Lab Quiz 4 Flashcards by Mikayla Cleary

Where does a granulocyte come from, how many cell lines does it have, and name them

Bone marrow
3 cell lines
Neutrophilic, eosinophilic, basophilic

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List the granulocyte lineage

Myeloblast → promyelocyte (progranulocyte) → myelocyte → metamyelocyte → band → segmented

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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

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Myeloblast

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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

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Promyelocyte

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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

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Myelocyte

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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

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Metamyelocyte

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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

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Bands

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Segmented granulocytes

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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

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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

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Hypersegmentation

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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

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Pelger-Huet anomaly

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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

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Pseudo Pelger-Huet anomaly

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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

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May-hegglin anomaly

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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

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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

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

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

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

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

Sustained and pronounced thrombocythemia Increased megakaryocytes in marrow Increased WBC, occasionally metamyelocytes and myelocytes present

Essential thrombocythemia

Fibrosis of marrow cavity Extramedullary hematopoesis Smear may show nRBC, immature granulocytes, micromegakaryocytes Tear drop cells

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