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The Morphology of Human Blood Cells - Illustration
The Morphology of Human Blood Cells - Illustration
The Morphology of Human Blood Cells - Illustration
Smears were given for photomicrographs by the following individuals and institutions: Dr. Luther Burkett Dr. Marion Dugdale Mrs. Janie Gardner, MS, H(ASCP) Ms. Rachel Lehman, MT(ASCP) Dr. Alvin Mauer Mrs. Ioye Thomas, MT(ASCP) Dr. Frank White Centers for Disease Control, Atlanta, GA LeBonheur Children's Medical Center, Memphis, TN St. Jude Children's Research Hospital, Memphis, TN Regional Medical Center, Memphis, TN
Note: The photomicrographs are from the University of Tennessee Division of Hematology teaching file, which was started more than twenty-five years ago. Stains and staining techniques have changed during this period of time and, hence, cell colors may vary and drawing paper used by the artist has darkened.
38
1A. Myeloblast
39
Bone Marrow
2A.
2B.
2C.
2D.
2E.
Plate 2. 1. Myeloblast, 2. Promyelocyte, 3. N. Myelocyte, 4. N. Metamyelocyte, 5. N. Band, 6. N. segmented, 7. Eosinophil, 8. Monocyte, 9 Polychromatophilic erythroblast, 10. Orthochromatic erythroblast, 11. Neutrophil-questionable stage
2F. Basophil
2H. Myeloblast
21. Promyelocyte
Bone Marrow
3A.
3C.
3B.
3D.
3E.
3F.
3G.
6 3
3H.
31.
:lJate3.1. Myeloblast, 2. Promyelocyte, 3. N. Myelocyte, 4. N. Metamyelocyte, 5. N. band, 6. N. segmented, 7. Eosinophilic metamyelocyte, 8. Basophil, 3. Monocyte, 10. Polychromatophilic erythroblast, 11. Orthochromatic erythroblast, 12. Lymphocyte, 13. Plasma cell, 14. Smudge
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4A. Erythrocytes 4B. Large lymphocyte with purplish-red (azurophil) granules and deeply indented by adjacent erythrocytes 4C. Neutrophilic segmented 40. Eosinophilic segmented 4E. Neutrophilic segmented
4F. Monocyte with gray blue cytoplasm, coarse linear chromatin, blunt pseudopods 4G. Platelets (thrombocytes) 4H. Lymphocyte 41. Neutrophilic band 4J. Basophil
The arrangement is arbitrary and the number of leukocytes in relation to erythrocytes and thrombocytes is greater than would occur in an actual microscopic field.
42
Plate 5. Lymphocytes
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50, Lymphocyte of intermediate size 5E, Lymphocyte with pointed cytoplasmic projections (frayed cytoplasm)
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5G, Large lymphocyte with indented nucleus and pointed cytoplasmic projections
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5L, Large lymphocyte with purplish-red (azurophilic) granules
5K, Large lymphocyte with purplish-red (azurophilic) granules and with indentations caused by pressure of erythrocytes
Plate 7. Monocytes
7A. Monocyte with "ground-glass" appearance, evenly distributed fine granules, occasional azurophilic granules, and vacuoles in cytoplasm
7B. Monocyte with blue granular cytoplasm, lobulation of nucleus with linear chromatin
7E. Monocyte with gray-blue cytoplasm, band type of nucleus, linear chromatin, blunt pseudopods, and fine granules
7F. Monocyte with gray-blue cytoplasm, blunt pseudopods, and multilobulated nucleus
7H. Monocyte with multiple blunt nongranular pseudopods, nuclear indentations, and folds
45
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8B. Monoeytes
80. Monoeytes
8F. Monocytes
9C. Large lymphocyte with scalloped shape and absence of folds in nucleus
9E. Monocyte with gray-blue cytoplasm, prominent granules, brain-like convolutions in nucleus and linear chromatin strands
9G. N. myelocyte
9H. Typical monocyte with lobulated nucleus, gray-blue granular cytoplasm, and blunt pseudopods
91. Large lymphocyte with purplish-red (azurophilic) granules and lumpy nuclear structure
47
Plate 10. Lymphocytic, Monocytic, Plasmacytic Systems
10A. Lymphoblast
10B. Monoblast
10C. Plasmablast
100. Prolymphocyte
10E. Promonocyte
10F. Proplasmacyte
10H. Monocyte
101. Plasmacyte
48
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11A. 11 B. 11 C. 11 D. Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthochromatic erythroblast 11 E. Polychromatophilic erythrocyte 11 F. Erythrocyte
11 H. Proerythroblasts (2), polychromatophilic and orthochromatic erythroblasts, N. band, N. segmented, and smudge
49
12A. Plasmacyte with intense-blue cytoplasm, eccentric nucleus, clear zone, vacuoles, irregular shape (marrow) 12B. Plasmacyte with foamy and fibrillar reddish-blue cytoplasm (marrow) 12C. Lymphocyte with slightly indented nucleus, unevenly stained bluish cytoplasm
120. Lymphocyte with foamy cytoplasm and frayed (hair-like margins 12E. Basophilic erythroblast with reddish-blue cytoplasm (marrow) 12F. Polychromatophilic erythroblast with reddish cytoplasm (marrow)
Plasma Cell, Lymphocytes, Immature Nucleated Red Cells from Bone Marrow and Blood Smears
50
13A. Plasma cell with globular bodies (Matt cell) 13B. Plasma cell with globular bodies (Matt cell)
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130. Plasma cell with globular bodies in nucleus, reticular cytoplasmic structure, shaggy margins, and red secretions
13F. Plasma cell with "flame" red cytoplasm and two nuclei
51
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14A. Magakaryoblast with single oval nucleus, nucleoli, and bluish foamy marginal cytoplasmic blebs 14B. Promegakaryocyte with two nuclei, granular blue cytoplasm, and marginal bubbly cytoplasmic blebs 14C. Megakaryocyte with lobulated nucleus, granular cytoplasm, and without platelets
14D. Megakaryocyte with lobulated nucleus and platelets 14E. Megakaryocytic nucleus with attached platelets 14F. Platelets
52
- -A. Megakaryoblast
158. Megakaryoblast
15C. Promegakaryocyte
15D. Promegakaryocyte
15E. Megakaryocyte with lobulated nucleus, granular cytoplasm surrounded by vacuoles, and no platelets
53
..
