Photomicrograph Information and Courses from MediaLab, Inc.

Photomicrograph of a gram stain prepared from an 18 hour old broth culture.The organism is a small, non-spore-forming bacillus measuring between 0.4 to 0.5um by 1.0 to 3.5um.Coccobacillary forms, diplobacilli, and bacilli in short chains or in diphtheroidal clusters (upper right in photograph) may all be observed in gram stain preparations.When found in the CSF, the organism may be found both intracellularly and extracellulary.

Red blood cells contain hemoglobin, which carries oxygen from the lungs to the tissues of the body. Hemoglobin gives blood its red color. Red blood cells are shown in the photomicrograph of a stained blood smear to the right.

A ten-year-old boy came to a physician's attention because of recent jaundice and icteric sclerae. The immediate laboratory work revealed: Hct 24%(normal 36%-47%), MCV 79.5 fl (normal 78-95fl),RDW 13%(normal 11.5-15.0%). His blood smear findings are reflected in these photomicrographs. Note particularly the spherocytes in the upper picture. Some resemble a half-blister with the other half of the cell containing solidly-staining hemoglobin. These are called eccentrocytes. When present, they should trigger a search for red cell hereditary G-6PD deficiency and the oxidant that triggered hemolysis. These morphological findings are only clues; specific testing for G-6PD deficiency should be performed. The blue arrows in the upper photomicrograph are directed toward solid-staining spherocytes in which the cell membrane is beaded by inclusions wrapped within the cell membrane, suggesting the remains of denatured hemoglobin. Included on the smear is a target cell, several acanthocytes, a smudge cell, and a few schistocytes. The lower photomicrograph is supravital staining of affected red blood cells, verifying the presence of Heinz bodies. This disorder was first recognized during the Korean war in 10% of black American soldiers given the antimalarial drug primiquine.

Illustrated in the photomicrograph of a peripheral smear are two populations of erythrocytes. Approximately 50% of the erythrocytes are normal size and contain a full complement of hemoglobin. The patient had received blood transfusions. The transfused red blood cells are the normocytic, normochromic red cells. Admixed are microcytic erythrocytes and larger erythrocytes, some faintly mottled or smudged, suggestive of reticulocytes. This picture represents a hemolytic process with a reticulocyte response. A similar dimorphic red cell population appears following erythropoietin therapy. It is important to recognize when a population of cells in the peripheral smear is not in context with anticipated laboratory findings and the clinical situation.

Several erythrocyte abnormalities are present in both the upper and lower photomicrographs. Many of these atypical cells are probably present as a result of the patient's splenectomy. Considerable anisocytosis and poikilocytosis with many tear-drop cells, bite cells, fragmented forms, and a few target cells are apparent. Some of the erythrocytes in the upper frame contain Howell-Jolly bodies (DNA fragments) that may be single or multiple, especially in myeloproliferative disorders. These inclusions stain negatively for iron and are eccentrically placed in the red cell cytoplasm. .

Echinocyte comes from the Greek word meaning “sea urchin,” which relates to its shell-like appearance. Echinocytes are reversible, meaning that this alteration can be the result of the cell’s environment, pH of the medium (including the glass slides on which blood smears are made), the metabolic state of the cell and the use of some chemical substances. An example of an echinocyte can be seen in the center of this slide. Notice the projections (10-30 can be seen) are rounded and evenly spaced around the cell. Acanthocytes have irregularly spaced thorn-like projections. An echinocyte is shown left of the B in this photomicrograph. A polychromatophilic cell is seen just above the echinocyte.