Blood Morphology

Blood morphology adds greatly to the value of a routine blood count. A skilful examination of a well-made blood smear constitutes the most valuable single procedure in the hematology laboratory. Despite normal blood count figures, careful observation of blood morphology suggested previously unsuspected disorders. For example, in some cases, the finding of hypersegmented neutrophils on the blood smear was the first hematologic clue to a significant deficiency of vitamin B12 or folate, the erythrocytes lacking the characteristic macrocytosis associated with such deficiencies.

Hypersegmented Neutrophil

The reporting of blood morphology has been improving in recent years, although in many clinical laboratories, it still receives little attention. The blood count report form frequently leaves only a tiny area for morphologic comments!

A blood smear is a drop of blood spread thinly onto a glass slide that is then treated with a special stain and examined under a microscope by a trained laboratorian. It is a snapshot of the cells that are present in the fluid portion of the blood (plasma) at the time the sample is obtained.  The results of a blood smear typically include a description of the appearance of the red blood cells, white blood cells, and platelets as well as any abnormalities that may be seen on the slide.

Red Blood Cell Morphology

Red blood cells (erythrocytes) are biconcave disks with a diameter of 7-8 microns, which is similar to the size of the nucleus of a resting lymphocyte.  In normal red blood cells, there is an area of central pallor that measures approximately 1/3 the diameter of the cell.  Though reference ranges vary between laboratories and in different age groups, normocytic red blood cells typically have a mean corpuscular volume (MCV) between 80-100 fL.

Normal RBCs

Normal RBCs

Spherocytes are formed when there is a loss of part of the red blood cell membrane.  This may occur in the setting of immune-mediated hemolysis or congenital red cell membrane defects such as hereditary spherocytosis.  Spherocytes are smaller than normal red blood cells and lack central pallor.  They are less deformable and less able to navigate through small vessels, leading to increased destruction in the spleen.

Spherocytes – Hereditary Spherocytosis

Microcytic red blood cells measure 6 microns or less in diameter.  The mean corpuscular volume is generally less than 80 fL, though the normal range varies slightly between laboratories and in different age groups.  In contrast to spherocytes, which are also decreased in diameter, microcytes retain their central pallor.  In microcytosis due to iron deficiency, the central pallor is increased (more than 1/3 the diameter of the cell).

Microcytosis with lymphocyte for comparison

Teardrop cells in a peripheral blood smear from a patient whose bone marrow was extensively replaced by B lymphoblastic leukemia.  Teardrop cells may be seen in the setting of marrow infiltration (by fibrosis, granulomatous inflammation, hematologic or metastatic malignancy), splenic abnormalities, megaloblastic anemia, and thalassemia.  True teardrop cells have slightly rounded or blunted ends.  In contrast, teardrop cells that are formed as an artefact of smear preparation have very sharp points, all facing in the same direction.

Teardrop Cells (Dacrocytes)

Cabot rings are thin, threadlike, red to violet rings or “figure 8” shaped inclusions in red blood cells.  Cabot rings are remnants of the mitotic spindle and can be seen in megaloblastic anemia, medication effect, myelodysplasia and other forms of dyserythropoiesis.  In this image of a blood smear from a patient with vitamin B12 deficiency, the Cabot ring is visible as a faint ring-shaped inclusion in the polychromatophilic cell in the center of the field.

Cabot Ring

Peripheral blood smear of a 38-year-old female with long-standing Crohn’s disease (CD) and development of microcytic anemia. The smear shows numerous target cells and a spur cell (top right). All liver function tests were abnormal indicating that the target cells are due to liver disease secondary to CD. This patient originally had a concomitant iron deficiency. Spur red cells have elongated projections while Burr cells are red cells with circumferential blunted borders. The former is typically seen in liver disease while the latter is seen in uremia. The “Burr” morphology, in this case, is artifactual related to slide preparation and not related to uremia.

