Morphology of Human Blood and Marrow Cells:

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Chapter 1

• Morphology of Human Blood and Marrow Cells
• Hematopoiesis

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1. Study Questions2. Homework Assignment3.
Exam for Unit I
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Morphology of Human Blood and Marrow Cells

• In this chapter, you will learn the morphology of
  the leukocytes found in the peripheral blood.  It
  is important that you learn these characteristics
  as you will be identifying these leukocytes and
  platelets on blood smears in the laboratory
  portion of this course.  This chapter also
  discusses the maturation sequence for each of the
  individual cell lines.  The final topic is a
  brief introduction to molecular hematology.

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Introduction to Clinical Hematology

• Hematology - study of blood and its related
  disorders.
• Average blood volume in adult is 4-6 liters.
• Composed of 55 plasma (fluid portion) and 45
  formed elements or cells.
• Plasma is composed of about 92 water and 8
  solutes (proteins, albumins, globulins,
  fibrinogen, electrolytes, hormones, nutrients,
  and respiratory gases).

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Cellular Components of Blood

• RBCs (Red Blood Cells) (Erythrocytes)
• PLTs (Platelets) (Thrombocytes)
• WBCs (White Blood Cells) (Leukocytes)
• Granulocytes
• Neutrophil
• Segmented neutrophil (Segs)
• Neutrophilic band (Bands)
• Eosinophil (Eos)
• Basophil (Basos)
• Lymphocytes (Lymphs)
• Monocytes (Monos)

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proteins, albumins, globulins, fibrinogen,
electrolytes, hormones, nutrients, and
respiratory gases
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Morphology of Cells on the Normal Blood Smear
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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. 

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A Erythrocytes (RBCs) BH Lymphocytes CE
Segmented neutrophil D Eosinophil F
Monocyte G Platelets I Neutrophilic
band J Basophil
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Normal Adult Values for Leukocytes
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Erythrocytes(RBCs)
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Erythrocytes (RBCs) 1 of 2

• Evaluated 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.

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Erythrocytes (RBCs) 2 of 2

• After 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.

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Platelets(PLTs)(Thrombocytes)
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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.

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White Blood Cells(WBCs)(Leukocytes)
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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.

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• Granulocytes
• Segs Bands
• Eosinophils
• Basophils

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Neutrophil
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Segmented Neutrophil 1 of 3

• 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".

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Segmented Neutrophil 2 of 3

• Nuclear chromatin heavily clumped, coarse, or
  pyknotic and stains purplish-red.  Cytoplasm is
  light pink and secondary granules are fine,
  numerous and evenly distributed.  Granules stain
  either pink or neutral color.
• Secondary granules contain lysosomes.

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Segmented Neutrophil 1 of 3

• About twice the size of normal erythrocytes.
• Play important roles in inflammation and
  phagocytosis.
• May migrate from bloodstream into surrounding
  tissues.

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Band Neutrophil 1 of 2

• 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.

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Band Neutrophil 2 of 2

• 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!!

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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.

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Basophil

• Normally 0-2 normal blood cells.
• Have large, abundant, purple-black 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.

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Lymphocytes 1 of 3

• 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.

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Lymphocytes 2 of 3

• 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.

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Lymphocytes 3 of 3

• Chromatin structure is lumpy or clumped and
  stains dark purple.
• Nucleoli may be present but are not visible in
  light microscopy.

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Monocytes 1 of 2

• 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.

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Monocytes 1 of 2

• Nucleus may be kidney-shaped, 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.

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Large Lymphocyte Versus Monocytes

• Easy to confuse them.
• Use chromatin structure, character of cytoplasm,
  and shape of cell to aid in differentiation.

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Summary
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A Erythrocytes (RBCs) BH Lymphocytes CE
Segmented neutrophil D Eosinophil F
Monocyte G Platelets I Neutrophilic
band J Basophil
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Normal Adult Values for Leukocytes