Morphology of
Cells on the
Normal Blood
Smear
Morphology of Cells on the Normal
Blood Smear
► First
and most important step in obtaining
information leading to diagnosis of hematologic
disorder is examination of cellular elements of
blood.
► Identifying cell types and morphology very
important skill to master
► Will learn to identify leukocytes, erythrocytes and
platelets
► In this chapter, you will begin to learn how to
identify each of the cellular elements of the blood
and to recognize both normal and abnormal
morphologies.
A
B&H
C&E
D
F
G
I
J
Erythrocytes (RBCs)
Lymphocytes
Segmented neutrophil
Eosinophil
Monocyte
Platelets
Neutrophilic band
Basophil
Normal Adult Values for Leukocytes
LEUKOCYTE TYPE
Segmented Neutrophil
% IN NORMAL
ADULT BLOOD
50-70%
Band Neutrophil
2-6%
Eosinophil
0-4%
Basophil
0-2%
Lymphocyte
20-40%
Monocyte
2-9%
Erythrocytes
(RBCs)
Erythrocytes (RBCs)
► Evaluated
1 of 2
in an area of stained slide where
red cells evenly distributed and do not
overlap (feathered edge).
► Consist of plasma membrane surrounding
solution of proteins and electrolytes.
► Is biconcave disc that is 7-8 μm in diameter.
Erythrocytes (RBCs)
► After
2 of 2
being stained, is circular cell with
distinct and smooth margins and a pinkish
color. In center of cell is an area of central
pallor. Should be fairly uniform in shape and
size. Have no nuclear inclusions.
Platelets
(PLTs)
(Thrombocytes)
Platelets (Thrombocytes)
► Evaluate
the number and morphology of
platelets in the feathered edge of smear.
► Are approximately 2-4 μm in diameter and
vary in shape.
► Should see between 7 and 15 platelets per
oil immersion field. Do an estimate in a
minimum of ten fields.
► On stained smear, will have reddish-purple
granules and small amount of bluish
cytoplasm. Have no nucleus.
White Blood Cells
(WBCs)
(Leukocytes)
Leukocytes or WBCs
► Are
five different types of leukocytes
commonly found on peripheral blood
smears: neutrophils, eosinophils,
basophils, lymphocytes, and monocytes.
► Immature cell forms are considered
abnormal. Any abnormalities in cytoplasm
or nucleus should be noted.
► Granulocytes
 ‘Segs’ & ‘Bands’
 Eosinophils
 Basophils
Neutrophil
Segmented Neutrophil
► Comprise
50-70% of mature
granulocytes on peripheral blood
smear.
► Also called filamented neutrophil,
polymorphonuclear neutrophil, or
"seg".
► Nucleus is segmented into two to
five lobes, with a narrow segment
or filament connecting lobes.
► If have one lobe, call a "band".
1 of 3
Segmented Neutrophil
► Nuclear
chromatin heavily
clumped, coarse, or pyknotic
and stains purplishred. Cytoplasm is light pink
and secondary granules are
fine, numerous and evenly
distributed. Granules stain
either pink or neutral color.
► Secondary granules contain
lysosomes.
2 of 3
Segmented Neutrophil
► About
twice the size of
normal erythrocytes.
► Play important roles in
inflammation and
phagocytosis.
► May migrate from
bloodstream into
surrounding tissues.
1 of 3
Band Neutrophil
►
►
►
►
►
Blood normally contains 2-6% band
neutrophils.
Have a horseshoe shaped nucleus
in which opposites are almost
parallel.
Do NOT have lobes connected by
filament.
Nuclear chromatin clumped and is
usually pyknotic mass at each pole.
Secondary granules are small,
evenly distributed, and stain various
shades of pink.
1 of 2
Band Neutrophil
► May
have difficulty in
distinguishing between mature
segmented neutrophil and a
band neutrophil. Filaments are
threadlike connections with no
visible chromatin in them
► Also, lobes may overlap,
making seeing filaments very
difficult.
► If in doubt, call cell the more
mature form!!
2 of 2
Eosinophil
► Have
large, round, secondary,
refractile granules that stain
bright reddish-orange.
► Granules evenly distributed
and uniform in size.
► Normally see 0-4% eosinophils
in peripheral blood.
► Slightly larger than neutrophils
and have band or two-lobed
nucleus with condensed
chromatin.
Basophil
► Normally
0-2% normal blood
cells.
► Have large, abundant, purpleblack granules. Granules are
visible above nucleus as well as
lateral to nucleus. May
obscure nucleus from view.
► Granules are coarse, vary in
size, number, shape and
color. Are unevenly
distributed.
Lymphocytes
► Are
the second most common
leukocyte. Comprise 20-44% of
blood cells.
► Most are small in size. Variable in
size. Do not use size as a criteria
in determining cell type.
► Tend to become small and
spherical in thick areas of
smear. May spread out and
appear large in thin areas of
smear.
1 of 3
Lymphocytes
► Cytoplasm
stains blue (robin egg
blue). May vary in color
intensity.
► Most do not have granules. May
have few granules that stain
purplish-red. Have been called
azurophilic granules.
► Diameter of small lymphocyte
slightly larger than
erythrocyte's. Has large nucleus
in relationship to amount of
cytoplasm available. Nuclei
round or slightly indented.
2 of 3
Lymphocytes
► Chromatin
structure
is lumpy or
clumped and stains
dark purple.
► Nucleoli may be
present but are
not visible in
light microscopy.
3 of 3
Monocytes
►
►
►
►
►
Is large cell. Is larger than mature
neutrophil.
Have abundant cytoplasm in
relation to nucleus. Cytoplasm is
dull blue-gray color.
Have numerous small granules
evenly distributed throughout
cytoplasm. Gives cytoplasm a
"ground glass" appearance.
May also contain no granules or
very large granules.
May also see digestive vacuoles in
cytoplasm.
1 of 2
Monocytes
► Nucleus
may be kidneyshaped, deeply folded or
indented, and occasionally
lobular. Nucleus may appear
convoluted - resembling
brain.
► Chromatin may be lacy and
delicate appearing.
► Size is variable. May see
blunt pseudopods.
► Account for 2-9% of normal
blood leukocytes.
1 of 2
Large Lymphocyte Versus Monocytes
► Easy
to confuse them.
► Use chromatin
structure, character of
cytoplasm, and shape
of cell to aid in
differentiation.
Summary
A
B&H
C&E
D
F
G
I
J
Erythrocytes (RBCs)
Lymphocytes
Segmented neutrophil
Eosinophil
Monocyte
Platelets
Neutrophilic band
Basophil
Normal Adult Values for Leukocytes
LEUKOCYTE TYPE
Segmented Neutrophil
% IN NORMAL
ADULT BLOOD
50-70%
Band Neutrophil
2-6%
Eosinophil
0-4%
Basophil
0-2%
Lymphocyte
20-40%
Monocyte
2-9%