Target and Spur cell in liver disease

Acanthocytes in two patients with liver disease. Acanthocytes (also called spur cells) are spiculated cells with irregular, pointed or club-like projections that are unevenly distributed on the cell surface.  Central pallor is absent.  Acanthocytes form as a result of membrane lipid abnormalities and can be seen in liver disease, neuroacanthocytosis, severe malnutrition, and abetalipoproteinemia.


Acanthocytes (Spur Cells)

Sickle cells (drepanocytes) are elongated red blood cells with pointed ends.  They are seen in sickling hemoglobinopathies such as sickle cell anemia (homozygous hemoglobin SS), hemoglobin SD disease, and hemoglobin S/beta-thalassemia.

Sickle Cells

Echinocytes (Burr Cells) have multiple short, blunt projections evenly spaced over the cell surface.  The central pallor is retained.  Echinocytes can be seen in uremic patients.  They can also be seen as an artefact of slide preparation or prolonged specimen storage.

Burr Cells or Echinocytes

Stomatocytes are red cells with a slit-like or “fish-mouth” central pallor. Stomatocytes may be seen in patients with alcoholic liver disease, hereditary stomatocytosis, or Rh null disease, among other conditions.  They may form in vitro in the presence of certain cationic medications or low pH.


Red cell fragments (schistocytes) in a patient with microangiopathic hemolysis due to thrombotic thrombocytopenic purpura (TTP).  Small triangulocytes and larger, crescent-shaped helmet cells are present.  Both of these are red cell fragments and would be included in the schistocyte count.  When numerous small schistocytes are present, automated cell counters may count the small red cell fragments as platelets, leading to a falsely elevated automated platelet count.

Schistocytes – triangulocytes and helmet cells

Oxidative hemolysis induced by furosemide in a patient with G6PD deficiency.   In oxidative hemolysis, the peripheral smear may show irregularly contracted red blood cells, hemighost or blister cells, and spherocytes.  Irregularly contracted cells lack central pallor, and the hemoglobin appears condensed and irregularly distributed in the red blood cell.

Irregularly contracted cells in oxidative hemolysis

Clumping (agglutination) of red blood cells is frequently caused by cold agglutinins.  Cold agglutinins are IgM antibodies that may arise following viral or Mycoplasma infections, or in the setting of plasma cell or lymphoid neoplasms.  Agglutination of red cells can interfere with red blood cell indices.  The red blood cell count may be falsely decreased, and the MCV falsely increased, as clumps of red cells are measured as single cells.  The hemoglobin level will be accurate, as this parameter is measured after lysing the red cells.

Red Cell Agglutination

Polychromasia (polychromatophilic cells) in a neonate.  Polychromatophilic cells are young red blood cells that have been recently released from the bone marrow.  They are larger than mature red cells, and are bluish in color.  Polychromasia is increased in hemolysis, blood loss, and marrow infiltration.  Normal neonates have a higher number of polychromatophilic cells than older children and adults. Polychromasia

Howell-Jolly body: the red blood cell in the center of the image contains a Howell-Jolly body.  Howell-Jolly bodies are small (0.5-1 micron) purple inclusions that contain DNA.  They are thought to represent chromosomes that have separated from the mitotic spindle that is left behind when the red cell nucleus is extruded.  These inclusions are generally removed by the spleen.  Patients with asplenia or hyposplenism may have increased Howell-Jolly bodies on their peripheral blood smear.  A nucleated red blood cell is also present at the bottom left side of the image. Howell-Jolly body

Blood Morphology – Erythroid Precursors

Proerythroblasts (also called pronormoblasts) are the earliest erythroid precursors.  These are large cells with basophilic, agranular cytoplasm, round nuclei, and high nuclear-cytoplasmic ratios.  The chromatin is evenly dispersed but is slightly more dense than myeloblast chromatin.  One or more nucleoli may be visible.  A perinuclear clear area (hof) may also be seen.  A single proerythroblast is seen in the center of this image.  Polychromatophilic and orthochromic normoblasts are present on the right side of the field.


Basophilic normoblasts (also called basophilic erythroblasts or early erythroblasts) are smaller than proerythroblasts, with more condensed chromatin and lower nuclear-cytoplasmic ratios.  The cytoplasm is deep blue, and a pale perinuclear halo may present. The two cells in the center of the field are basophilic normoblasts.

