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PROERYTHROBLASTS

Size of the cell: 15 - 25 m

ALTERAES MORFOLGICAS DOS ERITRCITOS


Prof. Jos Trezza Netto

Shape of cell: round, sometimes oval Colour of cytoplasm: deep blue with perinuclear halo Granularity: none Nucleus' shape: round Type of chromatin: coarse grained Nuclear/cytoplasmic ratio: high Nucleoli: hardly visible, relatively large, staining like surrounding chromatin Occurrence: blood: not present marrow: < 5%

Comment: Two typical proerythroblasts are seen in the middle of this picture. Also, two Staining: MGG polychromatophilic and two eosinophilic erytroblasts are present. Single plasmocyte with different Magnification: x 1000 chromatin structure and a lower nucleuscytoplasm ratio differs from the near polychromatophilic erythroblast. 1. proerythroblast 2. polychromatic normoblast 3. pycnotic normoblast 4. monocyte 5. plasmocyte 6. basophil 7. lymphocyte 8. neutrophil myelocyte 9. neutrophil metamyelocyte 10. promyelocyte

POLYCHROMATIC (INTERMEDIATE) NORMOBLASTS PROERYTHROBLASTS


Size of the cell: 15 - 25 m Shape of the cell: round, sometimes oval Colour of cytoplasm: deep blue with perinuclear halo Granularity: none Nucleus' shape: round Type of chromatin: coarse grained Nuclear/cytoplasmic ratio: high Nucleoli: hardly visible, relatively large, staining like surrounding chromatin Occurrence: blood: not present marrow: < 5% Size of the cell: 10 - 15 m Shape of the cell: round, sometimes deformed by surrounding cells Colour of cytoplasm: grey Granularity: none Nucleus' shape: round Type of chromatin: dark, distinct condensation Nuclear/cytoplasmic ratio: moderate Nucleoli: not visible Occurrence: blood: not present marrow: 2 - 18 %

Comment: The arrow indicates the proerythroblast. Also, there are nine maturing erythroblasts and two plasmocytes, which should be differentiate with basophilic erythroblasts.

Staining: MGG Magnification: x 1000

Comment: Indicated polychromatophilic erythroblast is one of the 13 present erythroblastic precursors

Staining: MGG Magnification: x1000

1. basophilic normoblast 2. polychromatic normoblast 3. pycnotic normoblast 4. plasmocyte 5. eosinophil 6. promyelocyte 7. neutrophil metamyelocyte

1.proerythroblast 2.basophilic normoblast 3.polychromatic normoblast 4.pycnotic normoblast 5.neutrophil metamyelocyte 6.band neutrophil 7.lymphocyte

POLYCHROMATIC (INTERMEDIATE) NORMOBLASTS


Size of the cell: 10 - 15 m Shape of the cell: round, sometimes deformed by surrounding cells Colour of cytoplasm: grey Granularity: none

PYCNOTIC (LATE) NORMOBLASTS


Size of the cell: 8 - 12 m Shape of the cell: round, often deformed by surrounding cells Colour of cytoplasm: pink or the same as in erythrocytes Granularity: none Nucleus' shape: round Type of chromatin: dark, distinct condensation Nuclear/cytoplasmic ratio: moderate Nucleoli: not visible Occurrence: blood: not present marrow: 2 - 18 % Nucleus' shape: round Type of chromatin: dark, intense condensation Nuclear/cytoplasmic ratio: low Nucleoli: not visible Occurrence blood: not visible marrow: 5 - 15 %

Comment: Both cells indicated by the arrow are the polychromatophilic cells. Also in the picture 12 other erythroblasts at different stages of maturation are present, including one with divided nucleus.

Staining: MGG Magnification: x 1000 Comment: The arrow points one of five clearly visible eosinophilic erythroblasts Staining: MGG Magnification: x 1000 1.pycnotic normoblast 2.polychromatic normoblast 3.myeloblast 4.promonocyte 5.segmented neutrophil myelocyte 6.eosinophil 7.band neutrophil 8.neutrophil

1.polychromatic normoblast 2.pycnotic normoblast 3.basophilic normoblast 4.plasmocyte 5.megakarioblast 6.neutrophil metamyelocyte 7.lymphocyte 8.monocyte 9.polychromatic normoblast in division state.