Plate 18. Early Eosinophils and Mast Cells on Bone Marrow Smears
18A. Early eosinophil with nucleoli and tapering cytoplasmic extensions (formerly called tissue eosinophil)
56
19A. Fat cell with small round nucleus, linear chromatin, globular body in nucleus, ample cytoplasm with lipoid globules, wrinkled membrane, reticular stroma, fibrillar marginal structures, and erythrocytes.
198. Fat cell showing cytoplasmic lipoid bodies separated by reticular structures. Mature erythrocytes surround fat cell.
20A. Osteoblast with prominent light zone in cytoplasm located away from nucleus
20B. Osteoblast with oval eccentric nucleus, distinct linear chromatin and nucleolus, blue bubbly cytoplasm with prominent light zone adjacent to nucleus, and fibrillar marginal structures
20C. Osteoclast: Large multinucleated cell with uneven number of separated oval nuclei with nucleoli, blue granules, and frayed cytoplasmic margins
58
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21 B. Osteoblasts 21 C. Osteoblasts
21 D. Aggregate of osteoblasts
21 E. Osteoclast
21F. Osteoclast
21G. Osteoclasts
21 H. Osteoclast
Normal
Crenated
Burr (echinocyte)
Target
Sickled
SC crystal
CC crystal
,
Elliptocyte (ovalocyte) Stomatocyte Folded cell Marginal achromia (blister) Helmet Pinched
filamented
Triangular
Small fragments
Membranous ghost
Crescent (Semilunar)
240. Iron deficiency anemia: (red cells: microcytic and smaller than nucleus of a small lymphocyte; hypochromic)
24F. Megaloblastic anemia: (red cells: large and oval; two teardrop cells); hyperlobulated N. segmented
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24G. Iron deficiency anemia after transfusion (two populations of red cells)
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24H. Iron deficiency anemia after iron therapy (two populations of red cells) 241. Megaloblastic anemia (red cells: oval and larger than nucleus of small lymphocyte; two teardrop cells)
Plate 25, Part 1. Erythrocyte Morphology on Blood Smears in Microangiopathic Hemolytic Anemias
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25A. Thrombotic thrombocytopenic purpura (TTP) 25B. Chronic nephritis with hypertension
25C. Sickle cell anemia with schistocytes in some cases of pulmonary embolism
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25F Sickle cell anemia with schistocytes in some cases of pulmonary embolism
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251. Sickle cell anemia with schistocytes in some cases of pulmonary embolism
Plate 25, Part 2. Erythrocyte Morphology on Blood Smears in Microangiopathic Hemolytic Anemia Due to Heart Valve Dysfunction
Patient 1
Patient 1
Patient 2
Patient 3
Patient 3
Patient 4
Patient 5
Patient 5
64
Plate 27. Erythrocyte Morphology on Blood Smears in Sickle Cell Anemia, Sickle Cell-Hemoglobin C, Hemoglobin CC
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27C. Hemoglobin CC (Hb CC)
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27A. Sickle cell anemia (Hb SS) 27B. Sickle cell-hemoglobin C (Hb SC)
270. Hemoglobin SS
27E. Hemoglobin SC
27F. Hemoglobin CC
27G. Hemoglobin SS
Plate 28. Moist Unstained Preparations of Blood from Patients with Sickle Cell Trait and Sickle Cell Anemia
28A. Moist unstained preparation of blood from a patient with sickle cell trait showing reversible elongated multipointed red cells
28C. 28B and 28C. Moist unstained preparations of drop of blood from patient with sickle cell anemia mixed with drop of sodium metabisulfite solution showing irreversible elongated sickle cells and a few multipointed erythrocytes
67
Plate 29. Erythrocyte Morphology on Blood Smears in Hereditary Spherocytosis, Hereditary Elliptocytosis, and Thalassemia Major
-.
Plate 30. Erythrocyte Morphology on Blood Smears from Patients with Thalassemia Minor
:--:-aJassemia minor
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301. alpha-thalassemia 1
Plate 31. Erythrocyte Morphology on Blood Smears from Patients with Burns, Hereditary Pyropoikilocytosis, and Myelofibrosis
31C. Myelofibrosis
31F. Myelofibrosis
32A. Selected stippled erythrocytes in a Wright-stained blood smear from a patient with lead poisoning
32C. Selected reticulocytes containing granulofilamentous structures in a smear from blood mixed with new methylene blue stain. Polychromatophilic red cells and stippled cells stain as reticulocytes in this preparation
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320. Stippled cells in Wright-stained smear from lead poisoning 32E. Polychromatophilic erythrocytes (arrows) in a Wright-stained smear of thrombotic thrombocytopenic purpura 32F. Reticulocytes increased in a new methylene blue preparation of blood from sickle cell-thalassemia (Sturm)
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32G. Stippled red blood cell; lymphocyte 32H. Polychromatophilic erythrocytes (arrows) in a Wright-stained smear of hemolytic anemia
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33A. Orthochromatic erythroblast with partial extrusion of portion of nucleus 338. Stippled orthochromatic erythroblast with Howell-Jolly body and Cabot rings 33C. Erythrocyte containing malarial ring 33D. Thrombocyte on red cell (Note clear area around platelet indicating it is on top of cell)
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33E. Howell-Jolly bodies in erythrocytes 33F Cabot rings in erythrocytes; stippling and HowellJolly body in one red cell with Cabot ring
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72
34A. Wright stain showing one orthochromatic erythroblast and multiple erythrocytes with Pappenheimer bodies (or siderotic granules in iron stain). The granules vary in number, size, shape, and color, and are unevenly distributed.