Early Erythroblasts

Orthochromic normoblasts (also called orthrochromatophilic normoblasts, orthrochromatophilic erythroblasts, or late erythroblasts) are slightly larger than mature red blood cells.  They have small, round nuclei and dense, pyknotic chromatin.  The cytoplasm is generally slightly more basophilic than the cytoplasm of a mature red blood cell.

Late Erythroblasts

Erythroid precursors at various stages of maturation.  Basophilic normoblasts are present at the center of the field.  Polychromatophilic normoblasts and orthochromic normoblasts are present near the bottom of the field.  As erythroid precursors mature, the cell size and nuclear-cytoplasmic ratio decrease, and the chromatin becomes progressively more condensed.  The cytoplasm changes color from deep blue to gray-blue to gray-pink as the hemoglobin content increases.

Erythroid Precursors

A deficiency of either vitamin B12 or folic acid results in megaloblastic erythroid cells-megaloblasts. These deficiencies result in a decrease in DNA synthesis which slows and inhibits DNA replication (nuclear division). Nuclear maturation is slowed whereas cytoplasmic maturation (largely dependent on RNA function) is unaffected. The impaired nuclear maturation is seen as open, loose, immature chromatin (cut-salami pattern). In contrast to the nucleus, the cytoplasm of megaloblastic cells is abundant with normal hemoglobinization. This disparity between the nucleus and cytoplasm is known as nuclear-cytoplasmic asynchrony. Although most noticeable in erythroid cells failure of DNA synthesis also affects myeloid and megakaryocytes. Giant bands and hypersegmented polymorphonuclear neutrophils are common.


Giant Bands

Vacuolated erythroid precursors can be seen in copper deficiency, Pearson syndrome, and myelodysplastic syndromes.  In this image, a vacuolated erythroid precursor is adjacent to another dysplastic erythroid precursor with megaloblastic features (nuclear-cytoplasmic asynchrony) and nuclear irregularities.  The patient had acute myeloid leukemia with myelodysplasia-related changes.

Vacuolated Erythroid Precursor

White Blood Cell Morphology

Mature segmented neutrophils have condensed chromatin and 2 to 5 nuclear lobes separated by thin filaments.  The cytoplasm is pale pink and contains numerous specific granules.  In healthy adults, approximately 40-80% of peripheral blood leukocytes are segmented neutrophils.

Blood Morphology

Band neutrophils are slightly less mature than segmented neutrophils and have indented, unsegmented “C” or “S” shaped nuclei.  Band neutrophils normally account for approximately 5-10% of peripheral blood leukocytes.  An increased proportion of band neutrophils can be seen in infectious and inflammatory conditions.

Blood Morphology

Toxic granulation in neutrophils is found in inflammatory states. The toxic granules are azurophilic and may be found in the promyelocyte, metamyelocyte, band (shown here), and mature stages.

Toxic Granulation Hypersegmented neutrophil in a patient with vitamin B12 deficiency.  Hypersegmented neutrophils have 6 or more nuclear lobes. They are typically seen in megaloblastic anemia due to vitamin B12 or folic acid deficiency, but may also be present in myelodysplastic syndromes and rare congenital conditions.

Blood Morphology

Pelger-Huet anomaly is a congenital autosomal dominant anomaly in which neutrophil nuclei fail to segment normally. In homozygotes, the nucleus is round. In heterozygotes, most granulocytes have bilobed nuclei (“pince-nez” cells) resembling bands.

Pelger-Huet anomaly Neutrophils with prominent hypolobation and Pseudo Pelger-Huet cytomorphology in a patient seen in the posttransplant setting. This patient was on mycophenolate which is sometimes known to induce such changes. One must be cautious not to make a diagnosis of myelodysplastic syndrome in the setting.

Pseudo Pelger-Huet cells

Neutrophilic metamyelocytes have condensed chromatin and a slightly indented nucleus (the indentation is less than half the diameter of the nucleus). The cytoplasm contains abundant specific granules and rare primary (azurophilic) granules.  Metamyelocytes are not normally present in the peripheral blood but can be seen in infectious or inflammatory states, and other reactive and neoplastic conditions.

