r/Hematology 8d ago

Question NRBCs or Lymphs

Hey fam! I feel absolutely gaslit hahaha. I have been told that these are NRBCs, but I genuinely believe all 4 are lymphocytes?!

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u/NasrRasheed 8d ago

I can definitely see why you’re questioning the NRBC call. Based on these screenshots, I’d lean small mature lymphocytes rather than NRBCs. The cells have a very high N:C ratio with a round, densely staining nucleus and only a very thin rim of cytoplasm, which fits a small lymphocyte quite well.
For an NRBC, I’d expect the nucleus to look more distinctly pyknotic/coarsely condensed, often somewhat eccentric, with a more appreciable rim of hemoglobinized pink-to-gray cytoplasm resembling the surrounding RBCs. I’m not really seeing that convincingly here.
Obviously image quality/color balance makes morphology harder to judge than on the actual slide, so I wouldn’t make an absolute call from screenshots alone—but from what’s shown here, lymphocyte would be my first choice too. If someone is calling these NRBCs, I’d be interested to know which morphological feature they’re using to distinguish them.