34B. Prussian blue stain for iron showing one orthochromatic erythroblast with siderotic granules (ringed sideroblast) and erythrocytes containing siderotic granules. The nucleus of the erythroblast stains red with safranin. (Howell-Jolly bodies, Heinz bodies, and stippling do not give a blue color with iron stain).
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34D. Sideroblasts (top). Ringed sideroblasts (below). Prussian blue iron stain (marrow) 34E. Ringed sideroblasts in Prussian blue iron stain (marrow)
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:Iythrocytes with Pappenheimer .=r:fE in Wright stain (blood) 34G. Erythroblasts with siderotic granules in Prussian blue iron stain (marrow) 34H. Ringed sideroblasts in Prussian Ius iron stain (marrow)
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35A. Normal blood with one to four Heinz bodies in most erythrocytes
35B. Erythrocytes from a patient with G-6-PO deficiency. Majority of red cells have five or more Heinz bodies
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35E. Heinz body preparation of normal erythrocytes 35F. Heinz body preparation of erythrocytes in G-6-PO deficiency
Plate 36. Erythrocytic Sequence in Bone Marrow: Megaloblastic Anemia, Normal Marrow, and Iron Deficiency Anemia
Left column: Megaloblastic Anemia in B12 and Folic acid deficiencies Middle column: Normal Erythroblast Sequence Right column: Iron Deficiency Anemia (IDA)
Promegaloblast
Proerythroblast
Proerythrobast (small)
Basophilic megaloblast
Basophilic erythroblast
Polychromatophilic megaloblast
Polychromatophilic erythroblast
Polychromatophilic erythroblast
Orthochromatic megaloblast
Orthochromatic erythroblast
Orthochromatic erythroblast
Polychromatophilic macrocyte
Polychromatophilic erythrocyte
Polychromatophilic erythrocyte
Macrocyte
Normal erythrocyte
Hypochromic microcyte
Plate 37. Comparison of Erythrocyte Morphology in Blood and Bone Marrow: Iron Deficiency Anemia and Megaloblastic Anemia
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378. Iron deficiency anemia with three late erythroblasts (iron-deficient) having minimal bluish cytoplasm (marrow)
37C. D. Iron deficiency anemia with numerous late erythroblasts (iron-deficient) having minimal bluish cytoplasm (marrow)
37E. Megaloblastic anemia with large oval and round macrocytes and pear-shaped erythrocytes (blood)
37F. Megaloblastic anemia with large oval and round macrocytes and one orthochromatic megaloblast (blood)
37H. Megaloblastic anemia with three promegaloblasts (right) and three basophilic megaloblasts (left) (marrow)
76
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38A. Polychromatophilic megaloblast with two nuclei 38B. Polychromatophilic megaloblast with fragmentation of nucleus (karyorrhexis) 38C. Basophilic megaloblast with asynchronism between nuclear structure and cytoplasmic color
38H. Pro,megaloblast, basophilic and orthochromatic megaloblasts, plasma cell (lower left)
77
Plate 39, Part 1. Pathological Erythroblasts and Erythrocytes in Bone Marrow of Megaloblastic Anemia
Selected nucleated and nonnucleated red cells in bone marrow smears of patients with untreated megaloblastic anemia. There is asynchronism between nucleus and cytoplasm with the nucleus less mature than the cytoplasm. Identification of nucleated cells is based primarily on chromatin configuration and not on cytoplasmic coloration. Anisocytosis, poikilocytosis, and anisochromia may be observed in nonnucleated erythrocytes.
39A. Orthochromatic megaloblast showing karyorrhexis and asynchronism 39B. Orthochromatic megaloblast with Howell-Jolly bodies 39C. Teardrop erythrocyte 39D. Basophilic megaloblast with asynchronism 39E. Stippled oval macrocyte 39F. Cabot ring in oval macrocyte 39G. Polychromatophilic macrocyte 39H. Lobulated megaloblastic neutrophil 391. Orthochromatic megaloblast showing karyorrhexis and Howell-Jolly bodies 39J. Promegaloblast with multiple nucleoli 39K. Hypersegmented neutrophil 39L. Pear-shaped erythrocyte 39M. Polychromatophilic megaloblast 39N. Orthochromatic megaloblast with beginning nuclear extrusion
Polychromatophilic megaloblast with asynchronism Microcytic poikilocyte Promegaloblast Macrocyte with Howell-Jolly bodies Mitotic figure Orthochromatic megaloblast with one Howell-Jolly body 39U. Oval macrocyte 39V. Basophilic megaloblast 39W. Basophilic erythroblast
Plate 39, Part 2. Pathological Erythroblasts and Erythrocytes in Bone Marrow of Megaloblastic Anemia
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Plate 40. Pathological Leukocytes
40D. Degenerated roun . neutrophil nucleus (old E=~ blood); toxic @ranules
*40G. Neutrophil which contains a phagocytized reddish-purple nuclear mass from another leukocyte following a special technique which is no longer as an aid in diagnosis. This cell was designated as a so-called "LE cell" since it was observed in patients with lupus erythematosus.
