

Auer rods are present in the cytoplasm that is cornflower blue

Myeloperoxidase is present that will gives the cell the function of phagocytosis

Is not yet motile, able to phagocytose or adhere as it is still immature

Makes up 1% of bone marrow

12-20 micrometers wide

5:1 nucleus to cytoplasm ratio

Large round or oval shaped nucleus with chromatin becoming slightly more dispersed with 1-3 nucleoli beginning to fade

Cytoplasm has observable azurophilic granules that are also throughout the whole cell

Granules appear moderately blue and coarse

Make up 1-5% of bone marrow

Is still immature but is beginning to have some motility and now includes primary granules of peroxidase, lysozyme, acid phosphatase and esterase enzymes.

12-18 micrometers wide

2:1 nucleus to cytoplasm ratio

Nucleus is round or oval shaped with a flattened side with coarse chromatin that is condensing further

Chromatin can appear blotchy with 0-1 nucleoli

Cytoplasm loses dark coarse granulation and now looks dust and fine

Makes up less than 10% of bone marrow

This is the last cell in the lineage that is still able to divide in order to multiply

Will begin to differentiate into different lines and will be subtly different depending on line but is still immature.

• Neutrophil-pink tan

• Basophil-blue black

• Eosinophil-red orange

10-18 micrometers wide

1.5:1 nucleus to cytoplasm ratio

Nucleus will appear kidney bean shaped without crossing the middle of the nucleus with clumped chromatin and no nucleoli

Cytoplasm now contains complete set of primary and secondary granules

13-22% of bone marrow

Still immature and unable to respond to chemotactic factors or phagocytose

10-16 micrometers wide

1:2 nucleus to cytoplasm ratio

Nucleus is distinguishable by absence of segmentation

Chromatin is now fully matured and condensed

Cytoplasm will contain granules of corresponding cell line that is specific to that cells function

Make up 40% of bone marrow

Fully motile, able to adhere and phagocytose.

Membrane gains complement receptors

A transitional form that is partially mature and enters in the marginating or circulatory pool.

12-15 micrometers wide

1:3 nucleus to cytoplasm ratio

Nucleus is segmented with lobes of dense chromatin that is connected by strands

Cytoplasm contains numerous secondary granules:

• Thrombospondin receptor, beta 2 microgloblulin, apolactoferrin, lysozyme, plasminogen activators

Part of innate immune system

• Phagocytose invading bacteria

• Release cytotoxins

10-17 micrometers wide

1:3 nucleus to cytoplasm ratio

Nucleus has fully mature and condensed chromatin in 2-3 lobes

Cytoplasm will appear bright pink due to specific secondary granules:

• Major basic protein, proteolytic enzymes

Help fight off parasites and are involved in allergic reactions

Phagocytic and cytotoxic

Stimulates histamine release that causes allergies

10-14 micrometers wide

1:3 nucleus to cytoplasm ratio

Chromatin is fully matured in a segmented nucleus with 2-4 lobes

Cytoplasm is barely visible due to large purple granules that also disguises nucleus

Secondary granules include:

• Heparin, chondroitin sulfate, histamine, neutrophil chemotactic factor and kallikrein and platelet activating factor

Help fight bacterial, viral, fungal, and parasite infections

Help detect and destroy cancer cells

Mature further into mast cells

• Act as sentinel cells

• Release histamine, heparin, cytokines and other chemicals necessary for inflammation

14-20 micrometers wide

6:1 nucleus to cytoplasm ratio

1-2 prominent nucleoli in a large oval or round nucleus that is lacey and fine due to loose chromatin

Cytoplasm is usually free of granules and is a moderate blue color

Immature cell not yet functional

12-20 micrometers wide

3:1 nucleus to cytoplasm ratio

Chromatin is irregular with a flattened nucleus and possible nucleoli and folding or creasing.

Cytoplasm will be gray-blue with rare granules and possible vacuoles

Immature precursor to a monocyte

12-20 micrometers wide

1:1 nucleus to cytoplasm ratio

Nucleus can take many different shapes from lobed to s shaped.

