White Blood Cell Variants
- Page ID
- 70221
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Barr Body
- Represent an extra X-Chromosome unnecessary for normal nuclear function.
- Expressed as a miniature lobe or “drumstick” protruding from the nucleus of PMNs.
- Since females are XX it is normal for them to demonstrate one Barr body.
- Males that are XXY or XXXY can demonstrate Barr bodies.
- These are usually not reported.
Barr Body \(\PageIndex{}\)
Dohle Body
- Pale blue translucent bodies in the cytoplasm of granulocytes and occasionally monocytes
- Remnant RNA
- Severe infections and tissue destruction
- Often seen with toxic granulation, toxic vacuoles, and a shift to the left
Dohle Body \(\PageIndex{}\)
Toxic Granulation
- Dark purple-blue granules in PMNs and Bands
- Stimulation of granulocytic cells results in fewer mitotic divisions. Prevents normal dilution of nonspecific granules.
- Severe bacterial infection or toxicity
- Often seen with toxic vacuoles, Dohle bodies and a shift to the left.
Toxic Granulation \(\PageIndex{}\)
Toxic Vacuoles
- Clear holes contained in the cytoplasm of phagocytic cells
- Toxic is increased vacuolization - more numerous or larger than normal
- Severe bacterial infection or toxic states
- Often seen with toxic granules, Dohle bodies and a shift to the left.
Toxic Vacuoles \(\PageIndex{}\)
Hypersegmented Neutrophil
- Segmented neutrophils with six or more nuclear lobes
- Cells often larger than normal
- Congenital disorder or megaloblastic change
Hypersegmented PMN \(\PageIndex{}\)
Hyposegmented Neutrophil
- No granulocytes with > 2 nuclear lobes
- Bilobed cell – Pince-nez or spectacle
- Unilobed cell - Stodtmeister
- Benign congenital hyposegmentation of PMNs is known as Pelger-Huet anomaly.
- Greater than 68% of neutrophils are hyposegmented.
- It may also present with increased bands.
- Pseudo or Acquired Pelger-Huet will present with similar morphology but will have more normal PMNs present.
- Pseudo PH cells may be seen in severe bacterial infections, HIV, tuberculosis and mycoplasma pneumonia. Various drugs can induce this abnormal morphology.
Hyposegmented PMN \(\PageIndex{}\)
Pyknotic Degeneration (Necrotic or Necrobiotic Cell)
- Degenerating neutrophils
- Cells are undergoing apoptosis
- Nuclear material loses chromatin pattern
- One or several dense masses
- Watch Out! These are not nucleated rbcs.
Pyknotic PMN \(\PageIndex{}\)
Smudge Cell
- Cells destroyed in the process of making the peripheral smear.
- Associated with increased cell fragility.
- Often seen in Chronic Lymphocytic Leukemia (CLL) and Acute Lymphoblastic Leukemia (ALL)
- Reporting varies from lab to lab.
- Can add albumin and remake slide to avoid creating this artifact.
Smudge Cell \(\PageIndex{}\)