WBC 2: BM, Non-Malignant WBC Disorders

____ refers to the ratio between red marrow and yellow marrow.

cellularity

phagocytic cells in connective tissue:

histiocytes

a ____ refers to an aspirate collection where there is no liquid available.

dry tap

a BM evaluation of an aspirate specimen is examined under low power (x10) to detect the presence of ____.

spicules 

____ refer to relatively intact marrow consisting of hematopoietic and stromal cells.

spicules 

____ stain dark blue/purple in the BM.

spicules 

aspirate differential is performed under ____ magnification.

x100

the ____ series includes blasts, segs (neutrophils, eosinophils, basophils).

myeloid

all stages of development should be present but within their anticipated distribution during a BM differential count. true or false?

true

what is the range for normal M:E ratio?

1.5:1 to 3.3:1

the ____ tissue occupies 1.5 to 3.3 times more space than the erythroid precursors.

granulopoietic 

the reason granulopoietic tissue occupies 1.5 to 3.3 times more space than erythroid precursors is because of the ____ survival of granulocytes in circulation.

shorter

____ objective lens refers to low power.

x10

____ objective lens refers to high power.

x50 and x100

during a BM aspirate examination, which lens should be used when assessing peripheral blood dilution?

x10

during a BM aspirate examination, which lens should be used when finding bony spicules and areas of clear cell morphology?

x10

during a BM aspirate examination, which lens should be used when observing fat to marrow ratio and estimate cellularity?

x10

during a BM aspirate examination, which lens should be used when searching for tumor cells in clusters?

x10

during a BM aspirate examination, which lens should be used when examining and estimating megakaryocytes?

x10

during a BM aspirate examination, which lens should be used when observing myelocytic and erythrocytic maturation?

x50 and x100

during a BM aspirate examination, which lens should be used when distinguishing abnormal distribution of cells or cell maturation stages?

x50 and x100

during a BM aspirate examination, which lens should be used when performing differential count on 300 to 1000 cells?

x50 and x100

during a BM aspirate examination, which lens should be used when computing M:E ratio?

x50 and x100

megakaryocytes are too unevenly distributed to count in a differential. true or false?

true

clusters of megakaryocytes may indicate ____.

hyperplasia 

<2 ____ per low power field may indicate hypoplasia or poor quality aspirate.

megakaryocytes

classify the cellularity. include ratio.

normal; 1:1

classify the cellularity. include ratio.

hypercellular; 10:1

classify the cellularity. include ratio.

hypocellular; 1:10

is this an early or late megakaryocyte?

early 

is this an early or late megakaryocyte?

late

identify this cell.

mitotic cell

the ratio of all nucleated hematopoietic cells (ANC/red marrow) to fat cells (yellow marrow):

cellularity 

general rule to estimate normal cellularity for age is ____.

100 - age (±10)

individuals ages 1-3 years old tend to have a higher relative amount of ____.

lymphocytes

absolute neutrophilia is benign. true or false?

true

____ refers to a shift in neutrophils from marginal into circulatory pool.

absolute neutrophilia

can be caused by stress, trauma, labor, strenuous exercise, shock, burn, or increase in epinephrine:

absolute neutrophilia

absolute neutrophilia cannot occur in infections. true or false?

false

the release of neutrophils from the storage pool to peripheral blood is associated with ____.

absolute neutrophilia

describes an increased number of immature cells as an indicator of infection:

left shift

refers to an increase in bands, metamyelocytes (possibly myelocytes):

left shift

usually seen with neutrophilia and toxic changes:

left shift

left shift is associated with an increased release from ____.

storage pool

refers to a reactive leukocytosis above 50 × 10³/uL with neutrophilia and a marked left shift, bands, and often metas/myelo could have rare pro or blast:

leukemoid reaction 

____ are mostly a result of:

• severe and/or chronic infection (e.g., TB, pneumonia)

• metabolic disease 

• inflammation 

• response to a malignancy 

leukemoid reaction 

leukemoid reaction or CML: normal count and morphology of eosinophils and basophils?

leukemoid reaction

leukemoid reaction or CML: toxic granulation and dohle bodies often seen in neutrophils?

leukemoid reaction

leukemoid reaction or CML: normal PLT count?

leukemoid reaction 

leukemoid reaction or CML: normal PLT morphology?

leukemoid reaction 

leukemoid reaction or CML: normal hemoglobin?

leukemoid reaction

leukemoid reaction or CML: elevated LAP score?

leukemoid reaction

leukemoid reaction or CML: normal genetics?

leukemoid reaction 

leukemoid reaction or CML: often elevated and may show granulation in eosinophils and basophils?