80
Plate 41. Cell Types on Blood Smears of Patients with Pelqar-Huet Anomaly
This hereditary anomaly is characterized by hypolobulation of the nuclei of neutrophils. The chromatin structure of the granulocytes with round or indented nucleus is that of mature cells. The size, chromatin structure, and phagocytic function of these cells are normal.
41 C. Round nucleus
41 D. "Peanut"-shaped nucleus
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":1H. Pseudo-Pelger cell in ;nyelodysplasia 411. Pseudo-Pelger cell in myelodysplasia 41J. Pelqsr-Huet cell with pince-nez nucleus ote: Pseudo-Pelger cells are observed in myelodysplasia and other myeloid dyscrasias. 8-
Plate 42. Cell Types on Blood Smears from Patients with Chediak-Higashi Anomaly
Leukocytes in smears of blood or of bone marrow from patients with Chediak-Higashi anomaly showing abnormal and giant Iysosomes in the cytoplasm.
42A. Lymphocyte (blood) 42C. Promyelocyte (marrow) 42B. Mitotic figure of promyelocyte (marrow)
42D. Eosinophil-large
granules (blood)
42E. Basophil-large
granules (blood)
Plate 43. Cell Types on a Blood Smear from a Patient with May-Hegglin Anomaly
Each leukocyte has one (or two) large bluish, elongated, irregularly shaped Diihle-like body
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43A. Monocyte with Diihle-like bodies 43B. Eosinophil with Diihle-like body 43C. Basophil with Diihle-like body
The number of cells in drawing is greater than occurs in a single oil-immersion field. Note shape variation in erythrocytes of this patient. The platelets are large and abnormal.
Plate 44. Cell Types on Blood and Marrow Smears from a Patient with Alder-Reilly Anomaly
The cytoplasm of neutrophils and basophils in blood or bone marrow of patients with Alder-Reilly anomaly contain multiple deep blue or lilac, round granules in blood and marrow smears. Eosinophil granules are large.
1
Plate 45. Selected Cells from Blood and Marrow Smears of Patients with Acute and Chronic Myelogenous (Myelocytic) Leukemia
45A. Myeloblast with prominent nucleoli, well-defined chromatin structure, blue cytoplasm with no granules
45C. Myeloblast with Auer rod 458. Megakaryoblast with dark coarse nuclear chromatin structure and blunt vacuolated blebs (marrow)
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45G. Atypical early neutrophil (simulating a monocyte) with indented nucleus, intermediate nuclear chromatin structure, nonspecific granules and pale cytoplasm
45H. Progranulocyte variant with abundant granular cytoplasm and irregular margin (marrow) (formerly called Ferrata cell)
Plate 46. Chronic Myelogenous (Myelocytic) Leukemia (CML), Blood Smears: Wright stain, and Leukocyte Alkaline Phosphatase (LAP) stain
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46B. Myeloid cells in CML 46C. Myeloid cells in CML
46F. CML, Leukocyte alkaline phosphatase stain (N. segmented and band are negative)
I entification of cells: yeloblast, 2. Promyelocyte, 3. N. myelocyte, 4. N. metamyelocyte, 5. N. band, 6. N. segmented, 7. Eosinophil, 8. Basophil, ~. seudo-Pelger neutrophil, 10.Early lymphoid cell (lymphoblast)
Plate 47. Acute Myelogenous (Myelocytic) Leukemia (AML): (FAB) M1, M2, M
Acute myelogenous leukemia: M1 without maturation; M2 with some maturation; M3 acute promyelocytic leukemia
Myeloblasts, MI (blood)
Sudan Black
Note: 47A and 47B from same patient; O-F same patient; G-I same patient
-.
Myeloperoxidase Stain: The two upper cells (48A) are myeloperoxidase negative (lymphocytes); the two lower cells (48B) are myeloperoxidase positive (neutrophils). The red cells are laked and appear as shadow forms. This stain is of aid in differentiating early cells of the myelocytic and monocytic systems from cells of the lymphocytic system.