PYCNOTIC (LATE) BASOPHILIC (EARLY) NORMOBLASTS


Size of the cell: 8 - 12 m Size of the cell: 13-18 m Shape of the cell: round, sometimes deformed by surrounding cells Colour of cytoplasm: dark blue Granularity: none Type of chromatin: dark, intense condensation Nucleus' shape: round Nuclear/cytoplasmic ratio: low Type of chromatin: dark, start of condensation Nuclear/cytoplasmic ratio: high Nucleoli: not visible Occurrence blood: not present marrow: 1 - 7 % Staining: MGG Magnification: x 1000 Comment: Indicated by the arrow is the eosinophilic erythroblast. Besides it, in the picture there are 19 other erythroblasts and one precursor of erythropoesis at the stage of division. Staining: MGG Magnification: x 1000 Nucleoli: not visible Occurrence: blood: not visible marrow: 5 - 15 % Shape of the cell: round, often deformed by surrounding cells Colour of cytoplasm: pink or the same as in erythrocytes Granularity: none Nucleus' shape: round

NORMOBLASTS

Comment: The early basophilic erythroblast, which chromatin begins to show the first signs of maturation and cytoplasm does not contain visible perinuclear halo. Besides that, nine other erythroblasts at different stages of maturation are seen. 1. polychromatic normoblast 2. pycnotic normoblast 3. neutrophil myelocyte 4. neutrophil metamyelocyte 5. band neutrophil 6. lymphocyte 7. megakaryoblast 8. eosinophil

1.pycnotic normoblast 2.polychromatic normoblast 3.erythroblast in divison state 4.plasmocyte 5.lymphocyte 6.neutrophil metamyelocyte 7.band neutrophil 8.promyelocyte 9.myeloblast.

NORMOCYTES
Size of the cell: 6 - 9 m

RETICULOCYTES
Size of the cell: 8 - 12 m

Shape of the cell: round

Colour of cytoplasm: pink or grey

Shape of the cell: round

Granularity: none Colour of cytoplasm: pale

Granularity: single or numerous, thick, violet granules

Nucleus' shape: none

Occurrence in blood: 0.5 - 1.5 % of erythrocytes Occurrence: in blood > 90 % of erythrocytes in normal blood Staining: MGG Magnification: x 1000

Staining: supravital, with Cresyl blue Comment: The indicated reticulocyte contains fine granules (remnants of the rybonucleic, substances). In the picture six reticulocytes are present. Magnification: x 1000

Comment: The picture shows normal erythrocytes seen at the correct site of the blood film. Only a few erythrocytes overlap, but in other cells there are distinct central halos. Among erythrocytes four normal platelets are seen.

RETICULOCYTES
Size of the cell: 8 - 12 m Shape of the cell: round Colour of cytoplasm: as in mature erythrocytes, with violet tint Granularity: none, very rarely with basophilic stippling Nucleus' shape: none

MICROCYTES

Size of the cell: < 6 m

Occurrence in blood: 0.5 - 1.5 % of erythrocytes Comment: The indicated cell is the reticulocyte, which in the May-Grunwald-Giemsa staining differs from the remaining mature erythrocytes. The indicated cell is greater, the perinuclear zone is not present and takes polychromatophilic staining. Staining: MGG Magnification: x 1000

Occurrence: in blood :< 10 % of erythrocytes in normal blood Comment: In the picture the visible erythrocytes are microcytes and their diameters are much smaller than the diameters of the small lymphocyte (its diameter is 10-12 m). The erythrocytes are hypochromic. Besides, normal platelets are present. Staining: MGG Magnification: x 500

MEGALOCYTES
Size of the cell: > 12 m

MICROCYTES

Size of the cell: < 6

Occurrence in blood: < 10 % of erythrocytes in normal blood Comment: Most erythrocytes presented in the picture are microcytes (compare with the small lymphocyte). The degree of hemoglobinization is sufficient. Normal platelets and single ovalocytes are present. Staining: MGG Comment: A typical example of anisocytosis of erythrocytes. The arrow indicates one of six megalocytes. Also mumerous macrocytes and microcytes are seen. Magnification: x 1000 1. microcyte 2. normocyte Occurrence in blood: < 2 % of erythrocytes in normal blood Staining: MGG Magnification: x 500

HYPOCHROMIA MEGALOCYTES
Definition: Excessive central pallor in the erythrocyte, exceeding one third of its diameter. It is due to insufficient hemoglobinization.