Chromatin is loose-weaved, lacy, and thin

Cytoplasm is gray-blue with moderate nonspecific granules and many vacuoles

Capable of phagocytosis

Releases inflammatory cytokines and growth factors helpful in healing

Identifies invaders and helps to kill and remove them

10-20 micrometers wide

4:1 nucleus to cytoplasm ratio

One or two nucleoli with smudgy chromatin

Cytoplasm appears a deep blue for the little of it there is with staining at the edge

Immature precursor to a lymphocyte

Activated by an antigen where it then rapidly divides and matures

7-18 micrometers wide

3:1 nucleus to cytoplasm ratio

Nucleus is round with lumpy chromatin

Cytoplasm is just a thin blue border

A few granules present with azurophilic red granules

Part of the adaptive immune system

Could be either a B lymphocyte, a T lymphocyte, or a natural killer cell

• B lymphocyte

  • Matures into a plasma cell

• T lymphocyte

  • Responsible for cell-mediated immunity

• Natural killer cell

  • Produces cytokines, identify cells for destruction, and destroy these cells

14-20 micrometers wide

1:2 nucleus to cytoplasm ratio

Circular nucleus with heterochromatin in a bike spoke pattern

Basophilic cytoplasm

Agranular

Responsible for antibody production and humoral immunity

Cytotoxic and an antigen presenting cell

Morphological change of lymphoctes

Larger than normal lymphocytes and can be as large as 30 micrometers

Lower nucleus to cytoplasm ratio that normal lymphocytes

Less densely clumped chromatin than in a normal lymphocyte with a finer texture

Light blue agranular cytoplasm with darkening at the edges of the cytoplasm especially where it touches other cells

Cytoplasm seems to reach and forms irregularly shaped cells

Recognize antigens and produce the correct antibody to neutralize and eliminate the antigen.

Are activated to fight off invading pathogen

Usually 2-3 micrometers wide

No nucleus or proper cytoplasm as platelets are not a cell

They will appear as small coarse purple disks

No granules

Intrinsic to clotting and stoping bleeding so the wounds can heal

Help attract immune cells to damaged areas

Needle-like pink inclusions seen in myeloblasts

Form from abnormal fusion of primary granules in the cytoplasm

Often seen in acute myeloid leukemia

Granules of neutrophils appear darker coarser and more abundant than usual

A result of increased and accelerated production of white blood cells with less maturation time being taken in the bone marrow

Severe infection, inflammation, burns, trauma, or the administration of granulocyte colony stimulating factor can result in toxic granulation

Small round or circular light blue grey inclusions in the cytoplasm of neutrophils

Made of remnants of rough endoplasmic reticulum

Found as a result of severe stress on the body such as infections, burns, traumas, and drug toxicity

Is abnormal nuclear segmentation in neutrophils, causing them to appear with a characteristic "dumbbell" bilobed shape

Caused by abnormal trafficking of the heterochromatin and nuclear lamins which are scaffolding proteins that control the shape of the nuclear membrane

Typically caused by an autosomal dominant disorder but can be acquired from a variety of diseases:

• Myeloid leukemia

• Myelodysplasia

• Bilineage acute lymphocytic leukemia

• Radiation exposure

• Severe infections

• Or medications such as mycophenolate or valproate

Numerous clear circular white areas in the cytoplasm of neutrophils

Vacuoles form when something is phagocytosed

Toxic vacuolization is a reactive condition to get rid of an infection seen often in septicemia, acute ethanolism, or with certain medication like chloramphenicol

Neutrophils with a six or more lobed nucleus

Impaired DNA synthesis from a deficiency of B12 or folate

Can be caused by cellular aging, but is a strong indicator of megaloblastic anemia as long as the smear is prepped in a timely manner

Abnormally large giant granules in granulocytes

Mutations of the CHS1/LYST gene that is involved in controlling the exocytosis of secretory lysosomes that results in the large granules seen

Chediak-Higashi syndrome is an autosomal recessive disorder that is characterized by frequent bacterial infection

18-20 micrometers wide

6:1 nucleus to cytoplasm ratio

Nucleus is round with dense chromatin with a deep violet color and one or two nucleoli

