Erythrocyte, Mature

SYNONYMS Mature erythrocytes in body fluids are morphologically

Red blood cell, anucleate similar to those present in the peripheral blood. They
have a round to oval, disc-shaped contour, with a cen-
VITAL STATISTICS
size ............................. 7 µm tral area of pallor that occupies less than one-third of
n:c ratio ..................... not applicable the total diameter. A nucleus is lacking, having been
cell shape .................. round to slightly oval on smear, extruded prior to release into the circulation, and the
biconcave disk cytoplasm is pink, a result of the abundant hemoglo-
nuclear shape ........... not applicable
bin present. These cells circulate for approximately 120
chromatin .................. not applicable
nucleoli ...................... not applicable days, before being removed from the circulation by
cytoplasm.................. pink-red, orange-red with area of the reticuloendothelial system in the spleen and liver.
central pallor The hemoglobin in the cytoplasm is then processed
KEY DIFFERENTIATING FEATURES by the phagocytic system, with much of the iron con-
homogenous, agranular cytoplasm served and released back into the circulation. They are
POTENTIAL LOOK-ALIKES
not found in normal body fluid samples. They may be
fat droplet (on cell chamber count) introduced as a “contaminant” when there is difficulty
yeast forms (on cell chamber count) in obtaining a specimen, represent traumatic hemor-
ASSOCIATED DISEASE STATES AND CONDITIONS
rhage, or occur secondary to other disease states such
traumatic tap as pancreatitis, pulmonary infarction, ruptured ectopic
hemorrhage pregnancy, or malignancy.
malignant bloody effusions
postoperative effusions

Normal Mature Red Blood Cell

central pallor is 1/3 the cell diameter

98 Erythroid Series
CM-09, 2001 (CSF, Wright-Giemsa, X400)
Identification Referee % Participant %
Erythrocyte, mature 100.0 88.9
This CSF specimen was obtained from a patient who
had sustained a subarachnoid hemorrhage and had an
externally draining ventriculostomy tube. The arrowed
cell in this CSF specimen is a mature erythrocyte. This
CSF sample contains numerous erythrocytes and large
numbers of extracellular bacilli. External collection de-
vices such as these are placed temporarily to relieve
intracranial pressure and are always potential sources
for bacterial colonization.

CM-07, 2004 (Peritoneal, Wright-Giemsa, X400)

Identification Referee % Participant %
Erythrocyte, mature 100.0 100.0
This peritoneal fluid was obtained from a 25-year-old
HIV-positive woman complaining of fatigue, weak-
ness and increasing abdominal girth. The arrowed cell
is a normal mature erythrocyte. It is small, ovoid, has
agranular pink-red cytoplasm, and is devoid of a nucle-
us. An area of faint central pallor can be appreciated.

CM-09, 1992 (CSF, Wright-Giemsa, X400)

Identification Referee % Participant %
Erythrocyte, mature 100.0 98.8
This CSF sample is from a premature neonate with
signs and symptoms of meningitis. The arrowed cell in
this CSF specimen is a mature erythrocyte. The large
cell noted above the erythrocyte is a ventricular lin-
ing cell. Ventricular lining cells may occur singly, as in
this photomicrograph, or in clusters. They are typical-
ly large with abundant, pink-blue, grainy cytoplasm.
They can be seen in neonatal specimens, particularly
those born prematurely, and should not be confused
with malignant cells.