Size of the cell: > 12

Occurrence in blood: < 2 % of erythrocytes in normal blood Comment: Megalocyte is indicated by the arrow. Considerable anisocytosis of erythrocytes (compare with the lymphocyte). Numerous ovalocytes and two schistocytes. Staining: MGG Magnification: x 1000 1. macrocyte 2. microcyte 3. elliptocyte 4. schistocyte

Occurrence in blood: < 10 % of erythrocytes in normal blood Comment: Most cells show extremely large perinuclear halo (hypochromic cells), which account for more than one third of the cell diameter. Only a few cells are normocytes. Staining: MGG Magnification: x 500

HYPOCHROMIA
Definition: Excessive central pallor in the erythrocyte, exceeding one third of its diameter. It is due to insufficient hemoglobinization.

ELLIPTOCYTES (OVALOCYTES)
Definition: Oval or elliptical erythrocytes.

Occurrence in blood: < 10 % of erythrocytes in normal blood Comment: Considerable hypochromia, only three cells are normocytes; moreover microcytosis and numerous ovalocytes are present. Staining: MGG Magnification: x 1000 Comment: The arrow points an ovalocyte. Also a single target cell is present.

Occurrence in blood: < 10 % of erythrocytes in normal blood Staining: MGG Magnification: x 1000

ELLIPTOCYTES (OVALOCYTES)
Definition: Oval or elliptical erythrocytes.

TARGET CELLS
Definition: Erythrocyte containing dark stained central area surrounded by lightly stained ring of cytoplasm without hemoglobin.

Occurrence in blood: < 10 % of erythrocytes in normal blood Comment: Indicated by the arrow extremely elongated ovalocyte is sometimes called pencil-like cell. Besides it other six ovalocytes less elongated are seen. Also distinct anisocytosis is present. Normal platelets are present. Staining: MGG Comment: The arrow indicates one of two target cells. Magnification: x 1000

Occurrence in blood: < 2 % of erythrocytes in normal blood. Sometimes cells may be seen in vitro and may cover large area of the blood film, separated from the : area of normal red cells. Staining MGG Magnification: x 1000

TARGET CELLS
Definition: Erythrocyte containing dark stained central area surrounded by lightly stained ring of cytoplasm without hemoglobin.

BURR-CELLS (ECHINOCYTES)
Definition: Erythrocytes with regular, short spicules of cytoplasm. The cells are usually biconcaved.

Comment: In the picture seven target cells are present. Also slight anisocytosis of the erythrocytes and platelets.

Occurrence in blood: < 2 % of erythrocytes in normal blood. Sometimes cells may be seen in vitro and may cover large area of the blood film, separated from the area of normal red cells. Staining: MGG Magnification: x 1000

Occurrence in blood: normally not present Comment: Many echinocytes, among them there are single normal erythrocytes. Staining: MGG Magnification: x 1000

BURR-CELLS SCHISTOCYTES (ECHINOCYTES)


Definition: Irregularly shaped erythrocyte. Definition: Erythrocytes with regular, short spicules of cytoplasm. The cells are usually biconcaved

Occurrence in blood: normally not present Occurrence in blood: normally not present Comment: The arrow indicates an echinocyte. Besides it, there are ovalocytes, target cells and schistocytes. Also slight anisocytosis. Staining: MGG Magnification: x 1000 1. target-cell 2. elliptocyte 3. schistocyte Comment: The indicated schisocyte is one of six presented in the picture. Also discrete anisocytosis of the erythrocytes. Staining: MGG Magnification: x 1000 1. schistocyte 2. microcyte

SPHEROCYTES

SPHEROCYTES
Definition: Spheroidal erythrocyte of lower diameter in comparison with normal red cell; without central pallor and more dark than normocyte. Definition: Spheroidal erythrocyte of lower diameter in comparison with normal red cell; without central pallor and more dark than normocyte.

