White Blood Cell Morphology

Haematological Atlas - White blood cell morphology

White Cell Morphological Abnormalities NEUTROPHILS: Drumstick Morphology: Drumstick shaped nuclear appendage. ± 1,5 µm in diameter and attached to the nucleus by a filament. Inactive X chromosome of the female. Found in: Neutrophils of females Males with Klinefelter syndrome   Sessile Nodule Morphology: Inactive X chromosome found as nodule on neutrophils of females. Found in: Neutrophils of females   Hypersegmentation or right shift of neutrophil nuclei Morphology: Average lobe count increased OR increased % of neutrophils with 5 - 6 lobes OR > 3% neutrophils with 5 lobes or more. Found in: Megaloblastic anaemia Iron deficiency Chronic infection Liver disease Uraemia Hereditary   Ring shaped nuclei Morphology: Nucleus ring or doughnut shaped Found in: Acute myeloid leukemia Chronic granulocytic leukaemia Megaloblastic anaemia MDS   Detached nuclear fragments Morphology: Detached nuclear material in cytoplasm. Found in: Dysgranulopoiesis Patients on anti cancer chemotherapy HIV   < MPO deficiency Morphology: Neutrophils appear normal on Romanowsky stain but are not counted as neutrophils by the cell counters employing a myeloperoxidase stain. Found in: Inherited Refractory anaemia Blast crisis of CML     Toxic Granulation Morphology: Increased granulation. Granulation more basophilic and larger than normal. Found in: Severe bacterial infection Non specific finding - seen in tissue damage of various types. Normal pregnancy Therapy with cytokines   Hypogranulation Morphology: Reduced granulation in neutrophil cytoplasm. Found in: Myelodysplastic syndromes   Vacuoles Morphology: Vacuoles in the cytoplasm of granulocytes Found in: Infection Toxic effect of ethanol Jordan's anomaly     Döhle Bodies Morphology: Small pale blue cytoplasmic inclusions, often in the periphery of the cell. Found in: Infective and inflammatory states Severe burns Tuberculosis Post chemotherapy Pregnancy   Phagocytosed Parasites Morphology: Malaria - Plasmodium falciparum Found in: Severe malaria infection   Phagocytosed Organisms Morphology: DF2 organism. Rod shaped organism in vacuoles in cytoplasm of neutrophils Found in: Dog bite   Phagocytosed Platelet Morphology: Platelet in vacuole in neutrophil cytoplasm Found in Infection   Phagocytosed Red blood cell Morphology: Red cell in vacuole in cytoplasm of neutrophil Found in: Infection Auto immune haemolytic anaemia Incompatible blood transfusion   Auer Rods Morphology: Small azurophil rods in the cytoplasm of myeloblasts and promyelocytes. Sometimes found in mature neutrophils Found in: Acute myeloblastic leukemia Myelodysplastic syndromes   Macro Neutrophils Morphology: Twice the size of a normal neutrophil with tetraploid DNA content. Found in: Occasionally in the blood of healthy subjects Inherited Administration of G-CSF Megaloblastic anaemia Chronic infection   Necrobiotic / Apoptotic neutrophil Morphology: Dense homogenous nuclei (pyknotic) Found in: Occasionally in healthy subjects In vitro artefact AML   Shift to the Left Morphology: Presence of precursor of granulocytes in the peripheral blood Found in: Normal in pregnancy or neonate Infections Bone marrow fibrosis Bone marrow infiltration by malignancies   Pseudo Pelger Hüet Anomaly Morphology: Bilobed neutrophils with more condensed chromatin. Found in: Inherited Myelodysplastic syndromes Idiopathic myelofibrosis Chronic granulocytic leakaemia Therapy with colchicine, iboprofen Infectious mononucleosis, malaria, myxoedema CLL   Neutrophil aggregation Morphology: Small clumps of neutrophils. Happens in vitro if EDTA anticoagulated blood is allowed to stand. May lead to incorrect WBC Found in: In vitro finding Infectious mononucleosis Bacterial infections Auto immune disease EOSINOPHILS:   Eosinophilia Morphology: Increase in number of eosinophils in peripheral blood Found in: Parasitic infections Allergic reactions Drug hypersensitivity Hodgkin's disease   Left shift: Eosinophil Morphology: Eosinophil metamyelocyte in peripheral blood Found in: Reactive eosinophila Myeloproliferative disorders AML BASOPHILS:   Basophilia Morphology Increase in the neumber of basophils in the peripheral blood. Found in: Myeloproliferative disorders Myxoedema Ulcerative colitis Hyperlipidaemia LYMPHOCYTES:   Atypical Lymphocytes Morphology: Pleomorphic. Large with diameter of 15 - 30 µm. Abundant, strongly basophilic cytoplasm. Basophilia may be confined to the cytoplasmic margins. Found in: Viral infections - EBV, CMV, Hep A, Measles  Bacterial infections - brucella, tuberculosis Protozoa - malaria Immunization SLE   Plasmacytoid Lymphocyte Morphology: Lymphocyte with basophilic cytoplasm and eccentric nucleus. Found in: Reactive phenomenon   Mott cell Morphology: Plasmacytoid lymphocyte with globular inclusions composed of immunoglobulin. Found in: Reactive changes in peripheral blood   Large Granular Lymphocyte Morphology: Small eosinophilic granules in the cytoplasm of large lymphocytes Found in: Natural killer cells Lymphokine activated T cells MONOCYTES:   Monocyte Vacuolization Morphology: Vacuoles in the cytoplasm of monocytes Found in: Infections