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Blood Smear Morphology

Item Value
Approval req'd? No
Available Stat? No, except by Hematology/ Oncology only.
Test code MORP
Performed by Parnassus, Mission Bay & Mt. Zion Hematology
In House Availability 24 hours a day
Method Microscopic examination of Wright-Giemsa stained smear
Container type Lavender top
Amount to Collect 1 mL blood
Sample type EDTA whole blood
Preferred volume 1 mL blood
Normal range Normal
Critical value Blasts not previously identified
Synonyms Red cell morphology; Howell-Jolly bodies; Leukocyte morphology; WBC morphology; Schistocyte; Acanthocyte; Macrocyte; Microcyte; Spherocyte; Ovalocyte; Dacrocyte; Target cell; Burr cell; Hypersegmentation; Hyposegmentation; Pseudo Pelger-Huet; Atypical lymphocyte; Variant lymphocyte; Blast; Myeloblast; Lymphoblast; NRBC; Nucleated red cell; Nucleated red blood cell; Dohle bodies; Pappenheimer bodies; Plasma cell; Promyelocyte; Myelocyte; Metamyelocyte; band; Seg; Segmented neutrophil; PMN
Additional information Automatically included when Automated Differential is inadequate and a Manual Differential must be done.

WBC abnormalities reported include blasts, immature granulocytes, hyposegmented and hypersegmented neutrophils, toxic granulation, Dohle bodies, inclusions, variant lymphocytes and abnormal lymphocytes.

Platelet abnormalities reported include hypo- and agranular platelets, giant platelets and megakaryocyte nuclear fragments.

Small numbers of RBCs with "abnormal" morphology may be seen in smears from normal individuals. In an effort to simplify and standardize the reporting of smears, the Clinical Laboratories reports the average number of abnormal RBCs seen in at least 10 high power fields (/HPF). The relation of these numbers to qualitative reports is shown below.

Abnormal RBCs per high power field (/HPF)

Abnormality Normal Rare Few Moderate
Acanthocytes None 0-1 2-5 ≥6
Burr cells 0-1 0-1 2-5 ≥6
Drepanocytes (sickle) None 0-1 2-5 ≥6
Elliptocytes 0-1 0-1 2-5 ≥6
Howell-Jolly bodies None 0-1 2-5 ≥6
Polychromatic cells 0-1 0-1 2-5 ≥6
Spherocytes None 0-1 2-5* ≥6*
Schistocytes None 0-1 2-5* ≥6*
Basophilic stippled cells None 0-1 2-5 ≥6
Target cells 0-1 0-1 2-5 ≥6
Tear drop cells 0-1 0-1 2-5 ≥6

Abnormality*: Definition

anisocytosis: RBCs vary markedly in size. MCV variable.

bite cells: one or more peripheral "bite"-like defects in a cell with decreased central pallor

coarse basophilic stippling: diffuse purple inclusions

dimorphic smear: two distinct populations of cells, usually one normocytic and normochromic, the other microcytic and hypochromic

hgb C crystals: rhomboid-shaped, with parallel sides and triangular or sloping ends

hgb SC crystals: irregular, contracted hyperchromatic cells with hgb C crystal-like projections

hypochromia, severe: many RBCs with greatly increased central pallor

macroovalocyte: large ovalocyte often showing decreased central pallor

microorganisms: parasites (babesia, malaria), fungi or bacteria (including spirochetes)

Pappenheimer bodies: clusters of =2 small blue or blue-green inclu-
sions found focally in RBCs

rouleaux: several RBCs aligned like a stack of coins; only significant and reported if found in the optimal portion of the smear

* Automatically reviewed by a physician

See also CBC w/Differential and Parasites.

If unusual findings are noted a pathologist review and interpretation may be performed and separately billed for
CPT coding 85008
LOINC code 34994-4
Last Updated 6/22/2016 12:58:05
Entry Number 129
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