Lab Quiz 4 Flashcards
Where does a granulocyte come from, how many cell lines does it have, and name them
Bone marrow
3 cell lines
Neutrophilic, eosinophilic, basophilic
List the granulocyte lineage
Myeloblast → promyelocyte (progranulocyte) → myelocyte → metamyelocyte → band → segmented
Small cells (diameter 14um-18um)
Major part is occupied by a large oval nucleus
Chromatin is very fine, non-aggregated
2 or more nucleoli
Cytoplasm has basopholis character, devoid of granules
Myeloblast
Myeloblast
Primary (azurophilic) granules
Nucleus hidden by granules
Golgi zone and nucleoli may be visible
Approx. 2% of nucleated cells in BM
Don’t circulate in peripheral blood under normal conditions
Promyelocyte
Promyelocyte
Contain both primary and secondary/specific granules (secondary amount increases as cell matures)
Pink granules
Nucleus is round and lacks a nucleolus
Chromatin more condensed
Not normally present in peripheral blood
May be seen in infectious/inflammatory conditions, growth factor effect, marrow infiltration, and myeloid neoplasms
Myelocyte
Myelocyte
Condensed chromatin
Slightly indented nucleus
Abundant specific granules and rare primary granules
Not normally present in peripheral blood
Can be seen in infectious/inflammatory States, and other reactive and neoplastic conditions
Metamyelocyte
Metamyelocyte
Slightly less mature than segmented
Have indented, unsegmented “C” or “S” shaped nuclei
Approx. 5-10% of peripheral blood leukocytes
An increase can indicate infection and inflammation
Bands
Bands
Segmented granulocytes
Mature granulocytes with condensed chromatin
2-5 nuclear lobes separated by thin filaments
Cytoplasm = pale pink, numerous specific granules
40-80% of peripheral blood leukocytes
Segmented granulocytes
Has 6 or more nuclear lobes
Typically seen in megaloblastic anemia due to vitamin B12 of folic acid deficiency
May also be present in myelodysplastic syndromes and rare congenital conditions
Hypersegmentation
Hypersegmentation
Rare autosomal dominant disorder
Caused by failure of nuclear segmentation due to genetic defect
Heterozygous have dumbbell-shaped or hyposegmented neutrophils with coarse chromatin and normal granules
Homozygous have neutrophils with a single, round, eccentric nucleus with clumped chromatin and no nuclear segmentation
Benign condition
Pelger-Huet anomaly
Pelger-Huet anomaly
An acquired abnormality due to myelodysplastic disorders, myeloproliferative diseases, and acute and chronic leukemia’s, reactions to drugs, and so on.
Drug induced tends to have monolobated neutrophils with a single ovoid nucleus
Myelodysplastic syndrome tends to be bi-lobed neutrophils
Pseudo Pelger-Huet anomaly
Pseudo Pelger-Huet anomaly
Autosomal dominant abnormality characterized by large pale basophilic inclusions resembling Dohle bodies which appear to be altered RNA
Giant platelets and sometimes thrombocytopenia
May-hegglin anomaly
May-hegglin anomaly
Rare autosomal recessive disorder
Partial oculocutaneous albinism due to defects in melanin granules and recurrent pyogenic bacterial infections due to abnormalities in granulocytes
Basic defect is in microtubules resulting in fusion of lysosomal granules
All WBCs contain abnormally giant granules
Azurophilic granules form and fuse together to form mega granules
Chediak-Higashi syndrome
Chediak-Higashi syndrome
Caused by the deficiency of one of ten lysosomal enzymes and the resultant accumulation of glycosaminoglycans in tissues and organs
Evenly distributed granulocytes show metachromatic and darkly staining inclusions that resemble toxic granulation but are permanent