Occurrence in blood: normally not present Comment: Three spherocytes, one of them is indicated by the arrow. Also not much expressed anicytosis of the erythrocytes are shown. Occurrence in blood: normally not present Comment: Two spherocytes differ from the rest of the erythrocytes in diameter, having no perinuclear zone and darker staining. Staining: MGG Magnification: x 1000 Staining: MGG Magnification: x 1000

ANULOCYTES ANULOCYTES
Definition: Erythrocytes with a large area of central pallor with distinctive border between pallor and cytoplasm. They occur due to lowered hemoglobin concentration or as an artefact. Definition: Erythrocytes with a large area of central pallor with distinctive border between pallor and cytoplasm. They occur due to lowered hemoglobin concentration or as an artefact.

Occurrence in blood: < 5% of erythrocytes in normal blood Comment: The arrow lies between two anulocytes. In the illustration there are more cells of this kind, lying among normal normocytes. Staining: MGG Magnification: x 1000 1. anulocyte Comment: The arrow indicates one of three anulocytes present in the picture.

Occurrence in blood: < 5% of erythrocytes in normal blood Staining: MGG Magnification: x 1000

POIKILOCYTOSIS POIKILOCYTOSIS
Definition: Simultaneous occurrence of differently shaped erythrocytes in blood. Definition: Simultaneous occurrence of differently shaped of erythrocytes in blood.

Occurrence in blood: < 10 % of erythrocytes in normal blood Comment: Severe anisopoikilocytosis in the course of -thalassemia. Different types of poikilocytes are present, beginning from microcytic to megalocytic form. Staining: MGG Comment: Distinct anisopoikilocytosis of erythrocytes with presence of different poikilocytes forms. Magnification: x 500

Occurrence in blood: < 10 % of erythrocytes in normal blood Staining: MGG Magnification: x 1000

1. target-cell 2. elliptocyte 3. acanthocyte 4. stomatocyte 5. schistocyte 6. polychromatophilic erythrocyte.

CABOT'S RINGS
Definition: Loop shaped or "8"- shaped occlusion found in erythrocytes during failure of erythropoiesis. The occlusion is probably formed from part of a mitotic spindle.

CABOT'S RINGS
Definition: Loop shaped or "8"- shaped occlusion found in erythrocytes during failure of erythropoiesis. The occlusion is probably formed from part of a mitotic spindle.

Occurrence in blood: normally not present Comment: Cabots ring is indicated by the arrow. Also anisocytosis of the erythrocytes and several stomatocytes. Staining: MGG Magnification: x 1000 Comment: Cabots ring is indicated by the arrow. Also anisocytosis of erythrocytes and presence of ovalocytes and schistocytes.

Occurrence in blood: normally not present Staining: MGG Magnification: x 1000

PAPPENHEIMER BODIES
Definition: Very fine dark separated or connected granules present in the cytoplasm of the erythrocyte, particularly often near the periphery of the red cell. Probably these are the equivalent to iron granules of siderocytes.

PAPPENHEIMER BODIES
Definition: Very fine dark separated or connected granules present in the cytoplasm of the erythrocyte, particularly often near the periphery of the red cell. Probably these are the equivalent to iron granules of siderocytes.

Occurrence in blood: a small number present in normal blood Comment: In many erythrocytes there are Pappenheimers bodies (granules indicated by the end of the arrow). Also anisocytosis of the erythrocytes and presence of ovalocytes and schistocytes. Polychromatophilic cell is present. Staining: MGG Magnification: x 1000 1. schistocyte 2. elliptocyte 3. acanthocyte 1. Pappenheimer bodies 2. target-cell Comment: Six erythrocytes contain Pappenheimers bodies. Also not much expressed anisocytosis of the erythrocytes and two target cells.

Occurrence in blood: a small number present in normal blood Staining: MGG Magnification: x 1000

BASOPHILIC (EARLY) NORMOBLASTS


Size of the cell: 13-18 m Shape of the cell: round, sometimes deformed by surrounding cells Colour of cytoplasm: dark blue Granularity: none

BASOPHILIC (EARLY) NORMOBLASTS


Size of the cell: 13-18 m Shape of the cell: round, sometimes deformed by surrounding cells Colour of cytoplasm: dark blue Granularity: none

Nucleus' shape: round Type of chromatin: dark, start of condensation Nuclear/cytoplasmic ratio: high Nucleoli: not visible Occurrence blood: not present marrow: 1 - 7 % Staining: MGG Magnification: x 1000 Comment: The basophilic erythroblast with proceeding condensation of the chromatin and without the perinuclear zone is presented. In the picture there are also ten polychromatophilic and eosinophilic erythroblasts.

