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Peripheral blood cell abnormalities

Acanthocytosis

Description: Irregularly spiculated RBC with projections of varying length and position
Associated disease: Abetalipoproteinemia alcoholic liver disease Postsplenectomy, Malabsorptine states

Anisocytosis

Description: Abnormal variation in size
Associated diseases: Any severe anemia

Basophilic stippling

Description: Punctate stippling when Wright-stained
Associated diseases: Hemolytic anemia, lead poisoning, Thalassemia

"Burr" cells

Description: Spiculated RBC with short, equally spaced projections over entire surface
Associated diseases: Hemolytic anemias, liver disease, normal infants, uremia, microangiopathic hemolytic anemia, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, pyruvate kinase deficiency, carcinoma

Cabot rings

Description: Purple, fine, ring-like, intraerythrocytic structures
Associated diseases: Pernicious anemia, lead poisoning

Elliptocytes

Description: Oval cells
Associated diseases: Hereditary elliptocytosis, iron deficiency

Heinz inclusion bodies

Description: Small round inclusions seen under phase microscopy or with supravital staining
Associated diseases: Congenital hemolytic anemias (eg, glucose 6-phosphate dehydrogenase deficiency), hemolytic anemia secondary to drugs (dapsone, phenacetin), thalassemia (Hb H), hemoglobinopathies (Hb Zurich, Kln, Ube, 1, etc)

Howell-Jolly bodies

Description: Spherical purple bodies (Wright's stain) within or on erythrocytes; nuclear debris
Associated diseases: Hyposplenism, pernicious anemia

Hypochromia

Description: Pale cells with decreased concentration of hemoglobin (MCHC > 31 g/dL)
Associated diseases: Iron deficiency and iron-loading (sideroblastic) anemia, thalassemia, lead poisoning, transferrin deficiency, anemia of chronic disease (inflammatory diseases, eg, rheumatoid arthritis, collagen diseases, malignancies)

Macrocytosis

Description: Large cells, greater than 8 um MCV > 100 fl
Associated diseases: Megaloblastic anemia, liver disease, hypothroidism, hemolytic anemia (reticulocytes), multiple myelome, physiologic macrocytosis of newborn, myelophthisis

Macro-ovalocytosis

Description: Large > 8 m oval cells MCV > 100 fl
Associated diseases: Megaloblastic anemia

Mircocytosis

Description: Small cells, less than 6 um MCV < 80 fl
Associated diseases: Iron deficiency and iron-loading (sideroblastic) anemia, thalassemia, lead poisoning

Nucleated red cells

Description: Erythrocytes with nuclei still present; may be normoblastic or megaloblastic
Associated diseases: Hemolytic aneamias, leukemias, myeloproliferative syndrome, polycythemia vera, myelophthisic anemia (neoplastic, granulomatous, or fibrotic marrow infiltration), multiple myeloma, extramedullary hematopoiesis, megaloblastic anemias, any severe anemia

Pappenheimer bodies (siderocytes)

Description: Siderotic granules, staining blue with Wright's or Prussian blue stains
Associated diseases: Iron-loading anemias, hyposplenism, hemolytic anemias

Poikilocytosis

Description: Abnormal variation in shape
Associated diseases: Any severe anemia - eg, megaloblastic, iron deficiency, myeloproliferative syndrome, hemolytic; certain shapes are diagnostically helpful

Polychromasia

Description: RBCs containing RNA, staining a pinkish blue color; stains supravitally as reticular network with new methylene blue
Associated diseases: Hemolytic anemia, blood loss, uremia, following treatment of iron deficiency or megaloblastic anemias

Rouleaux

Description: Aggregated erythrocytes regularly stacked on one another
Associated diseases: Multiple myeloma, Waldenstrm's macroglobulinemia, cord blood, pregnancy, hypergammaglobulinemia, hyperfibrinogenemia

Schistocytes

Description: Red cell fragments of any size or shape including helmet, horny, blister, or other irregular unusual or unclassifiable shapes
Associated diseases: Uremia, carcinoma, hemolytic-uremic syndrome, disseminated intravascular coagulation, microangiopathic hemolytic anemia, toxins (lead, phenylhydrazine), burns, thrombotic thrombocytopenic purpura

Sickle cells

Description: Crescent-shaped cells
Associated diseases: Sickle cell hemoglobinopathies

Spherocytosis

Description: Spherical cells without pale centers; ofter small, ie, microspherocytosis
Associated diseases: Hereditary spherocytosis, Coombs' - positive hemolytic anemia; small numbers are seen in any hemolytic anemia and after transfusion of stored blood

Stomatocytosis

Description: Red cells with slit-like, instead of circular, area of central pallor
Associated diseases: Congenital hemolytic anemia, thalassemia, burns, lupus erythematosus, lead poisoning, liver disease, artifact

Target cells

Description: Cells with a dark center and periphery and a clear ring in between
Associated diseases: Liver disease, thalassemia, hemoglobinopatheis (S, C, SC, S-thalassemia)

Teardrop cells

Description: Cells shaped like teardrops
Associated diseases: Myeloproliferative syndrome, myelophthisic anemia (neoplastic, granulomatous, or fibrotic marrow infiltration), anemia with extramedullary hematopoiesis or ineffective erythropoiesis

¤Reich, Paul R, M.D., Hematology: Physiopathologic Basis for Clinical Practice
Boston, MA: Little, Brown & Company (Inc), 1984, 19-21.