Gargoylism and dwarfish
Can be neurological impairments, vision, hearing, and developmental issues
Tay-sachs, Hunter syndrome
Alder-reilly anomaly
Alder-reilly anomaly
Alder-Reilly anomaly
Rare genetic disorder
Deposition of glucocerebroside in cells of the macrophage-monocyte system
Disorder results from the deficiency of the enzyme glucocerobrosidase
Lipid storage problem
Gaucher Cell
Gaucher cell
Lysosomal storage disease that affects metabolism and caused by genetic mutations
Some not able to metabolize cholesterol and other lipids property within the cell
Others have a deficiency of a specific enzyme, acid sphingomyelinase
Niemann-pick disease
Niemann-pick cells
Develop when a series of acquired genetic mutations take place within the bone marrow compartment leading to a proliferation of clones of abnormal stem cells
Myeloproliferative disorders (neoplasm)
Peripheral blood demonstrates neutrophilia with prominent left shift, eosinophilia, and basophilia
Typically numerous myelocytes and segmented neutrophils predominate
Dark primary granules, metamyolocytes, band neutrophils
Chronic myelogenous leukemia
Chronic myelogenous leukemia
Very high WBC count and immature WBC (blasts, promyelocytes, myelocytes, and metamyelocytes)
Often have anemia or thrombocytopenia
Band neutrophils, increase in basophils and eosinophils
Chronic myelogenous leukemia
Chronic myelogenous leukemia
Chronic myelogenous leukemia
Solid green arrows = atypical monocytes, they are slightly larger and show a decreased lobularity of the nucleus
Dotted green arrow = large promonocyte
Solid yellow arrows = hypogranular/agranular segmented neutrophils
Dotted yellow arrow = band neutrophil
White arrows = myelocyte with lower amount of cytoplasm
Cyan arrow= a megaloblastoid metamyelocyte with hypogranular cytoplasm
Chronic myelomonocytic leukemia (CMML)
Condition where peripheral WBCs on a stained blood smear may have some resemblance to leukemia cells
High neutrophil count with more immature cells, particularly myelocytes
High leukocyte alkaline Phosphatase score
Metamyelocytes, neutrophils
Leukemoid reaction
Leukemoid reaction
What disease?
Leukemoid reaction
Used to differentiate chronic leukemia vs leukemoid reaction
An enzyme present in the secondary granules of neutrophils and not present in eosinophils or basophils
Each cell is assigned a score between 0-4 (0 = no stain retained, 4 = very dark)
Scores of each cell are added up which give a potential score 0-400
Leukocyte alkaline phosphatase (LAP)
Leukocyte alkaline phosphatase
Normal morphology
Increase in RBCs, granulocytic WBCs, platelets, hemoglobin, and hematocrit
Polycythemia Vera
Polycythemia Vera
Sustained and pronounced thrombocythemia
Increased megakaryocytes in marrow
Increased WBC, occasionally metamyelocytes and myelocytes present
Essential thrombocythemia
Essential thrombocythemia
Fibrosis of marrow cavity
Extramedullary hematopoesis
Smear may show nRBC, immature granulocytes, micromegakaryocytes
Tear drop cells
Primary myelofibrosis
Primary myelofibrosis
Acute myeloblastic leukemia, minimally differentiated
Acute myelogenous leukemia M0
Acute myeloblastic leukemia, without maturation
Acute myelogenous leukemia M1
Acute myeloblastic leukemia, with granulocytic maturation
Acute myelogenous leukemia M2
Promyelocytic, or acute promyclocytic leukemia (APL)
Acute myelogenous leukemia M3
Acute myelomonocytic leukemia
Acute myelogenous leukemia M4
Myelomonocytic together with bone marrow eosinophilia
Acute myelogenous leukemia M4eo
Acute monoblastic leukemia (M5a) or acute monocytic leukemia (M5b)
Acute myelogenous leukemia M5