Nucleus' shape: round Type of chromatin: dark, start of condensation Nuclear/cytoplasmic ratio: high Nucleoli: not visible Occurrence blood: not present marrow: 1 - 7 % Staining: MGG Magnification: x 1000

Comment: The early basophilic erythroblast, which chromatin begins to show the first signs of maturation and cytoplasm does not contain visible perinuclear halo. Besides that, nine other erythroblasts at different stages of maturation are seen. 1. polychromatic normoblast 2. pycnotic normoblast 3. neutrophil myelocyte 4. neutrophil metamyelocyte 5. band neutrophil 6. lymphocyte 7. megakaryoblast 8. eosinophil

1. polychromatic normoblast 2. pycnotic normoblast 3. lymphocyte 4. myeloblast 5. promyelocyte 6. neutrophil myelocyte 7. neutrophil metamyelocyte 8. monocyte

PYCNOTIC (LATE) NORMOBLASTS


Size of the cell: 8 - 12 m Shape of the cell: round, often deformed by surrounding cells Colour of cytoplasm: pink or the same as in erythrocytes Granularity: none Nucleus' shape: round Type of chromatin: dark, intense condensation Nuclear/cytoplasmic ratio: low Nucleoli: not visible Occurrence blood: not visible marrow: 5 - 15 %

PYCNOTIC (LATE) NORMOBLASTS


Size of the cell: 8 - 12 m Shape of the cell: round, often deformed by surrounding cells Colour of cytoplasm: pink or the same as in erythrocytes Granularity: none Nucleus' shape: round Type of chromatin: dark, intense condensation Nuclear/cytoplasmic ratio: low Nucleoli: not visible Occurrence: blood: not visible marrow: 5 - 15 %

Comment: The arrow points one of five clearly visible eosinophilic erythroblasts

Staining: MGG Magnification: x 1000

Comment: Indicated by the arrow is the eosinophilic erythroblast. Besides it, in the picture there are 19 other erythroblasts and one precursor of erythropoesis at the stage of division.

Staining: MGG Magnification: x 1000

1.pycnotic normoblast 2.polychromatic normoblast 3.myeloblast 4.promonocyte 5.segmented neutrophil myelocyte

6.eosinophil 7.band neutrophil 8.neutrophil

1.pycnotic normoblast 2.polychromatic normoblast 3.erythroblast in divison state 4.plasmocyte 5.lymphocyte 6.neutrophil metamyelocyte 7.band neutrophil 8.promyelocyte 9.myeloblast.

NORMOCYTES
Size of the cell: 6 - 9 m

NORMOCYTES
Size of the cell: 6 - 9 m

Shape of the cell: round

Shape of the cell: round

Colour of cytoplasm: pink or grey

Colour of cytoplasm: pink or grey

Granularity: none

Granularity: none

Comment: The picture shows normal erythrocytes seen at the correct part of the slide. Only a few erythrocytes overlap, but in all other cells there are distinct central halos.

Occurrence in blood: > 90 % of erythrocytes in normal blood Staining: MGG Magnification: x 500

Comment: The picture shows normal erythrocytes seen at the correct site of the blood film. Only a few erythrocytes overlap, but in other cells there are distinct central halos. Among erythrocytes four normal platelets are seen.

Occurrence: in blood > 90 % of erythrocytes in normal blood Staining: MGG Magnification: x 1000

MACROCYTES
Size of the cell: 9 - 12 m

ANISOCYTOSIS
Definition: Simultaneous occurrence of microcytes, macrocytes and normocytes in blood.

Occurrence in blood: < 10 % of erythrocytes in normal blood Comment: The arrow indicates normocyte. Most erythrocytes are macrocytes (compare with the lymphocyte). Five ovalocytes are seen. Staining: MGG Magnification: x 1000 1. macrocyte 2. elliptocyte 1. megalocyte 2. macrocyte 3. microcyte 4. schistocyte Comment: Distinct anisopoikilocytosis. One megalocyte and numerous macro- and microcytes are present. Most cells are ovalocytes, also schistocytes are visible.