CML

leukemoid reaction or CML: may see pseudo-pelger huet forms?

CML

leukemoid reaction or CML: elevated early and decreased late for PLT counts?

CML

leukemoid reaction or CML: possible giant, hypogranular, and/or bizarre forms for PLT morphology?

CML

leukemoid reaction or CML: often anemic hemoglobin?

CML

leukemoid reaction or CML: decreased LAP score?

CML

leukemoid reaction or CML: positive for t(9;22), BCR-ABL?

CML

what test is used to differentiate leukemoid reaction and CML?

LAP score

associated with the presence of immature neutrophils, nRBCs, and teardrop RBCs in the same sample:

leukoerythroblastic reaction 

leukoerythroblastic reaction is often accompanied by neutrophilia, but not always. true or false?

true

____ point to the possibility of a space-occupying lesion in the BM:

• metastatic tumor

• fibrosis

• lymphoma

• leukemia

leukoerythroblastic reaction 

strongly associated with primary myelofibrosis:

leukoerythroblastic reaction 

what nuclear abnormality is associated with the following:

• chronic infections

• megaloblastic anemia

• drugs

hypersegmented neutrophils

what nuclear abnormality is associated with the following:

• myelodysplastic syndromes

• asynchrony of nuclear maturation

  • very clumped chromatin

hyposegmented neutrophils

what nuclear abnormality is associated with the following:

• dying cell

• nucleus very dark/dense

• filaments still visible

pyknotic neutrophils 

what nuclear abnormality is associated with the following:

• dead cells

• no filaments

necrotic neutrophils

what image (left or right) shows the cytoplasmic abnormality associated with the following:

• absence of granules

• degranulation

• hypo- or -agranular

right

what image (left or right) shows the cytoplasmic abnormality associated with the following:

• abnormal granules present

left 

refers to dark, blue-black cytoplasmic granules present only in neutrophils:

toxic granulation

associated with inflammation, infection, administration of granulocyte colony stimulation factor (G-CSF):

toxic granulation

refers intracytoplasmic pale blue round or elongated bodies between 1 and 5 um in diameter, usually adjacent to cellular membranes:

dohle bodies 

nonspecific finding or associated with bacterial infections, sepsis, and pregnancy:

dohle bodies 

refers to small to large circular clear areas in cytoplasm, rarely may contain organism:

toxic vacuolation  

associated with the following:

• septicemia or other infection

• autophagocytosis secondary to drug ingestion, acute alcoholism or storage artifact

• sometimes seen in conjuction with toxic granulation

toxic vacuolation  

often seen with toxic granulation and can indicate phagocytosis, may contain bacteria and other material:

toxic vacuolation  

remnants of ribosomal RNA:

dohle bodies

identify the image:

platelet satellitism

identify the image:

yeast

identify the image:

bacilli

identify the image:

histoplasma capsulatum

autosomal dominant condition where there is hyposegmentation of neutrophils:

pelger huet anomaly 

which state of pelger huet anomaly refers to the following:

• bi-lobed nucleus

• dense heterochromatin

• incomplete nuclear segmentation

• aka dumbbell or prince nez

heterozygous

which state of pelger huet anomaly refers to the following:

• nucleus is round or oval

• no segmentation

homozygous

in pelger huet anomaly, about what percent of neutrophils are affected?

70-90%

what condition can be caused by the following:

• induced by drugs

• seen in patients with HIV, tuberculosis and mycoplasma pneumonia, severe bacterial infections

• secondary to myelodysplastic syndrome, acute leukemias and chronic myeloproliferative disorders

pseudo pelger huet

autosomal recessive condition characterized by abnormally large metachromatic granules in the cytoplasm of ALL types of WBCs (granulocytes, monocytes, lymphocytes):

alder reilly anomaly 

incomplete degradation of mucopolysaccharides is associated with:

alder reilly anomaly 

mucopolysaccharide deposits (granules) in most cells are associated with:

alder reilly anomaly 

alder reilly anomaly affects leukocyte function. true or false?

false

deep purple to lilac granules that appear in all types of WBCs:

alder reilly anomaly 

what condition may resemble promyelocytes or heavy toxic granulation?

alder reilly anomaly 

neutrophilia, dohle bodies and left shift are associated with:

toxic granulation

autosomal dominant condition characterized by giant and bizarre platelets and may be hypogranular:

may hegglin anomaly

platelet disorder (thrombocytopenia with giant forms) that displays with leukopenia with large basophilic inclusions:

may hegglin anomaly

large basophilic inclusions:

dohle like bodies

patients are usually asymptomatic or have mild bleeding disorders:

may hegglin anomaly

identify the image:

may hegglin anomaly