Acute erythroid leukemias, including erythroleukemia (M6a) and very rare pure erythroid leukemia (M6b)
Acute myelogenous leukemia M6
Acute megakaryoblastic leukemia
Acute myelogenous leukemia M7
This stains is an enzyme that is found in the primary grandes of all granulocytes and monocytes and not present in lymphocytes
Useful for differentiating between ALL and AML
Positive stain for acute myeloid leukemias M1, M2, M3, M4
Stains lipids present in the primary and secondary granules of granulocytes and monocyte lysosomes
Myeloperoxidase (MPO)
What stain is present
Myeloperoxidase (MPO)
Non-specific - used to differentiate granulocytes from monocytes
Specific - specific for granulocytes (myeloblasts)
Esterase stains
What stain is used
Esterase stain
Lack of obvious myeloid differentiation
Presence of myeloperoxidase in <3% of blasts
Blasts are small to large with no granules or auer rods
Blasts contain evenly distributed chromatin and prominent nucleoli
Appear similar to lymphoblasts
Acute minimally differentiated myeloid leukemia (AML-M0)
What disease shows myeloblasts that are larger than a small lymphocyte and does not show prominent nucleoli
Lymphoblastic leukemia
What disease
Acute minimally differentiated myeloid leukemia (AML-M0)
Presence of more than 90% myeloblasts in blood and/or bone marrow
Most blasts are large with prominent nucleoli
Acute myeloblastic leukemia with minimal maturation (AML-M1)
What disease
Acute myeloblastic leukemia with minimal maturation (AML-M1)
Presents with greater than 20% blasts, at least 10% maturing cells of neutrophil lineage, and fewer than 20% precursors with monocytic lineage
Auer rods and other aspects of dysplasia are present
Abnormal shapes and primary granules starting
Acute myeloblastic leukemia with maturation (AML-M2)
What disease
Acute mydoblastic leukemia with maturation (AML-M2)
Predominance of promyelocytes
Abundance of purple granules
Some have “bundles of auer rods”
Promyelocytes have abnormally coarse and numerous azurophilic granules
Several cells have bi-lobed nuclei (angel wings) and a cell in the center of the field contains multiple needle-like auer rods
AML-M3
Acute promyelocytic leukemia (APL)
What disease
AML M3
Acute promyelocytic leukemia (APL)
Myeloid and monocytic cells are present
Monocytic cells comprise at least 20% of all marrow cells, with monoblasts and promonocytes present
Acute myelomonocytic Leukemia (AML M4)
What is M4 eos
Acute myelomonocytic leukemia with eosinophilia
What disease
Acute myelomonocytic leukemia (AML M4)
More than 20% monoblasts and/or promonocyte cells in bone marrow
Large monoblasts with fine nuclear chromatin and prominent nucleoli
Absence of auer rods
Promonocytes show moderate amounts of cytoplasm and large nuclei with five chromatin but without prominent nucleoli
Presence of nuclear folds and creases
Acute monoblastic-monocytic leukemia (AML M5)
What disease
Acute monoblastic - monocytic leukemia (AML M5)
What kind of cell is the arrow pointing at?
What disease
Nucleated RBC (nRBC)
Erythroleukemia (AML-M6)
What disease
Acute basophilic leukemia (AML M8)
Lymphocytes are small but slightly larger than normal small lymphocytes and show scant cytoplasm and round to slightly irregular nuclei contains clumped chromatin
Nucleoli are small to indistinct
Presence of “smudge” or “basket” cells
B-cell chronic lymphocytic leukemia (CLL)
What disease
B-cell chronic lymphocytic leukemia (CLL)
Medium-sized lymphocytes with prominent single nucleoli, with a moderate amount of pale weakly basophilic cytoplasm, and somewhat condensed chromatin
What disease?