Plasma membrane can be irregular with a very blue cytoplasm

Initiates development of red blood cells

An immature precursor of erythrocytes

The cell can still divide and will then mature into basophilic normoblasts

16 micrometers wide

Nucleus is still round with chromatin beginning to condense with no more nucleoli but a lumpy nuclear membrane

6:1 nucleus to cytoplasm ratio

Cytoplasm is a deep rich blue as RNA masks the hemoglobin

Basophilic normoblasts synthesize hemoglobin as they continue to move towards mature erythrocytes

13 micrometers wide

4-2:1 nucleus to cytoplasm ratio

Chromatin has continued to condense leading to a spokes on a wheel pattern with a deep texture

Cytoplasm begins to be more red due to an increase in the amount of hemoglobin

Continues synthesizing hemoglobin as an intermediate in the process of maturation of erythrocytes

8 micrometers wide

1:1 nucleus to cytoplasm ratio

The nucleus is baseball round with chromatin appearing velvet like with homogenous appearance

Nucleus is becoming pyknotic as it is prepared to be ejected

Cytoplasm is pink-orange due to hemoglobin synthesis with some blue due to residual organelles

Final stage of erythroid maturation

8 micrometers large

Nucleus has been ejected

Cytoplasm is red/pink due to production of hemoglobin

A result of erythrocyte precursors not maturing correctly and leaving residual RNA

RNA casts blue hue to cell in a Wright stain causing polychromasia, can also be seen above with a New Methylene Blue stain

Approximately 6-8 micrometers wide

No nucleus as it has been ejected in maturation

Surface to volume ratio creates a biconcave disk with a central pallor

Mature end of erythrocyte cell line

Transports oxygen to the tissues and carbon dioxide waste to the lungs and out of the body

Erythrocytes have less color than normal

Red blood cells have a larger central pallor due to inadequate hemoglobin synthesis, most often due to iron deficiency

Can be caused by iron deficiency anemia, thalassemia, sideroblastic anemia, lead poisoning and some infections

Red blood cells are less than 6 micrometers wide

When compared to a lymphocyte erythrocytes are found to be much smaller

Caused by iron deficiency, blood loss, thallasemia, and some chronic diseases

Red blood cells are larger than 9 micrometers

Central pallor is much smaller than usual due to an increase in hemoglobin

Alcohol use disorder, liver disease, myelodysplastic syndrome, hypothyroidism, medication, aplastic anemia, myeloid leukemia and nutritional deficiency can cause RBC's to be macrocytic

Normally sized at 6.2-8.2 micrometers

The normal amount of hemoglobin is present making the RBC's the normal color

Will have a slight central pallor but not too much

Red blood cells are different sizes from each other.

Diseases and disorders that can causes anisocytosis:

• Anemias

• Genetic conditions

• Bone marrow disorders

• Chronic diseases

• Infections

• Medications

• Vitamin deficiencies

Red blood cells are different abnormal shapes

Disorders/Diseases that can cause poikilocytosis:

• Anemia

• Cancer

• Digestive disease

• and Vitamin deficiencies

Erythrocytes are varying colors either due to different concentrations of hemoglobin or retained RNA or other nuclear material.

Diseases that can cause polychromasia:

• Anemia

• Bone marrow injury

• Cancer

Small blue dots well dispersed where hemoglobin is usually found in erythrocytes

Formed from residual RNA and mitochondrial remnants

Can be caused by lead poisoning, thalassemia, various anemias and anything else that can cause accelerated erythropoiesis

Dense dark purple medium sized inclusions found anywhere inside an erythrocyte

Formed from residual DNA that is not removed when the nucleus is exocytosed

Would normally be removed by spleen causing bite cells

Can be caused by megaloblastic anemia, hemolytic anemias, thalassemia, and sickle cell anemia

Clusters of small dots near the edges of erythrocytes that can be different colors depending on the stain, either Prussian blue or the wright stain

Formed from iron inclusions aka aggregates of ferritin

Associated with:

• Sideroblastic anemia

• Thalassemia

• Sickle cell disease

• Hemochromatosis

• Splenectomy

• Myelodysplastic syndrome (MDS)

• Lead poisoning

Medium sized inclusions on the cell membrane of erythrocytes that look like they are being ejected.

