3RD HEMA - Part 1 Flashcards
Increase in the number of immature or young forms of white blood cells
Shift to the Left
2 Types of Shifts to the left
*Degenerative shift to the left
*Regenerative shift to the left
Normal or low WBC count
May be exhibited in cases of Tuberculosis
Degenerative shift to the left
Increased WBC count
May be exhibited in cases of Appendicitis
Regenerative shift to the left
Shift to the Right
Usually seen with ________ and cases such as _________ Anemia
Usually seen with neutrophils and cases such as Pernicious Anemia
Increase in the number of mature or old forms of WBC
SHIFT TO THE RIGHT
RBC Shift to the left denotes _______________
WBC Shift to the left denotes ________________
RBC Shift to the left denotes microcytosis
WBC Shift to the left denotes immature WBCs
Also known as
Leukoerythroblastosis
Leukoerythroblastic Anemia
LEUKOERYTHROBLASTIC REACTION
_________ is an autoimmune disease where antibodies attack parietal cells of the stomach, inhibiting HCl and IF release
Pernicious Anemia is an autoimmune disease where antibodies attack parietal cells of the stomach, inhibiting HCl and IF release
LEUKOERYTHROBLASTIC REACTION
The presence of the following are seen in PBS:
1.
2.
3.
Immature Neutrophils
Nucleated RBCs
Teardrop RBCs (Dacrocytes)
Observed in conditions involving the presence of space occupying lesion in the marrow (myelophthisis) such as:
Metastatic Tumor
Fibrosis
Lymphoma
Leukemia
Striking and Sustained leukoerythroblastic
Often, but not always, accompanied by Neutrophilia
A non-specific reaction, but provides important evidence of underlying disease or stress to the hematopoietic compartment of the body
Strongly associated with Primary Myelofibrosis (PMF)
LEUKOERYTHROBLASTIC REACTION
Hemolytic Anemia
Severe Infections
Cardiac Failure
Uremia
Megaloblastic Anemia
Mild and Transitory Leucoerythroblastic Reactions
Nuclear remnants of lymphocytes
Looks like thumbprint
Structureless Chromatin
Smudge Cells
Nuclear Remnants of Granulocytic Cells
Netlike Chromatin Pattern
Basket Cells
May be found normally in few numbers
Chronic Lymphocytic Leukemia
Smudge Cells
Contaminant of venipuncture (occasionally)
Must not be confused with malignant cells
Endothelial Cells
May be found normally in few numbers
Leukemias
Basket Cells
Neutrophils that engulfed foreign bodies like bacteria and fungi
Phagocytic Cells
Overwhelming Septicemia
Bacterial and Fungal Infections
Erythrophagocytosis (In which neutrophils engulfs RBCs)
Phagocytic Cells
Granulocytic Cells with Pyknotic Nuclei and Agranular Cytoplasm
Necrotic Cells
Prolonged EDTA exposure
Chemotherapy (rarely)
Necrotic Cells
Large cells (20 to 30 um) which line the veins
Stretched and ovoid in appearance
Single Nucleus with dense chromatin
Abundant cytoplasm which appears translucent
Usually found at the feathery edge
Endothelial Cells
Nude nuclei that stain dark purple
Megakaryocyte Fragments
Found in Newborns
May be found in aberrant platelet production, myelofibrosis, essential thrombocythemia
Megakaryocyte Fragments
Found in newborns
May be found also in cases of hemolysis, leukemia, myeloproliferative disorders, and others
Nucleated RBC
(NRBCS)
Varies according to cell maturity
Nucleated RBC
(NRBCS)
Defect or Deficiency in the catabolic enzyme: β-glucocerebrosidase
Gaucher Disease
WBC type of Gaucher Disease
Monocyte/ Macrophages
Most common of the lipidoses
An autosomal recessive disorder
GAUCHER DISEASE
Found in bone marrow
Large macrophage with small, eccentric nucleus
Cytoplasm is distended by glucocerebrosidase
Gaucher Cell
“Crumpled tissue paper” or onion like appearance
Gaucher Cell
These are the false/fake kinds of Gaucher cells
NOT found in Gaucher disease
Can be encountered in:
Thalassemia
Chronic Myeloid Leukemia
Acute Lymphoblastic Leukemia
Non-Hodgkin Lymphoma
Plasma Cell Neoplasms
Pseudo-Gaucher cells
What material accumulates in the cytoplasm of Gaucher Disease?