Chronic lymphocytic leukemia (CLL) with prolymphocyte transformation / prolymphocytic leukemia
What disease
Chronic lymphocytic leukemia (CLL) with prolymphocyte transformation / prolymphocytic leukemia
What type of Acute Lymphocytic Leukemia (ALL):
T cell or pre-B cell
Small and homogeneous (uniform) cells
ALL - L1
What type of Acute Lymphocytic Leukemia (ALL):
T cell or pre-B cell
Large and heterogeneous (varied) cells
ALL - L2
What type of Acute Lymphocytic Leukemia (ALL):
B cell
Large and varied cells with vacuoles
ALL - L3
Mostly B cells
Blasts have:
Minimal cytoplasm
Variable nuclear size and chromatin density
Irregular nuclear contour
Some small nucleoli
Acute lymphocytic leukemia L1
What disease
Acute lymphocytic leukemia L1
Blasts have:
Moderate cytoplasm
Round nuclei of variable size
Coarse chromatin
Some resemble mature lymphocytes
Not noticeable nucleoli
Acute lymphocytic leukemia L1
What disease
Acute lymphocytic leukemia L1
Large lymphoblasts have:
Moderate cytoplasm
Large nuclei with hoarsely reticular chromatin
Prolymphocytic transformation
Acute lymphocytic leukemia L2
What disease
Acute lymphocytic leukemia L2
Blasts have cytoplasmic azurophilic granules (uncommon)
Acute lymphocytic leukemia L2
What disease
Acute lymphocytic leukemia L2
Blasts:
Vary in size, small to large
May contain very scant to moderate amounts of cytoplasm and is a darker blue color
May be heterogeneous with respect to the amount of cytoplasm, nuclear size, and presence or absence of distinct nucleoli
Cytoplasmic vacuoles may be seen
Acute lymphocytic leukemia L3
What is a characteristic feature of Burkina lymphoma/leukemia and is related to the Epstein-Barr virus
The presence of cytoplasmic vacuoles
What disease
Acute lymphocytic leukemia L3
AKA Burkitt lymphoma
Tumor cells have moderate amounts of deeply basophilic cytoplasm with numerous lipid vacuoles
Acute lymphocytic leukemia L3
What disease
Acute lymphocytic leukemia L3
What is a group of malignancies that develop from lymphocytes, they originate in lymphoid tissue and spread to the bone marrow and other tissues over time
Lymphoma
What are the two main types of lymphoma
Hodgkin lymphoma and Non-Hodgkin lymphoma
Name the disease:
Malignant cells usually have B-cell markers
Associated with epstein-barr virus
Reed-sternberg cells in bone marrow
Hodgkin’s lymphoma
What disease
Hodgkin’s lymphoma
Seen in a bone marrow specimen with twin nuclei and prominent nucleoli
Clear area around the nucleoli with H&E stain, giving “owl’s eyes”
Reed sternberg cells
What type of cell
Reed sternberg cells
Rare b-cell lymphoproliferative disorder usually seen in middle-aged men
Shows the circumferential cytoplasmic ”fuzzy” projections (arrow)
Moderate light to pale blue cytoplasm
Hairy cell leukemia
What disease
Hairy cell leukemia
An aggressive form of lymphoma called cutaneous T-cell lymphoma. Cells are present in the blood, skin, and lymph nodes
Abnormally shaped nucleus
Sezary syndrome
What type of cell
Sezary cells
Intermediate to large sized lymphoid cells with irregular nuclei, dispersed chromatin, prominent nucleoli, and small amounts of cytoplasm
T-cell lymphoblastic lymphoma
Circulating lymphoma cells may be pleomorphic with basophil cytoplasm resembling blasts
Vary in size
Large B-cell lymphoma
Cells with cleaved nucleus and paucity of cytoplasm
What disease?
