Qualitative WBC Abnormalities Flashcards
Objective 1: Compare and contrast nonmalignant changes in leukocytes including: hyposegmentation
Focus on the following characteristics:
a. Method of acquisition (acquired or inherited, or both)
i. If inherited, is the condition autosomal dominant or autosomal recessive
b. Clinical Significance
Hyposegementation
a. Acquired
b. Absent or decreased number of granules in neutrophils
b. Fusion of cytoplasmic granules with phagosome, asynchronous maturation due to
accelerated proliferation, linked to myelodysplastic syndrome (MDS) and
leukemia
Objective 1: Compare and contrast nonmalignant changes in leukocytes including: Dohle bodies
Focus on the following characteristics:
a. Method of acquisition (acquired or inherited, or both)
i. If inherited, is the condition autosomal dominant or autosomal recessive
b. Clinical Significance
Dohle bodies
a. Acquired
b. Small, oval, pale blue inclusions (composed of RNA) in the peripheral cytoplasm
of bands and segs
b. Asynchronous maturation due to accelerated proliferation, caused by infections, burns, trauma, Post GM-csf administration, etc.
Objective 1: Compare and contrast nonmalignant changes in leukocytes including: Vacuolization
Focus on the following characteristics:
a. Method of acquisition (acquired or inherited, or both)
i. If inherited, is the condition autosomal dominant or autosomal recessive
b. Clinical Significance
Vacuolization
a. Acquired
b. Presence of vacuoles in cytoplasm of neutrophils
b. Septicemia, bacterial infections, prolonged exposure to EDTA, etc.
Objective 1: Compare and contrast nonmalignant changes in leukocytes including: Hypersegmentation
Focus on the following characteristics:
a. Method of acquisition (acquired or inherited, or both)
i. If inherited, is the condition autosomal dominant or autosomal recessive
b. Clinical Significance
Hypersegmentation
a. Acquired and Inherited (autosomal dominant)
b. Greater than 5 lobes in segs
b. Associated with megaloblastic anemia, WHIM syndrome
Objective 2: Correlate written descriptions or photomicroscopy images of the non-malignant changes seen in leukocytes such as (but not limited to) the presence of large azurophillic granules in lymphocytes (Chediak- Higashi) or pale blue cytoplasmic inclusions (Dohle Bodies/Infection or May Hegglin) with the probable qualitative anomaly/disorder.
May Hegglin: “Doehle-like” inclusions (composed of precipitated Myosin Heavy
Chains)
Alder-Reilly: Dark staining metachromatic granules in neutrophils, basophils,
monocytes and/or lymphocytes
Chediak-Higashi: LARGE azurophilic granules
Pelger-Huet: Dumbell, peanut, bikini-top granulocyte nuclei
Hypersegmentation: Greater than 5 lobes in segs
Objective 3: Describe the Aüer rod including morphologic appearance, composition, type of cells it is found in, and significance.
Morphologic appearance: Red staining rods found in the cytoplasm of malignant myeloblasts and promyelocytes
Composition: Fused primary granules
Cells: Myeloblasts and promyelocytes
Significance: Seen in a variety of Leukemias
Objective 4: For each of the following conditions (Pelger Huët, May Hegglin, Alder Reilly, Chédiak-Higashi, and
hypersegmentation) be able to:
a. identify the condition on a peripheral blood smear (or photomicscopy image) or through
written description
b. State whether it is inherited (recessive or dominant) or acquired
c. Identify major clinical features of these conditions
May Hegglin:
b. Inherited; autosomal dominant
c. Associated with thrombocytopenia and giant platelets
Alder-Reilly:
b. Inherited; autosomal recessive
c. Skeletal abnormalities, hepatosplenomegaly, cognitive impairment
Chediak-Higashi:
b. Inherited; autosomal recessive
c. Hypopigmentation, splenomegaly, hepatomegaly, neutropenia; delayed killing of
ingested bacteria due to defective granulation and abnormal membranes of
abnormal lysosomes
Pelger-Huet:
b. Inherited - autosomal dominant, Acquired
c. Homozygous - cognitive impairment, skeletal abnormalities, heart defects
Heterozygous - asymptomatic
Acquired - associated with leukemias, neoplasms, some drugs and infections
Hypersegmentation:
b. Acquired and Inherited (autosomal dominant)
c. Acquired - associated with megaloblastic anemia
Inherited: WHIM syndrome
Objective 5: State the name and principle for the diagnostic test for MYH-9 Disorders
Immunofluorescence assay – the use of a murine (mouse) antibody, followed by fluorescently labeled anti-mouse antibody, that are specific to the precipitated heavy chains
Objective 9: Describe the clinical significance of reactive lymphocytes and smudge cells and their relationship to disease.
Reactive lymphocytes: occur due to exposure to an antigenic stimulus
Viral infections lead to reactive lymphocytosis
- EBV: infectious mononucleosis
- CMV
- Rubella
Smudge cell: nuclear remnant of a lymphocyte; broken lymphocyte
Common in chronic lymphocytic leukemia (CLL) – only report is ~98% of the differential possesses normal looking lymphocytes
Objective 11: State the name and principle for the diagnostic test for infectious mononucleosis
Test name: Monospot
Principle: Heterophile antibodies agglutinate with horse RBCs
Identify the alteration
(L) Toxic granulation
(R) Normal granulation
Identify the alteration
Toxic granulation
Identify the alteration
Dohle Bodies
Identify the alteration(s)
Toxic Granulation & Dohle Bodies
Identify the alteration
(L) Normal Granulation
(R) Hypogranulation/Aglanulation
Identify the alteration
Hypogranulation/Agranulation
Identify the alteration
Vaculoization
Identify
Auer Rods
Identify
Auer Rods
Identify the Anomaly
May-Hegglin
Identify the Anomaly
Alder-Reilly
Identify the Anomaly
What type of cell?
Chediak-Higashi Syndrome
Neutrophil
Identify the Anomaly
What type of cell?
Chediak-Higashi Syndrome
Lymphocyte
Identify the Anomaly
What type of cell?
Chediak-Higashi Syndrome
Eosinphil
Identify the Anomaly
Pelger-Huet
Identify the Anomaly
Pelger-Huet
Identify the Anomaly
Hypersegmentation
Identify the Anomaly
Hypersegmentation
Identify
Reactive Lympocyte
Identify
Reactive Lymphocyte
Identify
Reactive Lymphocyte
Identify
Normal Lymphocyte
Identify the condition
What cells?
Infectious Mono
Reactive Lymphocytes
Identify
Monocytes
Identify
(L) Reactive Lymphocyte
(R) Monocyte
Identify
Smudge cells
Identify
Pyknotic cells
Identify
Histoplasma capsulatum
Identify
Histoplasma capsulatum
Identify
Erythrophagocytosis
Identify
Loa Loa
Identify
Anaplasma phagocytophilum
Identify
P. falciprum
Identify
Babesia
Identify
Trypansoma gambiense