B-glucocerebrosides
What cell has a characteristic of crumpled tissue paper appearance?
Gaucher Disease
(2) Tests used in Gaucher Disease
● Chitotriosidase
● Periodic acid-Schiff Stain
○ From periodate
● Washington Monument Hemoglobin Crystals
○ Associated with ____ _
○ Associated with Hb C
Not unique in megaloblastic anemia
HYPERSEGMENTED NEUTROPHILS
WBC type of Hyper segmented Neutrophils
Neutrophils
Morphologic of Functional Defect of Hyper segmented Neutrophils
Nucleus has ≥ __ lobes
Nucleus has ≥ 6 lobes
Can be encountered in:
Megaloblastic anemias
Myelodysplastic syndromes
Hereditary neutrophil
Hypersegmentation
Myelokathexis
HYPERSEGMENTED NEUTROPHILS
Pertains to a rare hereditary condition characterized by normal granulocytic production; nevertheless, there is impaired release in to the blood (leads to neutropenia)
Here, neutrophils appear hypermature. There may be hypersegmentation, hyper condensed chromatin, and pyknotic changes in this condition.
Myelokathexis (Hypersegmented Neutrophils)
Expected in:
● Megaloblastic anemias
○ Vit. B12 & folate deficiency
Hypersegmented Neutrophils
2 Nutritional deficiencies associated with the megaloblastic anemia:
● Vitamin B12 deficiency
● Folate deficiency
3-5 lobes
Normal neutrophil
> 5 lobes
Hypersegmented
<3 lobes
Hyposegmented
AKA
True/Congenital PHA
PELGER-HUET ANOMALY
WBC type of PELGER-HUET ANOMALY
Neutrophils
Failure of the neutrophil nucleus to segment
PELGER-HUET ANOMALY
Pince-nez or “spectacle” form of neutrophil nucleus
Pelger-Huet Cell
Hyposegmented neutrophils (with 1 to 2 nuclear lobes)
Autosomal dominant disorder
PELGER-HUET ANOMALY
Most common genetic disorder of WBCs
PELGER-HUET ANOMALY
Decreased
nuclear segmentation (bilobed, unilobed)
coarse chromatin clumping pattern potentially affecting all leukocytes, although morphologic changes are MOST obvious in mature neutrophils
PELGER-HUET ANOMALY
A result of a mutation in the lamin β-receptor gene
an inner nuclear membrane protein
plays a major role in leukocyte nuclear shape changes that occur during normal maturation
PELGER-HUET ANOMALY
Neutrophils show normal granulation in true ___
Neutrophils in ___ appear to function normally
PELGER-HUET ANOMALY
Round, ovoid, peanut-shaped
Unilobed
Spectacle-like (“pince nez”) morphology with nuclei attached by a thin filament
Bilobed
All neutrophils are affected and demonstrate round nuclei
Homozygous PHA
55% to 93% of the neutrophil population are affected (there is generally a mixture of all of the aforementioned nuclear shapes)
Heterozygous PHA
What WBC has a “pince nez” appearance for their nuclei?
Bilobed Pelger-Huet Cell
are eyeglasses worn on the bridge of the nose
Pince nez
True or false, The Pseudo-Pelger-Huet cell can be found in PHA?
False
Chronic Myeloproliferative Neoplasms
Myelodysplastic Syndromes
HIV
Leukemia
Mycoplasma Pneumoniae
Severe Bacterial Infections
ACQUIRED PELGER-HUET ANOMALY
Russell Bodies are globules found in plasma cells, containing ___ antibodies or immunoglobulins
GRAPE CELL
ONLY
AKA
Morula Cell or Mott cell
GRAPE CELL
An abnormal plasma cell with a cytoplasm that is completely filled with ________ _______
GRAPE CELL
An abnormal plasma cell with a cytoplasm that is completely filled with Russell Bodies
Multiple Myeloma or Plasma Cell Myeloma
GRAPE CELL
What is the abnormal protein found in the urine excreted by patients with Plasma Cell Myeloma?