Erythroid Series 99
 Erythrocyte, Nucleated
SYNONYMS Nucleated red blood cells are uncommonly found in
nucleated red blood cell (NRBC) body fluids. When present, they are usually second-
VITAL STATISTICS
ary to blood contamination in cases where circulating
size ............................. varies with the stage of matura- nucleated red blood cells are present in the peripheral
tion (7 to 25 µm) blood. Less commonly they represent accidental aspi-
n:c ratio ..................... varies with the stage of matura- ration of the bone marrow from either a rib or vertebral
tion; decreases with maturation body during the fluid collection procedure. Nucleated
cell shape .................. round to oval
nuclear shape ........... round to oval
red blood cells due to peripheral blood contamination
chromatin .................. varies with the stage of matura- tend to be at a later stage of development (orthochro-
tion; more condensed with matu- matophilic) as that is the stage of nucleated red blood
ration cell most commonly found in the blood. If nucleated
nucleoli ...................... vary with the stage of maturation; red cells present in a body fluid are due to bone mar-
present in early stages; disap-
pears in later stages
row contamination, earlier stages (polychromatophilic,
cytoplasm.................. varies with the stage of matura- basophilic and rarely proerythroblast) may be noted.
tion; early stages are blue with Immature granulocytes and rarely megakaryocytes
more orange or pink-red color- may also be present in fluids with bone marrow con-
ation predominating as the cell tamination (see A Closer Look… page 47). Bone marrow
matures
contamination is most commonly seen in newborns or
KEY DIFFERENTIATING FEATURES infants and in adults with osteoporosis. This is second-
normal nucleated red blood cell morphology matching ary to the difficulty with which the needle is introduced
bone marrow morphology
agranular cytoplasm into the fluid cavity being sampled. They are also seen
in association with lumbar canal stenosis or kyphosis
POTENTIAL LOOK-ALIKES
where accessing the CSF is technically challenging due
necrobiotic segmented neutrophils
lymphocytes to the narrow space through which the needle must
pass. In either situation, the bone marrow elements
ASSOCIATED DISEASE STATES AND CONDITIONS
enter the needle and then contaminate the fluid col-
peripheral blood contamination due to traumatic tap or
hemorrhage lected. Absence of immature granulocytes and/or nu-
bone marrow contamination cleated red blood cells on the peripheral blood smear
provides support for the conclusion that the nucleated
erythroid and immature granulocytic elements noted
in the patient’s corresponding body fluid represent
bone marrow contamination.
It is important to appreciate the homogeneous
agranular cytoplasm of nucleated red blood cells so
as not to confuse them with necrobiotic neutrophils,
which can display a similar pyknotic nucleus. While
sometimes faint, the cytoplasm of the necrobiotic neu-
trophils will be granular.

Nucleated Red Blood Cells

(various maturation stages) 5µ

100 Erythroid Series

CM-11, 1990 (CSF, Wright-Giemsa, X250)
Identification Referee % Participant %
Erythrocyte, nucleated 100.0 99.7
The CSF sample is bloody and shows several nucleated
red blood cells (arrowed) and a promyelocyte. The
NRBCs demonstrate agranular orangeophilic cyto-
plasm and dense pyknotic nuclei. Above the group
of arrowed nucleated red blood cells are several other
NRBCs at a slightly more immature stage of matura-
tion reflected by their more polychromatophilic pink-
gray cytoplasm and more open nuclear chromatin. No
nucleated RBCs were found in the peripheral blood;
the sample represents marrow contamination. The
agranular homogeneous cytoplasm helps to distin-
guish the cells from necrobiotic neutrophils, which
may also have pyknotic nuclei.
CM-27, 1999 (CSF, Wright-Giemsa, X330)
Identification Referee % Participant %
Erythrocyte, nucleated 100.0 99.3
This CSF sample was taken from a 2-month-old infant
with fever and irritability. The fluid had a WBC=176/
µL; RBC=1302/µL. The arrowed cells are nucleated red
blood cells with polychromatophilic pink-gray cyto-
plasm and nuclei that have coarse clumped chroma-
tin. Immature granulocytic cells are also present. The
presence of immature granulocytic cells and nucleated
red blood cells suggests the possibility of bone marrow
contamination.

CM-18, 2005 (CSF, Wright-Giemsa, X400)

Identification Referee % Participant %
Erythrocyte, nucleated 95.2 84.4
Ventricular lining cell 4.8 9.4
This CSF was obtained from a 75-year-old woman with
a left-sided CVA (cerebrovascular accident). The ar-
rowed cells are nucleated erythroid precursors, which
are characterized by round nuclei with dark purple,
variably condensed chromatin. Most erythroid precur-
sors have moderate amounts of cytoplasm which var-
ies from blue to gray-pink to pink as the cell matures
and hemoglobinization occurs. These cells represent
bone marrow contamination during the lumbar punc-
ture. There are also numerous red blood cells and two
neutrophils in the background.

Erythroid Series 101