48E. Blasts: negative myeloperoxidase stain-ALL (L2) marrow (positive neutrophil in center right serves as quality control for adequate stain)
48F. Large Blasts: negative myeloperoxidase stain-ALL (L3) marrow (positive neutrophil myelocyte in lower center serves as control for adequate stain)
88
Periodic Acid Schiff (PAS) Stain: Reaction for the detection of intracellular glycog2r
48H. Negative PAS reactionlymphocyte (normal blood) Sudan Black Stain: For the detection of lipids
49A. M4 (blood)
49B. M4 (blood)
49C. M4 (blood)
Identification of Cells: 1. Monocyte; 2. Promonocyte; 3. Monoblast; 4. N. Myelocyte; 5. Basophil; 6. Eosinophil Note: 49A, 49B same patient; 490, 49G same patient; 49H, 491 same patient
Plate 50. Selected Cells from Patients with Acute Monocytic Leukemia: (FAB) M5
50E. Promonocyte: two nuclear lobes, nucleoli, prominent granules, clear ectoplasm
50H. Monocyte: folded nucleus, linear chromatin, distinct granules, elongated shape
Plate 51. Selected Cells from Blood Smear of Acute Erythroleukemia: (FAB) M6
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51G. M6 (See cells below) 51H. M6 (See cells below) 511. M6 (See cells below)
Identification of cells: 1. Proerythroblasts often with vacuoles; 2. Promyelocyte; 3. Pseudo-Pelger neutrophil; 4. Orthochromatic erythroblast; 5. Mitotic figure; 6. Polychromatophilic erythroblast Asynchronism: nucleus less mature than cytoplasm
Plate 52. Selected Erythroblasts from Bone Marrow Smears of Acute Erythroleukemia: (FAB) M6
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52E. Giant late erythroblast: multiple nuclei, fragmentation of nuclei and Howell-Jolly bodies
Plate 53. Pathological Erythroblasts from Bone Marrow Smears of Acute Erythroleukemia: (FAB) M6
Plate 54. Micromegakaryoblasts in Blood and Marrow Smears of Megakaryoblastic Crisis of CMl
Selected cells from patient with megakaryoblastic crisis of chronic myelogenous leukemia. Variant forms of micromegakaryoblasts. Nuclei are usually small and single but one cell has two nuclei. In most cells. granular cytoplasmic blebs (which represent early platelet formation) are noted.
Plate 55. Megakaryoblasts in Blood and Marrow Smears of Acute Megakaryoblastic (Megakaryocytic) leukemia: (FAB) M7
Plate 56. Myelodysplasia: Blood Smears (BS) and Bone Marrow (8M)
56D. Prussian blue iron stain: ringed sideroblasts, macrophage with hemosideMn,RARS,BM
56E. RARS, BM: erythroblastic hyperplasia: orthochromatic, polychromatic erythroblasts; and two nuclei in 2 cells
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56G. Pseudo-Pelger neutrophils (right); N. metamyelocytes (left), MDSBM 56H. RAEB: Three myeloblasts, 2 basophils, BM 561. CMML: Two atypical vacuolated monocytes, BS Myelodysplasia categories: RA: Refractory anemia; RARS: Refractory anemia with ringed sideroblasts; RAEB: Refractory anemia wit excess blasts; CMML: Chronic myelomonocytic leukemia
57G. Myelofibrosis: myeloblast (top); megakaryoblast; large platelets: one giant platelet
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57K. ET:thrombocytosis
Plate 58. Selected Cells in Smears of Acute lymphoblastic leukemia (ALL) and Chronic lymphocytic leukemia (Cll)
58F, Atypical early lymphocyte: clumping of nuclear chromatin, purplish-red nongranular cytoplasm, All
Plate 59. Acute Lymphoblastic Leukemia (ALL): (FAB) Blood Smear (BS), Bone Marrow (BM), Cerebrospinal Fluid (CSF); Pro lymphocytic
59A. ALL, BS. Smaillymphoblasts: little cytoplasm, no or faint nucleoli, thrombocytopenia (L1)
59C. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)
590. T cell ALL, BS. Lymphoc cells with prominent azure granules
59G. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)
59K. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)
Note: 59A, 59E, 591from same patient; 59B, 59F, 59J from same patient; 59C, 59K from same patient FAB L1: Small blasts; L2: Larger blasts; L3: Large blasts with vacuoles and nucleoli
Plate 60. Chronic lymphocytic leukemia (Cll): Blood Smear (BS) and Bone Marrow (BM); Pro lymphocytic Leukemia (Pll)
=::3.
Selected cells in blood smears from a patient with hairy cell leukemia. These cells have veillike cytoplasmic extrusions and delicate threadlike filaments. Hairy cells tend to push neighboring cells away or aside, leaving clear spaces around the hairy cell. One cell has prominent azure granules and a few hairlike projections.
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62A. Hairy cells, BS
Plate 63. Pathological Plasma Cells; Plasma Cell Myeloma, Bone Marrow (BM)
63C. Plasma cell: red-staining globules (Russell bodies) 63A. Proplasmacyte: three early nuclei and reticular cytoplasm
63B. Plasma cell: nebulous cytoplasmic margin, multiple globules, pink-staining secretory material
63E. Plasma cell: eccentric nucleus, red staining crystaline bodies and globules, reticulated cytoplasm
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63H. Plasma cell myeloma, BM: note nucleoli in 3 cells 631. (a) Rouleaux of erythrocytes, blood (myeloma); vs (b) Agglutination
64A. Vacuolated atypical immature lymphocyte: indented nucleus, swirled chromatin pattern, nucleoli: Sezary cell
648. Vacuolated atypical early lymphocyte: distinct chromatin pattern: Sezary cell
64C. Atypical lymphocyte of intermediate size: brainlike (cerebriform) convolutions and granules: Sezary cell
Plate 65. Selected Cells from Blood Smears of Patients with Infectious Mononucleosis
-.
65H. Large lymphocyte: prominent azurophilic granules 65G. Large lymphocyte; azure granules, scalloped borders (indented by red cells) 651. Atypical monocyte
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In this color plate leukocytes other than lymphocytes have been left out. Selected lymphocytes reacting to antigenic stimuli and showing heterogeneous forms have been portrayed in increased numbers in order to reveal the marked variation in size and shape and in nucleus and cytoplasmic characteristics. Note large cells with prominent basophilic cytoplasm, granules in one cell and indentation of some lymphocytes by red cells. Red cells and platelets are normal.
Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale
Early ring
Late ring
Early trophozoite /
Late trophozoite
Immature schizont
Mature schizont
Macrogametocyte
Microgametocyte
Plate 68, Part 1. Malarial Parasites, Blood Smears (Wright-Giemsa stain); Thick Drop Preparations (Giemsa stain)
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68B. P. talciparum gametocytes 68C. P. talciparum gametocyte
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68N. Platelet on RBC (left) vs Ring in RBC (right) 680, P. vivax trophozoites 68P. P. vivax trophoz "as
68, Part 2 B. Plasmodium talciparum, ring forms (one to four parasites per cell)
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69G. Ehriichia caffenesis in monocyte 690. Ehriichia phagocytophiia in neutrophil
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70A. Macrophage with phagocytized Histoplasma capsulatum (marrow) 70B. Macrophage with Leishmania donovani (marrow)
Plate 71. Giant Proerythroblasts in Bone Marrow from Patient with Parvovirus B19
Giant proerythroblasts with basophilic cytoplasm containing vacuoles in bone marrow smear stained with Wright stain are characteristic of Parvovirus 819. Note large nuclear inclusions (viral).
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73C. Platelets-myelofibrosis
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Myeloblast Monoblast
Basophilic myelocyte
Neutrophilic myelocyte
Basophilic metamyelocyte
Neutrophilic metamyelocyte
Eosinophilic metamyelocyte
Basophilic band
Neutrophilic band
Eosinophilic band
35 . nillc segmented
Neutrophilic segmented
Eosinophilic segmented
Monocyte
-------proerytl1roblast MegaKaryoblast
Plasmablast
\3asopl1iliCerytl1robl promegaKarvOcyte
ast
proplasmacyte
POlyc\lromatoPl1iliC ervtl1roblast
ort\1Ocl1romatic ervtl1roblast
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Platelets
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Index
Figures are indicated by a bold face "F" and the figure number, followed by the page number in parentheses. Page is indicated by number only. . Plates are indicated by a bold face "P" and the plate number. Tables are indicated by a bold face "T" and the table number, followed by the page number in parentheses.
Acanthocyte (spur, thorn) 15, P23, P26 Acid phosphatase stain P59 Acute erythroleukemia P52, P53 Acute lymphoblastic leukemia (ALL) 35, P58-P59 Acute megakaryocytic leukemia P54, P55 Acute myelogenous leukemia 30,31, P45, P47-P49 Acute myelomonocytic leukemia (AML) P30, P49 Alder-Reilly Anomaly 27, P44 Anemia aplastic 20 heart valve dysfunction P25 (Part 2) hemolytic due to burns, venoms 25, P31 hemolytic uremic syndrome 25 iron deficiency 18, P24, P36-P37 megaloblastic 19, P36-P39 (Parts 1-2) microangiopathic hemolytic anemias 25, P25 (Parts 1-2) sickle cell 22, P23, P27-P28 sideroblastic 19, P34 Thalassemia major 22, P29 Thalassemia minor 21,22, P30 Thrombotic thrombocytopenic purpura 25, P25 (Part 1) Anisocytosis 15 Aplastic anemia 20 Auerrod(body) 30,P45,P47 B cell 9, FI (2), F4 (10) Babesiosis 36, P68 (Part 2) Band neutrophil 1-3, FI (2), F2 (3), PI-P3, P74, Tl-T2 (1) Basophil 1,2,5, FI (2), PI-P4, P46, P74, Tl-T2 (1) band 5, FI (2), PI, P74 metamyelocyte 5, FI (2), PI, P74 myelocyte 5, FI (2), PI, P74 segmented 5, FI (2), PI, P74 Basophilic erythroblast 1,7, F1 (2), F7 (17), PH, P36, P74, T2 (1) Basophilic stippling 16, F7 (17), P32 Bite cell 15, P26 Blister cell P23 Blood cells, normal values TI (1) Bone cells l3, P20-P21 Bone marrow cells, normal values T2 (1) Burned patients, erythrocytes in 25, P31 Burr cell 15, P23, P26
