Educational Commentary - Blood Cell Id: Identifying Immature and Abnormal Cells Learning Outcomes

The cell in Image BCI-01 is a nucleated red blood cell (RBC). Although nucleated RBCs do not normally appear in the peripheral blood of an adult, it is not unexpected in this patient’s condition owing to hematopoietic bone marrow stress. Nucleated RBCs are immature erythrocytes that still retain their nucleus. The cell in this image is typical of those most often seen in the peripheral blood of persons with leukemia. The chromatin is dense and clumped, with indistinct areas of parachromatin. The nucleus is eccentrically located within the cell. The cytoplasm stains pinkish, as in this example, or sometimes blue-gray. Nucleated erythrocytes represent defined stages in RBC maturation, but do not need to be classified when noted on a peripheral blood smear. These cells should, however, be counted and reported.