Qualitative WBC abnormalities

Toxic granulation

• Dark blue/purple granules in meta ,bands, and neutrophils

• indicates infections, accelerated proliferation, asynchronous maturation

Doehle bodies

• pale blue inclusions in cytoplasm

• made of RNA

• indicate infection and asynchronous maturation

Hypogranulation/Agranulation

• absent or decreased number of granules

• fusion of granules and asynchronous maturation

• linked to MDS

Vacuolization/vacuolation

• vacuoles in cytoplasm

• infections

• prolonged exposer to EDTA

• acute alcoholism

Auer rods

• red staining rods

• malignant myeloblasts and promyelocytes

• primary granules fusion

May-Heggin Anomly

• most common MYH-9 disorder

• “Doehle like” inclusions

• autosomal dominant

• thrombocytopenia, giant platelets but normal WBC count

• all mature myeloid cells

• doesn’t really cause any issues

Allder-Relly Anomaly

• prominent dark staining metachromatic granules in neutrophils, basophiles, monocytes, and/or lymphocytes

• lysosomal storage disorders due to deficiency in enzymes to break down glycosaminoglycans (aka mucopolysaccharides)

• Autosomal recessive

• skeletal abnormalities, hepatosplenomegaly or cognitive handicaps

Diagnostic test for MYH-9 disorders

• immunofluorescent assay

• bright localization of signal indicates disorder

Chediak-Higashi syndrome

• coarse to LARGE azurophilic granules

• autosomal recessive

• neutropenia, impaired chemotaxis and delayed killing due to abnormal lysosomes

• childhood death

Pelgar-Huet anomaly

Inherited:

• Autosomal dominant

• >80% neutrophils affected

• bi-lobed nuclei

Acquired:

• “pseudo-pelgar huet”

• less then 50% of neutrophils affected

• bi-lobed nuclei

Hypersegmentation

• greater then 5 lobes

• Acquired → megaloblastic anemia

• Autosomal dominant → WHIM

  • myelokathexis = BM traps neutrophils in

Reactive lymphocytes

• large nucleus, less clumped, cytoplasm indented by RBC

• response to antigenic stimulus

• up to 25% in normal adults (<2 yrs have more)

• report % of lymph and reactive lymph separately unless <2 yrs

• Infectious mononucleosis

  • primarily affects B cells

Smudge cells

• nuclear remnant of lymphocytes

• largely associated with CLL

• if more then 10% present, re-smear with albumin

Monospot Test

• tests for mononucleosis

• heterophilic antibodies agglutinate horse erythrocytes (positive result)

Histoplasma capsulatum

fungus that is seen cytoplasm of leukocytes

Trypanosoma gambiense

Babesia spp

• Ring form (no crescent gametocytes)

• extracellular and intracellular

• new England area

• NOT malaria

Plasmodium falciparum

• protozoan parasite that causes malaria

• presents as rings in blood cells or crescent shaped gametocytes

Loa Loa

• ring worm

• in bloodstream