Bence Jones proteins are made with immunoglobulin light chains
GRAPE CELL
Characteristics of patients with Plasma Cell Myeloma:
[C-R-A-B]
[C-R-A-B]
Hypercalcemia
Renal Insufficiency
Anemia
Bone Lesions
WBC type of Grape Cell
Plasma Cell
WBC type of Chediak-Higashi Syndrome
Phagocytes and Lymphocytes, also a platelet disorder
A rare autosomal recessive disease of immune
dysregulation
Chediak-Higashi Syndrome
Basic defect: Golgi Complex
● Responsible for granule assembly w/in WBCs
● Defect in Golgi Complex results in incorrect
distribution of granules (e.g. aggregation)
○ If there is a defect there will be giant
granules in the WBCs
Chediak-Higashi Syndrome
Characterized by the presence of LARGE (GIANT),
● abnormal cytoplasmic GRANULES in
phagocytes (granulocytes and monocytes),
and occasionally in lymphocytes
Chediak-Higashi Syndrome
Abnormal granules in phagocytes are:
Peroxidase (+)
Abnormal granules in lymphocytes are:
Peroxidase (-)
Numerous types of cells in the body are affected and show abnormally large, lysosomes
○ Which contain fused dysfunctional granules
Chediak-Higashi Syndrome
_________ _______ is observed due to abnormal
packaging of melanosomes
○ (patient has silvery hair, pale skin and suffers from photophobia)
Partial albinism
Chediak-Higashi Syndrome
WBC type of Hairy Cells
Lymphocytes
Small lymphocytes with little cytoplasmic
projections
○ Hair like projections
Hairy Cells
TRAP (+) stain
Hairy Cells
TRAP (+) stain stands for
○ Cytochemical stain used
Tartrate
Resistant
Acid
Phosphatase
It is TRAP (+) because the hairy cell produces abundant amount of _________ _
isoenzyme 5
● Found in ___________________ (chronic lymphocytic leukemia)
● Nearly all blood cells contain 7 non erythroid isoenzymes of acid phosphatase (0, 1, 2, 3,
3b, 4 and 5)
● Found in Hairy Cell Leukemia (chronic
lymphocytic leukemia)
Tartrate resistant
Produced in abundance by the hairy cells
Isoenzyme 5
● Nearly all blood cells contain 7 non erythroid isoenzymes of acid phosphatase
(0, 1, 2, 3, 3b, 4 and 5)
What is the cytochemical stain utilized to
demonstrate hairy cells?
Tartrate Resistant Acid
Phosphatase (TRAP)
WBC type of Tart Cells
Monocytes
A monocyte that has ingested
a whole lymphocyte or a
nucleus (with an identifiable
nuclear chromatin)
TART CELLS
May be seen in drug sensitivity
TART CELLS
WBC type of Toxic Granulations
Neutrophil only
Altered primary granules found
in certain instances within
neutrophils (present because of
rapid cell maturation)
TOXIC GRANULATIONS
Described as dark-blue to black
granules found in the cytoplasm
of neutrophils
TOXIC GRANULATIONS
Seen in
○ Several and certain
bacterial infections
○ Chemical poisoning (e.g.
lead)
- Plumbism (lead
poisoning)
TOXIC GRANULATIONS
In Plumbism (lead poisoning), what RBC
inclusion body/abnormality is seen?
Basophilic
stippling
In Plumbism (lead poisoning), what WBC inclusion body/abnormality is seen?
Toxic granulation
WBC Type of Auer Rods
● A cytoplasmic inclusion body not a
WBC
- Found in leukemic cells and/
promyelocytes
● Linear projections of primary
granules
● Abnormal needle-shaped, Rod-like
or round pink to purple inclusion in
the cytoplasm of myeloblasts and
promyelocytes;
● Composed of condensed primary
granules.
AUER RODS / AUER BODIES
● Seen in certain types of Acute
Myelogenous Leukemia (AML)
● Must be differentiated from toxic
granules (appearance)
AUER RODS / AUER BODIES
Appear as needles
FAGGOT CELLS
Are abnormal WBCs with bundles of Auer rods in its cytoplasm
FAGGOT CELLS
If there is only one Auer rod in the cell, it is reported as
abnormal WBC with an Auer rod
If there is a bundle or many Auer rods in the cell, it is now called as
faggot cell
WBC Type of REED-STERNBERG CELLS
Lymphocyte
● Characterized by its owl’s eyes
appearance due to the existence of two nuclei (with eosinophilic nucleoli within the nuclei) within the giant lymphoid
cell
REED-STERNBERG CELLS
● A large lymphoid cell which may
demonstrate two nuclei/or
binucleates (with eosinophilic
nucleoli) and an abundant
cytoplasm
REED-STERNBERG CELLS
● Presence of these cells is the
definitive histologic characteristic of Hodgkin’s Disease (Hodgkin’s Lymphoma)
REED-STERNBERG CELLS
WBC Type of Flower Cells
Lymphocytes
Nuclei is characterized with its
flower-like appearance (petal of
flowers)
FLOWER CELLS
Seen in Adult T-Cell Leukemia
FLOWER CELLS
POPCORN CELLS AKA?
