Section 5: WBC Variants Flashcards
What features do you look for when identifying toxic granulation?
Dark blue-purple granules in PMNs or bands that are finer, smaller, more numerous than basophils
When do you typically see toxic granulation?
- Severe bacterial infection or toxicity
- Toxic vacuoles
- Dohle bodies
- Left shift of neutrophils
What features do you look for when identifying toxic vacuoles?
Clear holes in cytoplasm of phagocytic cell (increase vacuolization)
When do you typically see toxic vacuoles?
- Toxic granulation
- Dohle bodies
- Left shift of neutrophils
What features do you look for when identifying Dohle bodies?
Pale blue translucent bodies of remnant RNA in granulocyte (more common) and monocyte cytoplasms
When do you typically see Dohle bodies?
- Severe infections
- Tissue destruction
- With toxic granulation, toxic vacuoles, and WBC left shift
What features do you look for when identifying hypersegmentation?
Segmented neutrophils with 6+ nuclear lobes. Cells are often larger than normal
What features do you look for when identifying Pelger-Huet cells?
Hyposegmented PMNs
What are the two categories of Pelger-Huet cells? Briefly define
- Pince-nez: Two nuclear lobes that look like glasses
- Stodtmeister: One nuclear lobe
Why should you be careful when calling Pince-nez anomalies? What should you look for before calling them?
Normal PMNs have 2-5 lobes, so 2 lobes can be normal. Call Pince-nez if you see 0 granulocytes with more than 2 lobes and increased bands. If you see normal PMNs with many lobes, likely pseudo Pelger-Huet
What features do you look for when identifying reactive lymphs?
- Distinctly blue cytoplasm
- Dark blue periphery (especially when attached to RBCs)
- Coarse nuclear chromatin
- Wandering appearance of cytoplasm
Which diseases are reactive lymphs associated with?
Viral infections such has mono, hepatitis…etc
What is a plasmacytoid lymph?
Activated B lymph
What features do you look for when identifying plasmacytoid lymphs?
- Slightly larger
- Darker royal blue cytoplasm (key identifier!!!)
- Heavily clumped chromatin
What are Barr Bodies?
Extra X chromosome expressed as miniature lobe that looks like a drumstick.
What features do you look for when identifying Barr Bodies? Are they reported?
See a smaller lobe that protrudes from regular-sized PMN nuclear lobe. Typically not reported
Who can demonstrate Barr bodies?
Females because XY
Males who are XXY or XXXY
What features do you look for when identifying pyknotic cells? With which cell do you not want to confuse them with?
- Loss of chromatin pattern (the nucleus looks smooth purple with zero texture)
- Loss of filament that usually connects lobes
- Still contain violet-pink granules characteristic of PMNs
- Don’t confuse with nRBCs!
What features do you look for when identifying smudge cells?
Only nucleus left. Cell membrane degraded
What is septicemia?
When there’s bacteria in the blood. It is considered a critical value. Must report both intracellular and extracellular. Can be confused with stain precipitate
Can you tell bacteria morphology and group forming behavior (diplo, chain, grape-cluster…etc) from Wright stain?
NO. May appear different from Gram-stain
Identify the abnormal WBC depicted by the arrow
Smudge cell
Identify the abnormal WBC depicted in the image
Pyknotic cell
Identify the abnormal WBC depicted in the image
Barr body
Identify the abnormal WBC depicted on the left side
Plasmacytoid cell (activated B lymph)
Identify the abnormal WBC depicted in the image
Reactive lymph
Identify the abnormal WBC depicted in the image
Pelger-Huet anomaly: Stodtmeister cell
Identify the abnormal WBC depicted in the image
Pelger-Huet anomaly: Pince-nez cell
Identify the abnormal WBC depicted in the image
Hypersegmentation
Identify the abnormal WBC depicted in the image
Dohle body
Identify the abnormal WBC depicted in the image
Toxic vacuoles
Identify the abnormal WBC depicted in the image
Toxic granulation
Identify the abnormal WBC depicted in the image
Septicemia