Not visible with a wright's stain, and a supravital stain must be used where they will appear dark purpleish blue (unlike with whatever stain was used in this picture)

Formed from denatured hemoglobin

Can be caused by oxidative stress, medication, mineral deficiency, G6PD deficiency, venom, and malaria.

Scattering of small dots through out the effected erythrocytes that can be varying colors depending on stain (see reticulocytes as a RBC precursor)

Formed from erythrocytes not maturing correctly and leaving residual RNA

Associated with anemias, bone marrow failure, chronic kidney diseases, cirrhosis of the liver, specifically hemolytic anemia, and erythroblastosis fetalis

Thin red-violet threadlike strands in a loop, figure eight, or B shape

Formed from remnants of microtubules from mitotic spindle

Can be caused by Megaloblastic anemia, lead poisoning, myelodysplastic syndrome, leukemia, and other disorders of erythropoiesis

Seen as a ring with small dark dots within the cytoplasm of a RBC

Formed by the invasion of the malarial parasite into the bodies erythrocytes

Associated with the disease malaria as this is the actual parasite of the disease that can be seen

A promyelocyte can be seen here which is common in AML as many immature cells are seen with many blasts and auer rods in these blasts.

Giant platelets, nucleated RBCs hypo and hyper segmented neutrophils are also seen

Rapid progression as it is acute with bone marrow failure resulting in constant coldness, paleness, fatigue, fever, dizziness and easy bruising.

Myeloperoxidase stain, Sudan Black B stain, and specific esterase stain positive because of myeloid lineage meaning it must be some kind of myeloid leukemia.

It is acute instead of chronic because symptoms would have come on suddenly and can impact all ages with immature cells being present in the blood smear.

Many lymphoblasts and lymphocytes with more immature cells.

Will progress with an abrupt onset at any age with bleeding bruising, fever, fatigue, infections, pale skin, headaches, shortness of breath, and joint pain.

Increase in production of immature cells will impact the hematological system by squeezing out healthy red blood cells causing anemia.

Myeloperoxidase, sudan black B, specific esterase, and terminal deoxynucleotidyl transverseas negative.

Differentiate from CLL with terminal deoxynucleotidyl transverseas as it is only positive for immature cells in the lymphoid line.

Mostly mature myeloid cells will appear in the blood smear with an elevated WBC count

Onset will be subtle and will occur in adults starting with a chronic stage, progressing to an accelerated stage and ending with a blast phase where AML can develop.

Myeloperoxidase stain, Sudan Black B stain, and specific esterase stain positive because of myeloid lineage meaning it must be some kind of myeloid leukemia.

Must be chronic because of the subtle onset and mature cells found in the blood smear

Mostly mature lymphoid line cells found in the blood smear with an increase in the WBC count

Disease starts subtly progressing through a chronic phase, accelerated and blast phase where it can progress to ALL.

Myeloperoxidase, sudan black B, specific esterase, and terminal deoxynucleotidyl transverseas negative.

Differentiates from ALL as will also be negative in the terminal doxynucleotidyl transferase because an excess of immature lymphoid cells are not present

Is also differentiated due to subtle onset making it chronic

Appear as flattened and usually bent fragments of red blood cells with two pointed ends

Formed through mechanical destruction or fragmentation hemolysis

Can be a characteristic of microangiopathic hemolytic anemia or from a variety of more common occurrences:

• fibrin strands in a clot

• turbulent blood flow

• rough vascular surfaces

Appear as erythrocytes with a chunk take out of them leaving them with a semi circular indent.

These cells are formed when cells in the spleen remove residual cell components such as DNA in the form of Howell jolly bodies.

There is less of a disease associated with the presence of bite cells and more the lack of them that signals some disease.

• Diseases or disorders that can cause an increase in the need for the spleen to remove residue are megaloblastic anemia, oxidative stress, thalasemia, etc. (Anything that results in a red blood cell inclusion).

• A decrease in bite cells with these inclusions still present can signal that the spleen is in some kind of distress.

  • This can be caused by splenomegaly, anemia, or mechanical damage to the spleen.