Ovalocyte/Elliptocyte 

- elongation of RBC with oval or elliptical shape,

non-specific, can be increased w/ chemo

- many elliptocytes indivative of hereditary elliptocytosis 

Spherocyte

- loss of membrane surface area causing a spherical shape

- no central pallor, cells appear round

microspherocytes - indivative of extravascular hemolysis

normal sphereocytes - hereditary spherocytosis (autosomal dominant) 

Stomatocyte: 

- central pallor is slit-like, instead of round

- nonspecific finding, increased in Myelodysplastic states

- associated w/ Rh nulld disease, hereditary stomatocytosis (autosomal dominant) 

Target Cell (codocyte) 

- central hemoglobin, rim of pallor, and peripheral hemoglobin staining, caused by increased cell membrane for amt of hemoglobin

- associated w/ liver disease, asplenia, hypochromic anemias, and hemoglobinopathies 

Tear Drop - "dacrocyte"

- cell has a "tear drop" shape

- associated w/ myelofibrosis 

Shizocyte - "schistocyte"

- fragmented RBC

- indicative of INTRAvascular hemolysis

- can be "helmet" cell or "bite" cell 

Acanthocyte - "spur cell"

- cell membrane has long projections & bulbous ends

- associated with liver disease and a-beta-lipoproteinemia

Burr Cell - "echinocyte"

- cell membrane w/ short spikes,

- symmetrical distribution, sharp pointed ends

- associated with renal failure 

Crenated cell

- peripheral membrane shape is scalloped

- usually seen as drying artifact but can be associated w/ hyperosmolality 

Sickle cell (depranocyte)

- cell is elongated and curved w/ pointed ends, most often seen in S-S- diasese, can be associated with few other hemoglobinopathies 

Basophilic Stippling

- small blue dots are remnants of RNA

- fine stippling is indicative of young RBC

- coarse stippling is indivative of thalassemia, lead intoxication, myelodysplastic states

Dyserythropoiesis

Howell-Jolly Body

- usally single, dense round inclusion of magenta color, remnant of nucleus

- most often seen in asplenia, but also in megaloblastic anemia and myelodysplastic states 

Nucleated RBC

- precurosors should not be seen in peripheral blood

- may be assoc. w/ stress such as acute hemorrhage, severe anemia, hemolysis, etc or a true marrow neoplasm 

Pappenheimer Body

- small blue inclusions usually eccentrically located, one or several, consists of stainable iron

- assoc w/ Iron overload in marrow and asplenia

- cells w/ Pap bodies are siderocyte

- nucleated RBC w/ iron is sideroblast

- nucleated RBC w/ iron around nucleus is ringed sideroblast 

Dyserythropoiesis

Cabot Ring

- ring-shaped structure that stains red-blue and thought to be remnant of microtubules from mitotic spindle

- assoc w/ disordered erythropoiesis 

Heinz Body

- only seen with supra-vital staining; 

- consists of precipitated hemoglobin and is indivative of unstable hemoglobin

- assoc w/ G-6-PD deficiency, some drugs, and some hemoglobinopathies 

Malaria P. Falciparum

- intracellular parasites include malaria and babesia 

Non-malarial intruders 

Hypochromic

- central pallor is widened 

Dimorphic Pop - 

- normocytic, normochromic cells and microcytic, hypochromic cells 

Hyperchromic

- small, absent central pallor,

- only seen in Hereditary Spherocytosis 

Polychromasia - 

- diffuse blue color of RBC, 

- remnant of RNA

- indicative of young RBC (reticulocyte) 

Reticulocyte

- young RBC that is slightly larger than mature RBC

- maybe seen as polychromsia, but best detection is by reticulocyte count 

Rouleau

- "sticking" together of RBC due to loss of Zeta potential caused by incrase of fibrinogen or gamma globulins 

Multiple Myeloma

Cold Agglutinins

- agglutinated clumps of RBC due to auto anti-bodies of IgM type 

Immediate Rxn - Neutrophilia

Mostly segs

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Neutrophilia (ANC >8K) à immediate reaction:

Occurs in MINUTES; mostly segs

Shift from marginating to circulating pool (doubles circulating pool of WBCs)

Causes:  extreme exercise, acute stress, Epi

= Acute Rxn (segs, bands,  & metamyelocytes) - Neutrophilia

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Neutrophilia (>8K) à acute reaction:

Occurs in HOURS; mostly Segs, some bands and metamyelocytes

Shift from maturation/storage à Marginating/circulating (doubles WBC!!! circulating and marginating cells populations are equal)

Causes = steroids, endotoxins, venoms

Neutrophilia (>8K) à Pathologic neutrophilia à Increase in ALL pools

Cases:  infections, metabolic disorders (i.e. uremia, gout, diabetic acidosis), sterile inflammation (i.e. necrosis from MI, burns), post-surgery, hemorrhage or hemolysis, drugs (i.e. Pb, steroids, benzene)

Leukemoid Reaction - Neutrophilia 

Left Shift = Accelerate release of immature neutrophils (Myelocytes, metemyelocyes, segs, bands, w/TG, and DB) in blood

Cause: bacterial infection

*Distingusihed from chronic myelocytic leukemia via:

-TG

-mature cells > immature

-High LAP (low in CML) b/c nl neutrophils have high LAP

Neutrophilia - Toxic Granulation

Very activated WBC à incr. primary granules (lysosomes)

Caused by bacterial infection

Severe bacterial infection  =  Toxic Granulation + Cytoplasmic Vacuolation + Dohle bodies

Dohle Bodies - Neutrophilia

DB assoc. w/TG

Severe bacterial infection  =  Toxic Granulation + Cytoplasmic Vacuolation + Dohle bodies

Immature WBC + nucleated RBCs

*WBC can be high, low, OR nl

Causes: 

BM stress:  hemorrhage, hemolysis, severe infection

myelphthisis (=inflitration of BM via tumor, fibrosis, or granuloma) (i.e. myelphthisis anemia)

Hematopoeitic disorder:  chronic idopathic myelofibrosis, myelofibrosis w/ myeloid metaplasia

Eosinophils (usually two lobed)

Causes Of Eosinophilia: Parasitic infections

Allergic reactions

GI disorders

Skin Disorders

Various neoplasms

Idiopathic eosinophilia

Various hematopoietic neoplasms

Causes of basophilia:

Allergy

Chronic myelocytic leukemia

Monocytosis =‘think CHRONIC conditions’

Causes:

Chronic ID, TB, CT disorders, chronic MONOcytic leukemia, neoplasm, SLE

Atypical Lymphocytosis 

Lymphocytosis (>4K) Atypical lymphocyte pop is HETEROGENOUS (they all look different from one another!)

LARGE, activated, transformed lymphocytes; mostly T-cells

Causes: infectious mono, all viral hepatitis, CMV

Reactive Lymphocytosis

Small NON-transformed lymphocytes indicates:

Adults à chronic lymphocytic leukemia; hodgekins lymphoma

Children à pertussis, infectious lymphocytosis (*bacterial substance causes lymphocyte to migrate, but does not respond; thus non-transformed)

Pelger-Huet anomaly

- inherited autosomal dominant disorder 

HYPOsegmented neutrophils (appear as bands); granules in cytoplasm

Inherited (AD) à bi-lobed neutrophils have NORMAL fxn

Pseudo-Pelger-Huet =acquired disorder

(some  bi-lobed, not all)

Nuetrophils =Non-lobed + HYPOgranulation (=clear cytoplasm)

Myelodysplasia of myeloid series (leukopeneia) à Loss of normal neutrophil fxn à prone to incr. infection

Dysmyelopoiesis

Hypersegmentation

= megaloblastic anemia or myelodysplastic disorder

Intracellular organisms (E. coli sepsis)

could also have strep, tb, etc 

Chronic Granulomatous Disease à caused by various mutations that cause a decr. in H2O2 production à cannot destroy intracellular organisms

Catalase positive bacteria  will survive in WBC lysosome (b/c not enough H2O2) à chronic bacterial persistance à chronic granulomatous disease

Chediak-Higashi Syndrome

Inherited (AR) lysosome disorder = pancytopenia + abnormal appearing lysosomes in lymphocytes and neutrophils

Affected cells = WBCs and melanosomes (àPartial albinism, photphobia)

Dysfunctional lysosome à  dysfunctional WBC (=large, magenta nucleus, and dark lysosomes) = fatal infections

Reed Schoenberg cell indicative of Hodgkin's Lymphoma 

- nodular sclerosis type