Mantle cell lymphoma
What cell
Plasma cell
Plasma cells with multiple cytoplasmic globules present in a single cell
Seen in some parasitic infections, malaria, leishmaniasis, trypanosomiasis, myeloma
Mott cells
Grape cell or morula cell
The term for individual inclusion/globule in a Mott cell
Russell body
Nuclear inclusions in Mott cells
Dutcher bodies
Plasma cells with a distinctive pinkish hue in the outer rim of the cytoplasm
Cells found in plasma cell dyscrasias as well as cases of chronic infection or inflammation
Flame cell
What cell
Flame cell
Varies from small mature-appearing plasma cells to large anaplastic cells without any apparent resemblance to plasma cells
Show “clonal” morphology
Multiple myeloma
Cells with crystalline inclusions
Forms include needle-like, coarse, azurophilic granules, prismatic, spindle shaped, spherical, and cylindrical shape
What disease?
Multiple myeloma
Yellow arrow = small lymphocyte
Two arrowheads = two plasma cells
Two long arrows = two plasmacytoid lymphocytes
What disease?
Waldenstrom’s macroglobulinemia
Contains small lymphocytes, plasma cells, and plasmacytoid lymphocytes (constant feature)
Can have rouleaux formation
What disease
Waldenstrom’s macroglobulinemia
Eccentric nuclei that protrudes from the cell and a pale hoff that is not adjacent to the nucleus
What kind of cell?
Osteoblast
How are thrombocytes generated
Start in bone marrow → stem cell → common myeloid progenitor → megakaryocyte - erythrocyte progenitor → megakaryoblast → promegakaryocyte → megakaryocyte → platelet
Large cell about 20-30 micrometers in bone marrow
Has a single oval or kidney- shaped nucleus, several nucleoli, and basophilie non-granular cytoplasm
Megakaryoblast
Large cell about 20-30 micrometers in bone marrow
Single oval or kidney - shaped nucleus, several nucleoli and basophilic non-granular cytoplasm
What cell
Megakaryoblast
More abundant cytoplasm
Cytoplasm is less basophilic and may begin to show azurophilic granulation
Nucleus becoming irregular even lobed in shape
Multiple nucleoli present
Still in bone marrow
What cell
Promegakaryocyte
Large cell, round or oval. 20-80 micrometers. In bone marrow
Cytoplasm appears lumpy, basophilic, with azurophilic granules
Chromatin is dense and multi-lobed
Basophilic megakaryocyte
Large cell 35-160 micrometers in diameter. Round or oval, often has unclear contour. In bone marrow
Edges are slightly basophilic or colorless
Filled with markedly red or bluish-red granules
Lobed condensed nucleus sometimes with separated lobuli
What cell
Acidophilic megakaryocyte
Large, round to oval cell 35 - 160 micrometers. In bone marrow
Cytoplasm is slightly reddish to colorless with clusters of azurophilic granules
Produces between 2000 - 7000 thrombocytes, which can be seen breaking off along the margins of the cell
Nucleus is irregular s often fragmented and pyknotic with denser chromatic
Thrombocytogenic megakaryocyte
What cell?
Megakaryocyte nuclei
15-30 micrometers
Nuclear chromatin may appear smudged or puddled looking
What cell?
Micromegakaryocyte
Rare autosomal recessive disorder
Giant hyper granular platelets with granules condensed in center creating a “pseudo-nucleus”
What disease?
Bernard - soulier syndrome
Normal to giant in size
Round, oval or irregular in shape, have surface projections
Cytoplasm is light gray to light blue
Contain rare azurophilic granules
What cell
Hypo granular platelet
Rare inherited disorder (autosomal recessive)
Moderate thrombocytopenia and agranular platelets
Platelets lack granules and appear as gray or pale blue splotches
What disease
Gray platelet syndrome
May occur as the result of partial clotting from not properly and promptly mixing the specimen or if the blood draw is poorly performed
Can cause pseudo-thrombocytopenia
Platelet clumps/aggregation
Can cause pseudo-thrombocytopenia
Result of an IgG plasma antibody coating platelets in the presence of EDTA. The platelets then rosette around segmented neutrophils, bands, and monocytes
Platelet satellitism
Nuclei with multiple overlapping lobes
Megakaryocyte
