Peripheral Blood Films

Question 1

Acanthocytes

Spur/spike cells

Answer 1

RBCs show many spicules

Abetalipoproteinaemia,
liver disease,
hyposplenism

Question 2

Basophilic stippling of RBC

Answer 2

Accelerated erythropoiesis or defective Hb synthesis, small dots at the periphery are seen (rRNA)

Lead poisoning, 
megaloblastic anaemia, 
myelodysplasia, 
liver disease, 
haemoglobinopathy e.g. thalassaemia

Question 3

Burr cells

Echinocyte

Answer 3

Irregularly shaped cells

Uraemia,
GI bleeding,
stomach carcinoma

Question 4

Heinz bodies

Answer 4

Inclusions within RBCs of denatured Hb

Glucose-6-phosphate dehydrogenase deficiency,
chronic liver disease

Question 5

Howell-Jolly bodies

Answer 5

Basophilic (purple spot) nuclear remnants in RBCs

Post-splenectomy or hyposplenism 
(e.g. sickle cell disease, 
coeliac disease, 
congenital, 
UC/Crohn's,
myeloproliferative disease, 
amyloid)

Megaloblastic anaemia,
hereditary spherocytosis

Question 6

Leucoerythroblastic (myelophthisic) anaemia

Answer 6

Marrow infiltration- nucleated RBCs and primitive WBCs into peripheral blood

Marrow infiltration i.e. myelofibrosis,
malignancy

Question 7

Pelger Huet Cells

Answer 7

Hyposegmented neutrophil

Congenital (lamin B Receptor mutation)
Acquired (myelogenous leukaemia
and myelodysplastic syndromes)

Question 8

Polychromasia
(sign of
reticulocytes)

Answer 8

Red Blood cells of multiple colours (particularly grey-blue), due to differing amounts of Hb in RBC

Premature/inappropriate release from BM

Question 9

Reticulocytes

Answer 9

Immature RBCs (mesh-like network of ribosomal RNA
becomes visible with certain stains i.e. new methylene blue)

↑in haemolytic anaemias
↓aplastic anaemia, chemo

Question 10

Right shift

Answer 10

Hypermature white cells -
hypersegmented polymorphs (>5 lobes to nucleus)

Megaloblastic anaemia,
uraemia,
liver disease

Question 11

Rouleaux formation

Answer 11

Red cells stacked on each other

Chronic inflammation,
paraproteinaemia,
myeloma

Question 12

Schistocytes

Answer 12

Fragmented parts of RBCs –
typically irregularly shaped, jagged and asymmetrical

Microangiopathic anaemia, e.g. DIC,
haemolytic uraemic syndrome,
thrombotic thrombocytopenic
purpura, 
pre-eclampsia

Question 13

Spherocytes

Answer 13

Sphere shaped RBC

Hereditary spherocytosis,
Autoimmune Haemolytic Anaemia

Question 14

Stomatocytes

Answer 14

Central pallor is straight or curved rod-like shape.
RBCs appear as ‘smiling faces’ or ‘fish mouth’

Hereditary stomatocytosis,
high alcohol intake,
liver disease

Question 15

Target cells
(codocyte)

Answer 15

Bull’s-eye appearance in central pallor

Liver disease,
hyposplenism,
thalassaemia,
iron deficiency aneamia