Microscopy of Abnormal Cells

Microscopy of Abnormal Cells

Red Blood Cells

·        Oval macrocytes + hypersegmented neutrophils Þ megaloblastic anaemia (B12/folate)

·        Target cell RBCs (haemoglobin in the middle – non-specific): most commonly seen in patients with liver disease (eg too much alcohol)

·        Small pale RBCs, target cells + pencil poikilocytes (elongated RBCs) Þ iron deficiency

·        Rouleaux: red cells stack like coins, fall fast if high ESR.  Stick together due to ­immunoglobulin or

·        fibrinogen).  Causes: inflammation, myeloma

·        No lighter patch in middle Þ spherocytes

·        Spherocytosis: if only some RBCs, then spleen has taken out a bit of membrane => autoimmune haemolytic anaemia. If all RBCs are spherocytes then hereditary spherocytosis. If spherocytes + reticulocytes then spherocytic anaemia

·        Cygnet shape (ring form with blue circumference) inside cell Þ malaria parasite

·        Tear drop red cells Þ myelofibrosis or polycythaemia

·        ­ Polychromasia Þ some red cells a bit blue due to stain – still contain some RNA

·        Reticulocytes: normal is 0.2 – 2%. Look big and blue. Will be high in anaemia (except ?anaemia of chronic disease)

·        Howell-Jolly Bodies: Little purple/black dots (like a ball bearing) in RBC = remnant DNA that hasn‟t been removed by the spleen. Seen in splenectomy patients

·        Fragmented cell: red cell sliced in circulation (DIC, artificial heart valve)

White Blood Cells

·        Normal lymphocyte: small, little/no cytoplasm

·        Neutrophils have multilobed nuclei, >= 6 lobes is hypersegmented (megaloblastic anaemia: B12, folate. Also drugs, chemotherapy, renal failure)

·        Plasma cell: eccentric nuclei, clock-face chromatin. If eccentric nucleus (clear area next to nucleus) in bone marrow Þ multiple myeloma

·  Neutrophil maturation:

·        Normal differentiation: Neutrophils 80%, Lymphocytes 20%

·        Lymphocyte: Toxic Changes (i.e. „switched on‟): ­granules, vacuoles, Dohle bodies (blue clumps in cytoplasm), nuclear clumping. Strong indicator of bacterial infection

·        If high lymphocytes and lots of „atypical lymphocytes‟ then viral infection: EBV, HIV, CMV

·        Auer rods in a blast Þ acute myeloblastic leukaemia

·        Eosinophil: normal is reddish cytoplasmic granules. ­ In toxoplasmosis, allergy (asthma, drugs, etc), gut parasites

·        Bone marrow biopsy: normal is about ½ fat, ½ cellular

 Leukaemias

·        Smudge cells Þ CLL.  Middle aged, significant lymphadenopathy

·        ­WCC, enlarged lymph nodes, splenomegaly, lots of white cells, majority are mature neutrophils Þ CGL (= CML)

·        Acute leukaemias: cells not mature