Cabot ring 16, F8 (17), P33, P39 (Parts 1-2) CALLA (Common acute lymphoblastic antigen) 9 CD (Cluster designation) Markers 9, F4 (10) Chediak-Higashi anomaly 27, P42 Chronic lymphocytic leukemia (CLL) 33, P58, P60 Chronic myelogenous leukemia (CML) 27, P45-P46 Classification of ALL 35, P58-P59 Classification of AML 30, P45, P47-P55 Classification ofMD5 31, P56, T6 (31) Clostridium perfringens P26 Cooley's anemia 22, P29 Crescent body (semilunar body) P23 Degenerated neutrophil 26, P40 D6We body 26, P40, P43 Drepanocyte (sickle cell) 16 Echinocyte 15, P23, P26 Ehrlichiosis 36, P69 Electrophoresis Hb 22, 23 Elliptocyte 24, P23, P29 Elliptocytosis 24, P23, P29 Endothelial cell 14, P22 Eosinophil 1,4, FI (2), PI-P4, PI8, P74, Tl (1), T2 (1) band 4, FI (2), PI-P2, P74 metamyelocyte 4, FI (2), PI-P3, PI8, P74 myelocyte 4, FI (2), PI-P2, PI8, P74 segmented 4, Fl (2), PI, P4, P74 Erythrocyte acanthocyte (spur, thorn) 15, P23 basophilic erythroblast 7, FI (2), PH, P36, P74, T2 (1) basophilic stippling 16, F7 (17), P32 bite 15, P26 blister (marginal achromia) P23 burn patient 25, P31 burr 15, P23, P26 Cabot ring in 16, F8 (17), P33, P39 (Part 1) crenated P23 crescent (semilunar body) P23 crystals (Hb 55, 5C, CC) 23, P23, P27 echinocyte 15, P23, P26 elliptocyte 24, P23, P29 filamented P23 folded P23 fragment (schistocyte) 16, 25, P23, P25 (Parts 1-2)
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helmet 15, P23, P25-(Parts 1-2) Heinz body 16, F7 (17), P35 Howell-Jollybody 16,F7 (17),P33,P39 (Parts 1-2) hypochromic 16, P24, P37 inclusions in 7, F7 (17), P32-P35 keratocyte 15 leptocyte 16, P24 macrocyte 15, P24, P36-P37, P39 (Parts 1-2) malaria in 36, P67-P68 membranous ghost P23 microcyte 15, 18, P24, P36-P37, P39 (Parts 1-2) normal 7, 15, P23-P24 orthochromatic erythroblast 7, FI (2), PH, P36, P74, T2 (1) oval (ovalocyte, elliptocyte) 24, P23, P29 pear 20, P23 pinched (pinchered) P23 poikilospherocyte P23 polychromasia 18 polychromatophilic erythroblast 7, FI (2), PH, P36, P74, Tl (1) polychromatophilic erythrocyte 7, 18, FI (2), Pll, P32,P36,P74 proerythroblast 6, FI (2), Pll, P36, P74, T2 (1) ringed sideroblast 18, P34 rouleaux 16,34, P63 schistocyte (fragment) 16,25, P23, P25 (Part 1) semilunar body (crescent) P23 sickle cell (drepanocyte) 16,22, P23, P27, P28 sideroblast 18, P34 siderocyte 18, P34, F7 (17) siderotic granules in 18, F7 (17), P34 spherocyte 16, P23, P26, P29 stippled 16, F7 (17), P32 stomatocyte 16, F9 (24), P23 target 16, P23, P27, P29-P30 teardrop 16, P23, P24, P39 (Parts 1-2), P56-P57 triangular 16, P23, P25 (Part 1) venoms.nn 25, P26 Erythropoiesis 2,6, F1 (2), Pll, P36 Esterase stains monocytic 31 myelocytic 30 FAB classification of ALL 35, P58-P59, T8 (35) FAB classification of AML 30, P45, P47-P55, T5 (30) FAB classification ofMDS 31, P56, T6 (31) Fat cell (lipocyte) 13, PI9 Ferrata cell P45 Fibroblast 15 Folic acid deficiency 19, P24, P36-P39 (Parts 1-2) Fragmented cell (schistocyte) 16,24,25, P23
Gaucher cell P72 G-6-PD Deficiency 15, P26 Granule(s) primary 1,3 secondary 1,3 siderotic (iron-containing)
18, P34
Hairy cell leukemia 33, P60-P62 Heinz body 16, F7 (17), P35 Helmet cell 15, P23, P25 (Parts 1-2) Hematopoiesis 1, FI (2) Hematopoietic stem cell 1, FI (2), F4 (10) Hemoglobin A 22, 23 Hemoglobin Az 23 Hemoglobin AC 23 Hemoglobin AE 23 Hemoglobin AS 22, P28 Hemoglobin ~o thalassemia 22, P29 Hemoglobin ~ + thalassemia 22, P30 Hemoglobin Bart's 21, T4 (21) Hemoglobin concentration 16 Hemoglobin CC 23, P27 Hemoglobin E 23 Hemoglobin E-I3-thalassemia 23, P30 Hemoglobin electrophoresis 22, 23 Hemoglobin H 21 Hemoglobin 0 23 Hemoglobin SC 23, P23, P27 Hemoglobin SS 23, P23, P27-P28 Hemoglobin ZUrich P26 Hereditary elliptocytosis 24, P23, P29 Hereditary pyropoikilocytosis 24, P31 Hereditary spherocytosis 24, P23, P29 Hereditary stomatocytosis 24, F9 (24), P23 Histioplasma capsulatum 37, FH (37), P70 Histoplasmosis 37, P70 HLA-DR 10 Hodgkin's disease 32 Howell-Jolly body 16, F7 (17), P33, P39 (Parts 1-2) Hydropsfetalis 21, T4 (21) Hyperlobulated neutrophil P24, P39-P40 Immunologic classification of adult ALL 35, T7 (35) Inclusions in erythrocytes 16, P33 Infectious mononucleosis 36, P65-P66 Iron deficiency anemia 18, P24, P36-P37 Iron Stain P34, P53-P56 Iron studies 19 Keratocyte 15