Occurrence in blood: < 10 % of erythrocytes in normal blood Staining: MGG Magnification: x 1000

POLYCHROMASIA
Definition: The red cell takes the basic and the acid dyes and exhibits violet tint, which results from the presence of ribonucleic acid in the cell. These cells are reticulocytes.

LACRYMOCYTES
Definition: Erythrocyte with a tear-drop shape. The central pallor shall be seen. (the cells are different from pseudolacrymocytes, which have pinched cytoplasm on one of the poles.These cells are observed excessively at the thin parts of the blood film.

Occurrence in blood: < 1.5 % of erythrocytes in normal blood Comment: In the picture four cells are polychrpmatophilic cells (one is indicated by the arrow). Also a few ovalocytes, acanthocyte, and normal platelets are seen. Staining: MGG Magnification:: x 1000 1. polychromatic erythrocyte 2. acanthocyte 3. elliptocyte 1.lacrymocyte 2.elliptocyte Comment: In the picture three lacrymocytes are seen. Besides, ovalocytes and anisocytosis are seen.

Occurrence in blood: normally not present Staining: MGG Magnification: x 1000

ACANTHOCYTE

CRENATED RED BLOOD CELLS


Definition: Erythrocytes with crimpsy cytoplasm. This is a typical artefact. They appear in vitro while making a blood film.

Definition: Erythrocytes with irregular, long, sharply pointed and bent spicules of cytoplasm. Presence of spicules of cytoplasm results in an absence of central pallor.

Occurrence in blood: normally not present Comment: In the picture a single acanthocyte is seen. Besides it, separated ovalocytes and echinocytes. Staining: MGG Magnification: x 1000 1. burr-cell 2. elliptocyte Comment: All erythrocytes, that are shown in the picture, are crenated red blood cells with shrinked cell membrane.

Occurrence in blood: not present Staining: MGG Magnification: x 1000

STOMATOCYTES
Definition: The erythrocyte with elongated central palor.

LEPTOCYTES
Definition: Erythrocyte with excessive central pallor and very thin area of stained cytoplasm. The diameter of this cell is larger than the diameter of normocyte, but the volume is the same.

Occurrence in blood: normally not present Occurrence in blood: < 5% of erytrocytes in normal blood Staining: MGG Magnification: x 1000 Comment: Leptocytes should be differentiated with polychromatophilic erythrocytes or reticulocytes, which biconcave shape is not finally formed. Besides polychromasia, there is an irregular perinuclear zone in the cells. The cell indicated by the arrow is not a leptocyte. Staining: MGG Magnification: x 1000

Comment: Very numerous stomatocytes in the course of inherited stomatocytosis.

SICKLE CELLS
Definition: Elongated erythrocytes, usually curved with sharply pointed one or two poles.

HOWELL-JOLLY BODIES
Definition: Round chromatin fragments remaining in the cytoplasm of mature erythrocyte, resulting from abnormal division of erythroblast.

Occurrence in blood: normally not present Comment: Single sickle cell. Also distinct anisopoikilocytosis and staining disturbance of erythrocytes. Staining: MGG Magnification: x 1000 Comment: Polychromatophilic erythrocytes with two Howell-Jolly bodies. Besides, anisocytosis of erythrocytes. There is another polychromatophilic erythrocyte above.

Occurrence in blood: normally not present Staining: MGG Magnification: x 1000

ERYTHROBLASTS IN THE BLOOD BASOPHILIC STIPPLING


Definition: Very fine, pinpoint cytoplasmic granules distributed evenly in the cytoplasm. Definition: Cells with dark, condensed nucleus, morphology like in the bone marrow

Comment: The cell with basophilic stippling. Also erythrocytes anisocytosis.

Occurrence in blood: < 0.1 % of erythrocytes in normal blood Staining: MGG Magnification: x 1000

Occurrence in blood: normally not present. Present only in the blood of newborn children. Comment: An early polychromatophilic erythroblast is present in the blood. Also several ovalocytes and microcytes are present. Staining: MGG Magnification: x 1000

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