White Blood Cell Variants
- Page ID
- 70221
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)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 \(\PageIndex{}\)