blood cells morphology
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The morphology of Blood cells
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Composition of the blood
The circulating blood is composed of plasmaand cells.The cells are red cells (or erythrocytes),
white cells (or leucocytes) and platelets .Blood cells can be identified in blood films
stained with a mixture of basic and acidicdyes.Normal white cells are divided intopolymorphonuclear leucocytes (orgranulocytes) and mononuclear cells.
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White blood cells
There are three types of granulocyte named
according to theirstaining characteristics inblood films. They areneutrophils ,eosinophilsand basophils .
Mononuclear cells aredivided intolymphocytes andmonocytes .
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Neutrophils
The neutrophils inthe circulatingblood are mainlymature segmented
neutrophils.
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Band form NeutrophilsThere are smallernumbers of cells of neutrophil lineage withnon-segmented nuclei.They are referred to asneutrophil band cells orband forms. They areless mature thansegmented neutrophils.
An increased numberof band cells is referredto as a'left shift'.
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Eosinophil
One eosinophil -mature. Normalblood - 100X.
Orange colourgranules.Bi-lobed nucleus.
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Basophil
One maturebasophil.Blackish granules
overlying thenucleus.
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Normal lumphocytesLymphocytes are thesmallest W BC .They have largecondensed nucleus,with a scanty bluish
cytoplasm.
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Normal monocyteMonocytes are thelargest W BC .The nucleus isslightly indented .The cytoplasm isabundant, sky bluein colour.Some have vacuolesin the cytoplasm.
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Red cells
Normal red cells orerythrocytes showonly slight variationin size and shape.The blood filmshould be examined
in the area wherethe red cells aretouching but not often overlapping.
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Red cells
. In this area many redcells have an area of
central pallor which maybe up to a third of thediameter of the cell. Thisis consequent on theshape of a normal redcell, which resembles adisc that is thinner in thecentre.
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Platelets
Normal platelets arealso apparent. Theyare small anuclearfragments betweenthe red cellscontaining smallpurple-staininggranules.
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Platelet ribbon
A string of plateletsor Platelet Ribbon.
This is theappearance of normalplatelets when beingshed by amegakaryocyte into
the marrow sinus.The ribbon thenbreaks up intonumerous smallplatelet fragments.Normal blood - 100X
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Platelet aggregates
P latelet aggregates maybe
composed of apparentlyintact platelets, degranulatedpale grey platelets or amixture of both, as inthis example. If theplatelet count is low it isessential to examine theblood film carefully forplatelet aggregates.
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Platelet satellitism
P latelet satellitismdescribes the
phenomenon of adherence of platelets towhite cells.It is an in vitro
phenomenon of no
clinical significance.However it is important that it is detected sincethe platelet count will befactitiously low.
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Nucleated epithelial cellsExtraneous non-haemopoietic cells are
sometimes seen in bloodfilms. These includeepithelial cells which arereadily identified fromtheir abundant sky-blue
cytoplasm and smallcentral nucleus. Theyare more often seenif capillary blood is
obtained by
percutaneous puncturethan when a film is
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ArtefactsFixation artefact is theterm used for the
artefact that occurswhen there is water inthe methanol used forfixation of the bloodfilm.This leads torefractile rings in redcells and makes it quiteimpossible to assess redcell morphology.
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Heat artefact Inadvertent heating of ablood
sample, for exampleduringtransport in a hot car, canlead to a heat artefact.R ed cells bud off
vesicles andmicrospherocytes seen.
W hite cells disintegrateand
proteins coagulate,producing weakly
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Storage artefact P rolonged storage of bloodbefore making the blood film,particularly storage at roomtemperature,leads to storageartefact.W hite cells become fragile
and may form smear cells[deep red arrow].Neutrophil nuclei round up
and form homogeneousround masses or a singlemass [blue arrow].These cellshave a resemblance to N R BC .R ed cells undergo an
echinocytic change orcrenation.