L and H cell
What type of leukemia can the flower cells be seen?
Adult T-Cell Leukemia
L and H cell means
- L = lymphocytic
- H = histiocytic
WBC Type of POPCORN CELLS (L & H CELLS)
● Lymphocytes
● Histiocytes
● Distinctive popcorn-like
appearance with polylobulated
nuclei and abundant cytoplasm
POPCORN CELLS (L & H CELLS)
● Large lymphoid cells with
abundant cytoplasm and
vesicular multilobulated nuclei or
popcorn nuclei
POPCORN CELLS (L & H CELLS)
● Seen in Nodular Lymphocyte
Predominant Hodgkin’s
Lymphoma (NLPHL)
POPCORN CELLS (L & H CELLS)
- _____neoplasm composed
of relatively rare neoplastic
cells scattered within nodules
of reactive lymphocytes
- B-cell neoplasm composed
of relatively rare neoplastic
cells scattered within nodules
of reactive lymphocytes
POPCORN CELLS (L & H CELLS)
- Hallmark cells of Hodgkin
lymphoma (HL) (Acc to
Rodaks)
POPCORN CELLS (L & H CELLS)
● Seen in Mycosis Fungoides
- Most common cutaneous
lymphoma
SEZARY CELLS
WBC Type of Sezary Cells
Lymphocytes
● Cerebriform nucleus
- Brain-like appearance
SEZARY CELLS
● Small to medium sized lymphoid
cells with irregular nuclear outlines
(source: rodaks)
SEZARY CELLS
● Round or oval blue-staining
cytoplasmic inclusions
DÖHLE BODIES
WBC Type of Dohle Bodies
● An cytoplasmic inclusion body, not a
WBC
- Found in Neutrophils
- A type/kind of cancer
(Non-Hodgkin’s Lymphoma) - Not a fungal infection
SEZARY CELLS - Mycosis Fungoides
● No giant platelets
DÖHLE BODIES
● Arranged in parallel rows and
consisting of ribosomal RNA
● Toxic granulation
DÖHLE BODIES
● Non-specific and can be found in:
- Pregnancy
- Severe burns
- Aplastic anemia
- Scarlet fever
- Other infectious diseases
- Following administration of toxic
agents
DÖHLE BODIES
● Autosomal dominant platelet
disorder
MAY-HEGGLIN ANOMALY (MHA)
WBC Type of MAY-HEGGLIN ANOMALY (MHA)
Leukocytes and platelets
● Characterized by variable
thrombocytopenia, giant platelets,
and large Dohle body-like
inclusions in neutrophils,
eosinophils, basophils, and
monocytes (source: Rodaks)
MAY-HEGGLIN ANOMALY (MHA)
● If they have Dohle body like
inclusions they have ____________________ which are treated
differently
MAY-HEGGLIN ANOMALY (MHA)
- Gray-blue, spindle-shaped
inclusions in the cytoplasm of
granulocytes and monocytes
Dohle body-like Inclusions
● Has Giant platelets
MAY-HEGGLIN ANOMALY (MHA)
Characteristics of _____________
- Leukopenia
- Variable thrombocytopenia
- Spindle shape Inclusions
- Giant platelets
May-Hegglin Anomaly
Dohle Bodies: SIZE
Smaller
Dohle Bodies: PAS
Positive
Dohle Bodies: SHAPE
Round
Dohle Bodies: CONTENT
Ribosomal RNA
Dohle body-like inclusions in MHA: SIZE
Larger
Dohle body-like inclusions in MHA: shape
Spindle-shaped
Dohle body-like inclusions in MHA: PAAS
Negative
PAS:
Periodic Acid-Schiff
Dohle body-like inclusions in MHA: CONTENT
Messenger RNA
______________ are composed of lamellar rows of rough endoplasmic reticulum.
Döhle bodies
Brain-like appearance
Cerebriform nucleus
The basophilic _________________________ in May-Hegglin anomaly are composed of precipitated myosin heavy chains.
Döhle body–like leukocyte inclusions
MHA:
May-Hegglin Anomaly
