QUALITATIVE BLOOD
CELL ABNORMALITIES
Nabila Ado Ya’u
Consultant Haematologist
(MBBS, FMCpath)
Outline
Introduction
Red cell shape abnormalities
Red cell size abnormalities
Red cell inclusions
White cell nuclear abnormalities
White cell cytoplasmic inclusions
abnormalities
Platelet size abnormalities
Introduction
Qualitative blood cells disorders are a group
of disorders characterised by variable
abnormalities in the functions or morphology
of the cells
They can be inherited or acquired
They are usually benign though some can
cause severe or life threatening conditions
In some cases abnormal function or
morphology may be associated with
quantitative abnormality
Introduction cont’d
Any of the cell lines can be affected:
◦ The red cells (erythrocytes)
◦ The white cells (leucocytes)
◦ The platelets (thrombocytes)
Red cell shape abnormalities
The normal erythrocyte on a blood film is
circular with central palor
Nearly uniform in size with a mean diameter
of approximately 7.5µm in diameter
Poikilocytosis is the term used to describe
variations in shape of erythrocytes
The predominant appearance of a specific
abnormality in red cell shape can be an
important diagnostic clue in patients with
anaemia
Red cell shape abnormalities cont’d
Some examples of poikilocytes includes:
◦ spherocytes; heriditary spherocytosis, immune
haemolytic anaemia
◦ Elliptocytes; heriditary elliptocytosis, IDA, MBA,
Myelofibrosis, MDS etc
◦ Dacrocytes (tear drop); xtic MF. Also seen in severe
IDA,
◦ Schistocytes; MAHA, mechanical HA
◦ Echinocytes; renal failure, malnutrition
◦ Acanthocytes; abetalipoproteinaemia
◦ Stomatocytes; heriditary stomatocytosis
◦ Target cells; thalassaemias, liver disease etc
Red cell size abnormalities
The normal size of an erythrocyte is about the
diameter of the nucleus of a small lymphocyte
though the MCV is a more sensitive measure of
the red cell volume than the diameter.
Anisocytosis is the term used to describe the
variation in size of erythrocytes and is the
morphologic correlate of RDW.
Macrocytes and microcytes are red cells larger
or smaller than normal, their presence is
usually consistent with the measured MCV and
suggest some diagnostic possibilities.
Red cell size abnormalities cont’d
Causes of macrocytosis
◦ Megaloblastic: folate or vitamin B 12
◦ Non-megaloblastic: alcohol, liver disease,
myelodysplasia, aplastic anaemia etc
Causes of microcytosis
-iron deficiency anaemia, thalassaemia,
anaemia
of chronic disease, lead poisoning,
sideroblastic anaemia
*dimorphic blood picture
Red Cell size and shape
abnormalities cont’d
Red Cell size and shape
abnormalities cont’d
Red cell inclusion abnormalities
Some inclusions inside red cell may be found and
may suggest a particular diagnosis
◦ Basophilic stippling- evidence of dyserythropoeisis eg seen
in lead poisoining, MBA, Thalassemia etc causing
accumulation of denatured RNA in red cells.
◦ Siderotic granules(pappenheimer bodies)- siderotic
erythropoeisis as in sideroblastic anaemia
◦ Heinz bodies- oxidised denatured haemoglobin as in G6PD
def
◦ Howell-jolly bodies- DNA remnant of RBC nuclei seeing in
blood film of patients with asplenia eg post splenectomy,
SCA etc
◦ Micro organism may also be found such as malaria parasite
Red Cell Inclusions cont’d…
Red Cell Inclusions cont’d…
Red Cell Inclusions cont’d…
Red Cell Inclusions cont’d…
Red Cell Inclusions cont’d…
Red Cell Inclusions cont’d…
Red Cell Inclusions cont’d…
White cell nuclear abnormalities
Pelger-Huet anomaly : bilobed neutrophil are
found in the peripheral blood. Congenital or
acquired
Hypersegmented neutrophil : occurs in MBA
White cell cytoplasmic inclusions
abnormalities
Toxic granules : overt large blue-black granules seen in neutrophils
in inflammatory conditions
dÖhle bodies : remnant of RNA blue rod-shaped structures found in
the cytoplasm of neutrophil usually in inflammatory condition
May-Hegglin disease : large blue-gray or basophilic inclusions seen
in the cytoplasm of neutrophils, ass with mild thrombocytopenia
and giant platelet. Inheritance is AD
Chediak-higashi syndrome : giant eosinophilic granule in monocyte
and numerous enlarged granules in lymphocytes. Granules can also
be seen in neutrophils and eosinophil, with assoiated neutropenia,
thrombocytopenia and marked hepatosplenomegaly. Inheritance is
AR.
Auer-rods : red staining rods found in the cytoplasm of blast cells
and occassionally in more mature leukaemic cells
mucopolysaccharide disorders : abnormal granulation or
vacoulations
White cell inclusions abnormalities;
Toxic granules
Chediak Higashi dx(note the large eosinophilic granule
in the monocyte and the numerous enlarged granules
in lymphocyte)
Hurler syndrome(dense cytoplasmic
inclusions in the mononuclear cell)
Example of apoptosis in neutrophils
(nuclear condensation and fragmentation)
. Döhle bodies. These RNA remnants in
neutrophils involved in inflammatory reactions
May-Hegglin disease. The large
blue-gray inclusions.
Platelet size abnormalities
Platelet appear in normal blood film as small blue or
colourless with red or purple granules
Normal platelets average approximately 1 to 2 μm in
diameter, but show wide variation in shape, from
round to elongated, cigar-shaped forms.
The most frequent occurrence of giant platelet is
myeloproliferative disorders (giant to small). Others
include Bernerd-Soulier syndrome.
Improper collection of platelet (during sample
collection); platelet becomes activated before the
sample is thoroughly mixed and they appear in
masses.