MetamyelocyteMyelocytes contain both primary (azurophilic) and secondary/specific (pink or lilac) cytoplasmic granules.  The proportion of secondary granules increases as the cell matures.  The nucleus is round and lacks a nucleolus.  The chromatin is more condensed than that of promyelocytes.  Myelocytes are not normally present in peripheral blood, but may be seen in infectious/inflammatory conditions, growth factor effect, marrow infiltration, and myeloid neoplasms. Myelocyte

Promyelocytes are larger than myeloblasts and have basophilic cytoplasm containing primary (azurophilic) granules.  A Golgi zone may be visible as a paranuclear hof or clearing.  The nuclear chromatin is finely dispersed, and nucleoli may be visible.  Promyelocytes comprise approximately 2% of nucleated cells in the bone marrow and do not circulate in peripheral blood under normal conditions.


Myeloblasts are approximately 15-20 microns in size and have high nuclear-to-cytoplasmic ratios.  The nucleus is usually round to oval but may be irregular.  The chromatin is smooth and open, and one or more nucleoli may be present.  The cytoplasm is pale blue.  Cytoplasmic granules are not typically seen, though rare small granules may be present.  Leukemic myeloblasts may contain a few cytoplasmic granules or Auer rods, which are reddish, linear structures composed of fused primary granules.  The presence of Auer rods indicates myeloid malignancy.

Myeloblast with Auer rodsEosinophils measure 10-17 microns in diameter and have abundant, slightly basophilic cytoplasm containing numerous coarse, reddish-orange cytoplasmic granules.   Most eosinophils have bilobed nuclei, but occasional forms with trilobed nuclei may be seen.  The chromatin is condensed.   Eosinophils usually account for a minor subset of peripheral blood leukocytes.  Increased numbers of eosinophils can be seen in parasitic infections, allergic conditions, drug hypersensitivity, myeloid neoplasms, and lymphoproliferative disorders.


Basophils have segmented nuclei that are often at least partially obscured by abundant coarse, dark blue to purple cytoplasmic granules.  Basophil granules are water soluble, and may wash out during staining.  Basophils normally circulate in low numbers.  Basophilia may be seen in inflammatory and allergic conditions, hypothyroidism, and myeloproliferative neoplasms.


Normal resting lymphocytes are small cells with condensed chromatin and a small amount of pale basophilic cytoplasm.  The nucleus of a resting lymphocyte is just slightly larger than a red blood cell.

resting lymphocyteReactive lymphocytes show a range of morphologic features.  Reactive lymphocytes with immunoblast-like morphology are large cells with high nuclear-cytoplasmic ratios, condensed chromatin, and deeply basophilic cytoplasm.   Another type of reactive lymphocyte has less condensed chromatin and abundant, pale blue cytoplasm that may appear to “hug” adjacent red blood cells.  These cells are also called Downey type II cells.  They can be seen in a variety of conditions, but are often increased in infectious mononucleosis due to EBV infection.

Reactive Lymphocyte

Reactive Lymphocyte

Reactive Lymphocyte

Lymphocytes with peripherally clumped chromatin and often deep blue cytoplasm similar to plasma cells are termed plasmacytoid lymphocytes. These transitional forms between lymphocytes and plasma cells are seen in the blood of patients with viral infections. These cells are variously known as atypical lymphocytes, lymphocytoid plasma cells or plasmacytoid lymphocytes.

atypical lymphocyte

Monocytes measure 12-20 microns in diameter and have abundant greyish-blue cytoplasm and fine, azurophilic cytoplasmic granules. Cytoplasmic vacuoles may be present. The nucleus is irregular, indented, or kidney-shaped. Although the chromatin is condensed, it is somewhat finer than the chromatin of a mature neutrophil or resting lymphocyte.

Monocyte ImageNormal monocyte in circulation with folded nuclei and abundant vacuolated cytoplasm.Normal Monocyte

Acute monoblastic/monocytic leukemia: blasts may vary in appearance. The cytoplasm may contain fine granules or vacuoles.


