Qualitative WBC Abnormalities Flashcards
When do primary granules appear?
Promyelocyte
What is the composition of a neutrophil’s secondary granule?
Leukocyte alkaline Phosphatase
What cell is this based on
- Dawn of neutrophilia (2’ granules)
- Flattened side of the nucleus
- Perinuclear clearing (hof area)
Myelocyte
What are the different types of alterations found in neutrophils?
- Toxic changes
- Leukemic inclusions
- Anomalies
What are some of the toxic changes found in neutrophils?
- Toxic granulation
- Doehle bodies
- Degranulation/Agranulation
- Vacuolization
What is the leukemic inclusion found in neutrophils?
Auer rods
What anomalies are found in neutrophils?
- May-Hegglin
- Alder Reilly
- Chediak-Higashi
- Pelger-Huet
- Hypersegmentation
Toxic granulation causes…
- Infections
- Poisons that affect BM (including chemo)
- Cytokine administration
Dark blue/purple cytoplasmic granules in metas, bands, or neutrophils; peroxidase positive (primary granules); Accelerated proliferation; CRP and ___ are in correlation w/ inflammation
Toxic granulation
Small oval, pale blue inclusions in the peripheral cytplasm of bands and seg; may be single or in multiples; asynchronous cytoplasmic maturation
Doehle bodies
Doehle bodies are made of _____
RNA
Doehle bodies cause…
- Infection
- Burns
- Trauma
- Pregnancy
- Tumors
- Post GM-csf
Absent or decreased number of granules in neutrophils that can be caused “naturally”
Hypogranulation/agranulation
This is caused by fusion of cytoplasmic granules w/ phagosome
Hypogranulation/agranulation
This is caused by asynchronous maturation due to accelerated proliferation
Hypogranulation/agranulation
Additional causes linked to chromosomal abnormalities in hypogranulation/agranulation
- MDS
- Leukemia
Toxic change in the cytoplasm of neutrophils; primarily caused septicemia and bacterial infections; other important causes include prolonged exposure to EDTA and acute alcoholism
Vacuolization/vacuolation
What 3 comrades are often seen together in infections?
Vacuoles, toxic granulation, Doehle bodies
Red staining rods or bodies found in the cytoplasm of malignant immature myeloid cells (myeloblasts and promyelocytes); found in Faggot cells; bundle of sticks
Auer rods
Auer rods are composed of fused ____ granules
Primary
Where are Auer rods seen in?
- Acute myeloid leukemia (AML)
- Acute promyelocytic Leukemia (APL)
- Acute myelomonocytic leukemia (AMML)
Inclusions in neutrophils that resemble Doehle bodies; found in all mature myeloid cells
May-Hegglin anomaly
May-Hegglin anomalies are composed ____
RNA
These are associated w/ thrombocytopenia and giant platelets
May-Hegglin anomalies
Prominant azurphilic granules (resembles toxic granulation); the granules are formed by the accumulation of partially degraded mucopolysaccharides in lysosomes
Alder-reilly anomaly
Alder-Reilly anomalies are autosomal ____
Recessive
May-Hegglin anomalies are rare autosomal ____ traits
Dominant
Lysosomal organelles affected; large azurophilic granules; red granules predominant in LYMPHOCYTES; grey/blue seen in neutrophils; neutropenia, causes impaired chemotaxis and defective granulation and abnormal membranes of abnormal lysosomes
Chediak-Higashi anomaly
Chediak-Higashi anomalies are rare and autosomal ____
Recessive
Anomaly caused by failure of segmentation of granulocyte nuclei; band form with two lobes, dumbbell, bikini top, peanut
Pelger-Huet anomaly
Pelger-Huet anomalies are autosomal ____; and > ____ of neutrophils are affected
Dominant; 80%
Is heterozygous or homozygous more common in Pelger-Huet anomalies? Why?
Heterozygous; asymptomatic
In acquired Pelger-Huet, when < 50% of neutrophils are affected, the most common disease is ____ _____
MDS
> 5 lobes or ≥ 6 polys w/ 5 lobes
Hypersegmentation
3 different disorders demonstrating hypersegs
- Autosomal dominant (no known clinical abnormalities)
- Acquired (megaloblastic anemia w/ vitamin B12 or folate deficiency)
- Autosomal dominant (myelokathexis w/ neutropenia and pyknotic cells)
Cytoplasm is basophilic and can be indented by RBCs/ballerina skirt; chromatin is less clumped than normal lymph; normal changes in response to antigenic stimulus
Reactive lymphocyte
Most common viral infections that lead to reactive lymphs
Infectious mononucleosis, EBV, and CMV
Can confirm mono vs. CMV w/ what test?
Monospot
Infectious mononucleosis primarily infects what kind of cells?
B-cells
Common age group affected by mono?
Ages 17-25
2 complications of infectious mono
- Cold agglutinins
- Hemolytic anemia
Are granules more common in reactive or normal lymphs?
Reactive lymphs
Nuclear remnant of lymphocyte; no discernable cytoplasm; aka basket cells
Smudge cells
What disease is most common seen w/ smudge cells?
Chronic lymphocytic leukemia (CLL)
If more than ____% smudge cells are present, what do you do?
10%; remake smear using 1 drop of albumin and 10 drops of blood
After remaking smudge cell slide w/ albumin how do you report it?
Differential is reported from the albumin smear but everything else is reported from the original smear (because you are diluting by 10% when you add ALB); occasional=10% or more than 5 remake this slide
Degeneration of a cell; may be seen in any nucleated cell as a result of aging and degeneration; nuclear chromatin condenses to a solid or structure-less mass
Pyknosis/necrosis
How do you report reactive lymphs?
Count reactive and non-reactive lymphs on separate keys and report % of each; for absolute lymph count, use the TOTAL percentage
How do you report Pelger-Huet?
Count as segs and make notation that Pelger-Huet like cells are present
How are toxic granulation, Doehle bodies, hypersegs, hypo- or agranulation, and Auer rods reported?
Report as present
Smudge cells and megakaryocytes are not reported in the 100 cell diff but are included in the _____ _______
WBC estimate
Fungus that is prevalent in OH and Mississippi River valleys; seen in cytoplasm of leukocytes
Histoplasma capsulatum
Obligate intracellular gram negative bacteria creates a morulae; usually Zoonotic, but it has been transferred to humans by ticks
Anaplasma phagocytophilum
filarial nematode that is most common in AFRICA and India
Loa loa
Protozoan parasite that is the cause of MALARIA; presents in peripheral blood as rings and as crescent shaped gametocytes
Plasmodium falciparum
Protozoan blood parasite that appears similar to malaria on a blood smear but crescent gametocytes are absent
Babesia (Babesiosis)
Linked to African Sleeping Sickness
Trypanosoma gambiense
Describe what homozygous Pelger-Huet looks like in a patient
- In the PB, round or oval nuclei
- Patient exhibits congnitive impairment, skeletal abnormalities, and heart defects
Describe patients w/ Chediak-Higashi anomalies
- Partial albinism, splenomegaly, hepatomegaly
- Early death from infections
A differential w/ appropximately 10% bi-lobed neutrophils is most characteristic of what condition?
Acquired Pelger-Huet anomaly
