8/12- Lab: Morphologic Abnormalities of WBC and Platelets Flashcards
What is this?
Macrophage
- Can see vacuoles where it has eaten something
What is this?
Neutrophil
- Coarser cytoplasm
- Pink granules (not as course as eosinophil)
What is the relative granule coarseness for granulocytes?
Basophil > Eosinophil > Neutrophil
What is this?
Toxic Granulation
- Neutrophils typically have very fine granules, but they are more coarse here
- Smaller than typical basophil granules and slightly different color
What is this?
Dohle Bodies
- Bluish inclusions in cytoplasm
- Remnants of RER or leftover free ribosomes
- Usually indicative of reactive process, but may be a benign condition
What is this?
Cytoplasmic Vacuoles
- Clear areas
- Debris present in vacuoles
What do these all have in common?
They are “Toxic” Changes
- Dohle bodies
- Toxic granulation
- Cytoplasmic vacuoles
- Band forms (not multilobulated nuclei); left shift
What is this? Benign or Malignant?
Pelger Huet Anomaly
- Neutrophils have only 2 lobes (same size, look like spectacles)
- Benign; does not change function of the cell
What is this?
Stodtmeister cell
- No lobation of neturophil nucleus at all (subcategory of Pelger Huet anomaly?)
What is a leukemoid reaction?
Increased numbers of WBCS
- Infection
- Stress
- Trauma
- Childbirth
What is seen here?
Many neutrophils
- Leukemoid reaction (typ increase in WBCs is mostly neutrophils?)
What is seen here?
Eosinophilia
- Characteristic 2 lobes and nice, bright, eosinophilic granules
What may cause eosinophilia?
- Allergic reactions
- Drug allergies
- Parasitic infections
What is seen here?
Lymphocytosis
- Coarse chromatin
- Slightly more cytoplasm than would normally be seen (somewhat reactive)
What is seen here?
Atypical lymphocytes
- Much more cytoplasm
- Somewhat glassy cytoplasm
- “Hugging” other cells; indented by RBCs
- These are reactive changes
When might you see atypical lymphocytes (reactive)?
EBV
What is this?
Leukoerythroblastic
- In center: immature myeloid cell
- Immature cells coming out of bone marrow (myeloid and erythroid)
What is this?
Acute Myelogenous Leukemia (AML)
- All the cells look very similar
- Nucleus is not as dark (chromatin not as clumped)
- Larger than normal (5-6x RBC)
What is this?
Closer look at AML
- Normal lymphocyte in lower middle
- Other cells are HUGE (blasts)
- Big nucleus; high N:C ratio
- Smooth (not clumped) chromatin
What is this?
More blasts in AML
- Myeloid blasts
- Prominent nucleoli
What is seen here?
AML
- Auer Rods
- FOR SURE MYELOID BLASTS!!!
What is this?
Multiple Auer Rods- AML
Sudan black is used for what? What is this?
Sudan Black is a cytochemical stain
- This is AML (confirms myeloid blasts)
What is this?
Acute promyelocytic leukemia (FAB AML M3)
- Cells stuck in promyelyte stage (1 step above blasts)
- Bilobed nuclei
- Nucleolus
- Granulate cytoplasm
- Auer rods
What is this?
Acute myelomonocytic leukemia with abnormal eosinophils (FAB AML M4eo)
- Eosinophilia
- Hard to differentiate between eosinophil and basophil; showing both types of granules (abnormal)
- This is a leukemia because you have blasts in the background
- Typically from chromosomal abnormality (inversion) in chrom 16
What is this?
Acute Monocytic Leukemia (AML M5)
- All monocytes (indented kidney bean nucleus)
- delicately folded nucleus
Confirm monocytes with:
- Specific esterase: negative (positive in myeloblasts)
- Nonspecific esterase: positive
What is this?
ALL- Acute Lymphocytic Leukemia
- Immature lymphocytes
- Still blasts! Not clumped chromatin
- These are large (mature ones are about same size as RBC)
- High N:C ratio
How to differentiate between ALL vs. Lymphocyte?
Lymphoblast
- Very dense, hardly any cytoplasm
What is this?
ALL (bone marrow)
What is this? Genetic cause?
Burkitt Leukemia (BM)
- Translocation 8;14
- Can see nice cytoplasmic vacuoles
- Lymphoid-looking cells - All look similar
What is this?
Chronic Lymphocytic Leukemia (CLL)
- Rogue lymphocytes: small, abnormal (NOT BLASTS)
- Strange lymphocyte morphology: much coarser clumping
- Will have increased WBC count
What is seen here?
Chronic Lymphocytic Leukemia (CLL)
- Smudge cells (very fragile cells; not much cytoplasm)
- Abnormal clumping in lymphocytes
What is this?
Multiple Myeloma (bone marrow)
- Plasma cells are normally very low in bone marrow (under 5%) (plasma cell dyscrasia)
Can tell they’re plasma:
- Slightly eccentric nucleus
- Bluish cytoplasm
- Perinuclear clearing
What is this?
Multiply Myeloma (BM)-- a plasma cell malignancy
Can tell they’re plasma:
- Slightly eccentric nucleus
- Bluish cytoplasm
- Perinuclear clearing
- Clockface nuclei!!!
What is this? Genetics?
CML- Chronic Myelogenous Leukemia
- t9;22 (translocation)- Philadelphia chromosome
- Myeloid cells are taking over
What is this?
Chronic Myelogenous Leukemia (CML)
What is this?
CML (Basophilia)
- Hardly ever see basophils in peripheral blood
- Many immature myeloid cells
What is this?
Essential Thrombocytosis
- Another myeloproliferative neoplasm
- Increased platelets (no benign reason for this)
- Platelets do look normal (normal size and granules)
What is this?
Megathrombocyte (giant platelet)
- About the same size as a RBC
- Just see cytoplasm and granules (no nucleus)
What is this?
Tear Drops
- Tells us there is myeloproliferative issue in the bone marrow
What is this?
Myelofibrosis (bone marrow biopsy)
Left: H and E stain
Right: Reticulin stain
- Looks like they’re “streaming”; streaming effect
- Things look packed
- Reticulin stain is showing much fibrosis (abnormal in bone marrow)
What is this?
Myelodysplastic syndrome (MDS)
- Left arrow = Pseudo Pelger Huet cell
- Right arrow = blast
What is this?
Myelodysplastic syndrome (MDS)
Top: Hypoblated pseudo Pelger Huet cells
Bottom L: Dysplasia in erythroid precursor (D)
Bottom R: Hypogranular and hypolobulated