Peripheral smear from a patient with monocytic leukemia. The monocytes are dysplastic with vacuolated and irregular cytoplasm.

acute monocytic leukemia

Platelet Morphology


Platelets are anucleate cells derived from megakaryocyte cytoplasm. Normal platelets are 1.5-3 microns in diameter and have pale blue cytoplasm. Platelets contain dense granules and alpha granules. The alpha granules are the fine purple granules that are visible on routine blood smears.

Giant Platelet and Dacrocytes

Large platelets have a diameter greater than 4 microns. Giant platelets have a diameter greater than 7 microns (larger than a normal red blood cell). Large platelets can be seen when platelet turnover is increased (as in immune thrombocytopenic purpura). They may also be present in myeloproliferative neoplasms, myelodysplasia, and some congenital thrombocytopenia syndromes, including Bernard-Soulier syndrome and MYH9-related disorders. Giant platelets may fall outside the upper size threshold for platelets on hematology analyzers. If sufficient numbers of giant platelets are present, the automated platelet count may be falsely decreased.

Platelet clumping can lead to a falsely decreased automated platelet count (pseudo thrombocytopenia/spurious thrombocytopenia). At higher magnification, the platelets within the aggregate appear normal in structure and granularity. Causes of platelet clumping include platelet activation (due to traumatic venipuncture) and EDTA-dependent antibodies that react with platelet glycoprotein IIb/IIIa.  In the latter case, the clumping can be corrected by using blood collection tubes containing an alternative anticoagulant, such as sodium citrate.

Platelet Rosetting

Blood smear showing neutrophil aggregate with platelet satellitism: a rare phenomenon of platelet rosetting around granulocytes observed in blood smears obtained from blood anticoagulated with EDTA. (May-Grünwald-Giemsa stain)

Platelet Morphology

A typical megakaryocyte is seen with platelets budding off the periphery. 

Platelet Morphology

Example of platelets release in mature megakaryocytes. This footage shows the formation and spontaneous release of platelets (small round-shaped blood cells), imaged with a live-cell imaging microscope.


Teresa Scordino. ASH Image Bank | American Society of Hematology:

Girish Venkataraman. ASH Image Bank | American Society of Hematology:

Peter Maslak. ASH Image Bank | American Society of Hematology:

John Lazarchick. ASH Image Bank | American Society of Hematology:

Perla Vicari. ASH Image Bank | American Society of Hematology:

Wikipedia contributors. (2023, September 13). Megakaryocyte. In Wikipedia, The Free Encyclopedia. Retrieved 22:54, December 4, 2023, from

Wikimedia Commons contributors. ‘File: Platelets release in mature megakaryocytes .gif’, Wikimedia Commons, 7 September 2023, 15:42 UTC, <> [accessed 4 December 2023]

Paul C. Hattersley, M.D. and Judith L. Engels, MT: The Reporting of Blood Morphology

Hattersley, P.G., and Engels, J.L: Neutrophilic Hypersegmentation Without Macrocytic Anemia, West. J. Med. 121:179-184, 1974.

De Gruchy, G.C.: Clinical Hematology in Medical Practice, ed 2, Philadelphia: F.A. Davis Co., 1964, p. 63.

Hattersley, P.G., and Ragusa, D.: Don’t Forget the Morphology: The Importance of Evaluation of Blood Smears, Calif. Med. 103:175-177, 1965.

Megaloblastic Anemia. Department of Pathology, University of Virginia, School of Medicine.


Red blood cells, White blood cells, Platelets, Hemoglobin, Hematocrit,
Mean corpuscular volume (MCV), Mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin concentration (MCHC), Differential white blood cell count, Blood smear, Blood film, Blood Morphology, Morphological Characteristics of Blood, Blood Cell Structure, Morphological Characteristics of Blood, Red Blood Cell Morphology, White Blood Cell Morphology, Blood Smear Examination, Abnormal Blood Morphology, Blood Cell Shape, Morphological Changes in Blood Cells.

