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White Blood Cell Variants

  • Page ID
    70221

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    White Blood Cell Variants.png

    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 \(\PageIndex{}\)


    This page titled White Blood Cell Variants is shared under a CC BY-NC-SA 4.0 license and was authored, remixed, and/or curated by Dawn Taylor, Kristin Whitman, and Caroline Doty.

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