WBC Abnormalities

Carlo Chris S. Apurillo,RMT

Instructor, Clinical Hematology College of Medical Technology

Morphologic Abnormalities of Granulocytes

1. Alder-Reilly anomaly
Large,

coarse, dark metachromatic granules Found in genetic mucopolysaccharidoses lack of lysosomal enzymes to break down mucopolysaccharides

1. Alder-Reilly anomaly

2. Auer Rods
Pink/red

rod like bodies fused with granules Associated with APL (M3) acute promyelocytic leukemia

2. Auer Rods

3. Chediak Higashi Granules

Large,

round blue gray

bodies Chediak Higashi syndrome rare autosomal recessive condition associated with abnormally large leukocyte granules resulting from fusion of lysozymes

3. Chediak Higashi Granules

4. Dohle bodies
small,

oval inclusions in the cytoplasm of PMNs that stain pale blue with Wrights stain. Aggregates of free ribosomes Associated with severe infection

4. Dohle bodies

4. Dohle bodies

5. May-Hegglin Anomaly
Rare

autosomal dominant condition characterized by presence of pale blue inclusions resembling Dohle bodies in neutrophils Larger and more prominent than Dohle bodies Characterized by giant plts

5. May-Hegglin Anomaly

6. Hypersegmented neutrophil
Neutrophil

with more than 5 segments Due to abnormal DNA synthesis Found in: megaloblastic anemia Shift to the right

6. Hypersegmented neutrophil

7. LE Cell
Large,

round, purple homogenous inclusion surrounded by flattened nuclei. Found in Systemic lupus erythematosus

7. LE Cell

8. Pelger Huet Anomaly

Single

or bilobed nucleus (hyposegmentation) Hereditary, autosomal dominant condition which involves failure of normal segmentation of granulocytic nuclei

8. Pelger Huet Anomaly

9. Toxic granulation
Large

dark blue to purple cytoplasmic granules in the metamyelocyte, and, or neutrohil stage. Primary granule enhancement Found in severe infections, toxic states, burns, malignancy and chemical poisoning

9. Toxic granulation

9. Toxic vacuoles
Large,

empty white areas End stage phagocytosis Found in: septicemia, severe infections, toxic states.

Morphologic Abnormalities of Lymphocytes

1. Basket Cell/Smudge cell

Degenerated

nucleus, ruptured cell due to its fragility Found in: chronic lymphocytic leukemia Artifact if few

1. Basket Cell/Smudge cell

2. Flame cell
Plasma

cell with pink to red cytoplasm Increase IgA (multiple myeloma)

3. Grape Cell/Mott Cell

Also

known as Russel bodies Vacuolated plasma cell Found in multiple myeloma; reactive states

3. Grape Cell/Mott Cell

4. Reactive Lymphocytes
Also

known as Atypical lymphocytes or Downey Cell Type I Vacuolated Type II Stress lymphocyte Type III Lymphoblast like

4. Reactive Lymphocytes
>20%

- infectious mononucleosis, viral Hepa <20% - pneumonia, systemic allergy, TB, toxoplasmosis

Review!

Alder-Reilly granules

Chediak Higashi granules

Auer Rods

Review!

May-Hegglin anomaly

Dohle bodies

hypersegmentation

Review!

LE Cell

Pelger Huet

Review!

Basket cell Toxic granulation

Review!

Flame cell

Grape cell

Review!

Atypical lymphocytes

The end