Blood Morphology
Article Name
Blood Morphology
Blood morphology adds greatly to the value of a routine blood count. A skillful examination of a well-made blood smear constitutes the most valuable single procedure in the hematology laboratory.
Publisher Name
Publisher Logo


  • Merci beaucoup pour cet article très complet.

  • Yidnekachew Fiseha

    Please send me things that are new

  • What are Dohle Bodies on RBC morthphogy blood test.

    • Hi Diane,
      Thank you for your comment.
      Döhle bodies are single or multiple blue cytoplasmic inclusions that are remnants of rough endoplasmic reticulum. They are seen in bacterial infections but also following tissue damage including burns, in inflammation, following administration of G-CSF, and during pregnancy.

  • Lisa Lutterman

    Can I ask you a question?
    I have iron deficiency anemia. The red blood cell morphology shows polychromasia 2+, anisocytosis 2+, microsytes 2+, hypochromia 1+, schistocytes 1+, ovalocytes 1+, dacrocytes 1+. What came first? The anemia or the irregular numbers? Do these not indicate a blood disorder that would in turn cause anemia, or the other way around? I hope I hear back from you.

    • Hi Lisa,
      Thanks for your comment.
      Iron deficiency anaemia can cause red cell abnormalities including hypochromasia, microcytosis, pencil cells, and others. You should identify the cause of the iron deficiency and treat it.
      After treating the anaemia with iron supplements repeat your CBC and see if the abnormalities have disappeared or are still present, if they are still present I would suggest checking Hb electrophoresis, hemolysis screen, B12 and Folate.

  • Farseh robabeh

    Hi Dr.
    This article was very useful for me.

  • Henry

    This article was very useful for medical team in order to provide a proper treatment to our clients or patients.

  • Thank you so much for this article. It is teaching me to be able to identify the Cells and the inclusion of courses really helped.
    More of these articles help.
    Is there more where you include the CBC parameters for Medical Technicians beginners to have a better understanding of interpretation of slides.

  • Jacob

    very useful, thank you so much……this article is going to help me alot

  • patrice stewart

    I hope someone can help me, I was looking in my chart test results and I found this liste under morphology~
    Component Results
    Component Your Value
    Platelet Estimate Normal

    Polychromia Rare

    This blood test was done when I was in the hospital with some breathing issues a few yr back ,everytime I had asked my Primary care r she doesn’t know what it means,,, she sent me to a hematologist an all he saqi was Maybe some low iron ,I have no idea what this test was for and what the poly test reading says Rare. I would love to understand this test and find out what the result Rare means >> thank you for your help

    • Hi Patrice,
      Thank you for your comment.
      Polychromasia occurs on a lab test when some of your red blood cells show up as bluish-gray when they are stained with a particular type of dye.
      This happens when red blood cells are immature because they were released too early from your bone marrow.
      These immature cells are called reticulocytes.
      Certain blood disorders e.g. anemia can cause your bone marrow to release blood cells early, and these cells show up as polychromasia on a blood test called a peripheral blood smear.

  • curiousjas

    how to identify blood morphology using microscopy?

    • Hi Curiousjas,
      Thank you for your comment.
      Importantly, viewing blood smears under the microscope needs to be done shortly after blood collection employing sterile technique (**wearing gloves) from a disinfected site (wiping off 1st drop of blood). Using a high quality clean glass slide (flat, no distortions and corrosion resistant) of 75mm X 25mm and 1mm thickness is ideal. Then place the blood drop 1cm from the end of the slide.
      Proceeding with the 45 degree wedge or push slide technique used in manual and automated environments, creates a monolayer blood smear. This is done in a smooth and quick motion. Fixation, staining, washing and air drying are quickly commenced. When staining either Romanowsky, Wright’s or Giemsa stain are used or a combination thereof, usually simply Wright’s stain.
      Read More

  • Dr Rakibul Hoque

    it was a worth reading. the content was informative. I have enriched myself reading this one.

  • Very inspiratif, thank you

  • Jacqueline Daniels

    Hello Doctor,

    I had been hospitalized after closed head impact injury, severe pulsating headache through my skull that felt like I was dying. I had sweating fever, vomiting, slurring, cognitive decline for ten days with walking instability-turned-lower leg paralysis, prior to becoming comatose and given 5% survival rate to live. What started as as small collection LSD amassed to becoming acute on chronic an bilateral subdural hematomas while awaiting craniotomy; I am trying to make sense of the bloodwork resulting in Abnormal RBC Morphology daily. I have read that the presence of slightly immature red blood cells may indicate hemorrhage, but not much more than that. I am trying to understand how Abnormal RBC Morphology results equate to the head trauma if at all.

    • Hi Jacqueline,
      Thank you for your comment. I am sorry to hear about your recent sufferings following a head injury. I hope you are feeling better now.
      Regarding your question about the immature RBCs on your blood film, it is not clear from your comment which type of immature RBCs you were referring to. Did you mean reticulocytes and polychromasia or NRBCs?
      Reticulocytes are immature RBCs which increase in numbers following hemorrhage and is a physiological body response which shouldn’t cause concerns. However, NRBCs shouldn’t be seen on the blood smear under normal conditions.
      Please let me know which type of immature RBCs you were referring to so I can provide you with the correct information. If you have any other questions or concerns, please don’t hesitate to ask.
      Best regards,
      Dr M Abdou

  • Christine Self MIBMS

    Amazing! I trained in 1958 & looking at all your slides I’m amazed at how much I retained in spite of not working in Haematology since I had the children in the late ’70s. The only change I can see is the current term for poikilocytes! Cheered me up no end. I was originally searching for the name of the arthritis linked disorder that produced a sort of nuclear lysis in white cells – it is on the tip of my tongue but evading me. The method for testing in those days was a right pain & I’m pretty sure there is a nice simple test for it now. Thank you for making my day.

    • Hi Christine,
      Thank you for your comment.
      I’m glad to hear that you found the article interesting and that you’ve regained your knowledge of blood morphology.
      It’s possible that you were referring to systemic lupus arthritis and LE cells.
      If I’m right here is a link to the LE cells
      Best regards,
      Dr M Abdou

  • Chloe

    Thank you so much for this article! I’m a biomedical sciences student and this helped a lot for me to identify different cells and different diseases based on cell morphology. I appreciate all the effort you put in and I hope you are doing very well in life!

  • Jen

    My hemoglobin was 8.3. I was treated for a year and my hemoglobin and iron stores returned to normal. A year after stopping supplements my hemoglobin was back down to 8.2. I took iron supplements again for 1 month and retested. My CBC then showed hemoglobin 11.4, normal lymphocytes, ABN lymphocytes high, anisocytosis 4+, elliptocytes +4, RBC morphology abnormal: tear drop cells present, Dimorphic RBC population present.
    I was referred to a hematologist. I’m wondering if this is necessary or if my results are just due to having iron deficiency anemia.

    • Hi Jen,
      Thank you for your comment.
      While the abnormalities could be related to your known iron deficiency, it would be advisable to consult a hematologist due to the high lymphocyte count and presence of tear drop red cells.
      Best wishes,
      Dr. M Abdou

  • Jennifer

    I was diagnosed with iron deficiency anemia over two years ago. My hemoglobin was 8.3. After being on iron supplements for 6 months my hemoglobin and iron stores were back to normal, so iron supplements were stopped.
    Two months ago I had routine bloodwork done and my hemoglobin level was 8.2. I was put back on iron supplements again and re-test a month later. Those test results showed hemoglobin 11.4, MCV, MCH, MCH, absolute granulocytes, and absolute monocytes all low, RDW unable to report due to abnormal histogram, RBC morphology: tear drop cells and Dimorphic RBC population present, normal lymphocytes but high ABN lymphocytes, platelet evaluation: adequate Large Platelets present, Anisocytosis 4+, and Elliptocytes 4+.
    I have now been referred to a hematologist. Could all of these abnormal results just due to the iron deficiency anemia?
    Thank you

Leave a Reply

Your email address will not be published. Required fields are marked *