L.E. cell P40 Leishmaniasis 37, P70 Leptocyte 16 Leukemia basophilic 5 erythroleukemia (erythroblastic) P51- P53, T5 (30) hairy cell 33, P60-P62 lymphoblastic, acute 35, P58, P59, T7-T8 (35) lymphocytic, chronic 33, P58, P60 megakaryoblastic, acute 30, P54-P55 monocytic, acute 30, P49-P50 myelocytic, chronic 27, P45-P46 myelogenous, acute 30, P45, P47-P55, T5 (30) myelogenous, chronic 27, P45-P46 myelomonocytic, acute 30, P49 myelomonocytic with eosinophilia 30 plasma cell 34 promyelocytic 30, P47, T5 (30) prolymphocytic 11, P59-P60 Leukocyte alkaline phosphatase (LAP) stain 28, P46, P48 (Part 2) Lipocyte (fat cell) 13, Pl9 Lymphoblast 9,35, PIO, P58-P59 Lymphocyte Tl-T2 (1) B cell 9, FI (2), F4 (10) cell markers 9, F4 (10) reactive 36, P65-P66 T cell 9, FI (2), F4 (10) Lymphopoiesis 9, FI (2), F4 (10) Macrocyte 15,20, P24, P37-P39 (Parts 1-2) Macrophage 12, PI6-PI7, P56 Malaria 36, P67-P68 (Parts 1-2) Mast cell 12, Pl8 May Hegglin anomaly 26, P43 Mean corpuscular hemoglobin (MCH) 19,22 Mean corpuscular values 19,20 Mean corpuscular hemoglobin concentration (MCHC) 19,22 Mean corpuscular volume (MCV) 19,20,22 Megakaryoblast 8, FI (2), Pl4-PI5, P74 Megakaryocyte 8, FI (2), PI4-PI5, P74 Megaloblastic anemia 19, P36-P39 (Parts 1-2) Metamyelocyte basophilic 1,5, FI (2), PI-P3, P74 eosinophilic 1,4, FI (2), PI-P3, P74 neutrophilic 1, FI (2), F2 (3),3, F3 (4), PI-P3, P74, T2 (1) Microangiopathic hemolytic anemia (MAHA) 25, P25 (Parts 1-2)
Microcyte 8, 15, 18, P24, P36-P37 Micromegakaryoblasts 8, P54-P55 Monoblast 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30) Monocyte 5,FI (2),P4,P7-IO,P74, Tl-T2 (1) Monocytic leukemia 6,30, P49-P50, T5 (30) Myeloblast 1, FI (2), PI-P3, P45-P47, P74 Myelocyte basophilic 1,5, FI (2), PI-P3, P74 eosinophilic 1,4, FI (2), PI-P3, P74 neutrophilic 1,3, FI (2), PI-P3, P74 Myelodysplastic syndrome 31, P56 Myelofibrosis 29, P57, P73 Myelogenous leukemia P45-P48 acute 30, P45-P55, T5 (30) chronic 27, P45-P46, P48 Myeloid: Erythroid ratio 1, T2 (1) Myeloma 34, FIO (34), P63 Myeloperoxidase stain (MPO) 30, P48 (Part 1) Myelopoiesis 1, FI (2) Neiman-Pick disease P72 Neutrophilic band 1-3, FI (2), F2 (3), PI-P4, P74, Tl-T2 (1) degenerated 26, P40 hypersegmented 26, P39-P40 hyposegmented (Pelger-Huet) 26, P41 metamyelocyte 1-3, FI (2), F2 (3), PI-P3, P74, T2 (1) myelocyte 1-3, FI (2), F2 (3), PI-P3, P74, T2 (1) segmented 1-4, FI (2), F2 (3), F3 (4), PI, P74, Tl-T2 (1) Non-Hodgkin's lymphoma 32 Normal values bone marrow 1, T2 (1) peripheral blood 1, Tl (1) MCH 19 MCHC 19,22 MCV 19,20,22 RDW 19,20,22 Orthochromatic erythroblast 7, FI (2), P11, P36, P74, T2 Osteoblast 13, F5 (14), P20-P21 Osteoclast 14, F6 (14), P20-P21 Pappenheimer body (siderocyte) 18, F7 (17), P34 Parvovirus B 19 37, P71 Pelger-Huet anomaly 26, P41 Periodic Acid Schiff (PAS) stain P48 (Part 2), P53, P59,P64
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Peroxidase stain 30, P48 (Part 1) Plasmablast 12, PlO, P63, P74 Plasma cell (Plasmacyte) 11, P10, P74 Plasma cell leukemia 12 Plasmodium falciparum 36, P67-P68 (Parts 1-2) malariae 36, P67-P68 (Part 1) ovale 36, P67 vivax 36, P67-P68 (Part 1) Platelet (thrombocyte) 8, Fl (2), P4, PI4-PI5, P73, P74 Pluripotent stem cell F4 (10) Poikilocytosis 15 Polychromasia 18 Polychromatophilic erythroblast 7, Fl (2), Pll, P36, P74 Polychromatophilic erythrocyte 7, 18, Fl (2), PI I, P32, P36,P74 Polycythemia vera 27,28 Precursor compartment 1, FI (2) Pre-B cell 9, FI (2), F4 (10) Pre- T cell FI (2) Pro-B cell 9, F4 (10) Pro- T cell F4 (10) Proerythroblast 6, F1 (2), PIl, P36, P74, T2 (1) Progenitor compartment 1, FI (2) Prolymphocyte ll, PIO, P58-P60, P74 Pro megakaryocyte 8, FI (2), PI4-PI5, P74 Promonocyte 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30) Promyelocyte (progranulocyte) 3, FI (2), PI-P3, P46-P47, P74 Proplasmacyte 12, PlO, P74 Prothymocyte F4 (10) Prussian blue iron stain on erythrocytes P34, P53, P56 macrophage P56 Pseudo-Pelger Huet cell 31, P56 Pyropoikilocytosis, hereditary 24, P3I Red cell distribution width (RDW) 19,20, T3 (19) Reactive lymphocyte 36, P65-66 Reticulocyte 18, F7 (17), P32 Ringed sideroblast 18, 19, P34 Rouleaux 12,34, P63 Russell body (plasma cell) 11, P63 Satellitosis (platelets around neutrophil) 9, P73 Schistocyte 16,25, P23, P25 (Parts 1-2) Semilunar (crescent) body P23 Sezary syndrome 34, P48, P64 Sickle cell 22, P23, P27, P28 Sickle cell anemia (Hb SS) 22, P23, P27-P28 Sickle cell-hemoglobin SC disease (Hb SC) 23, P23, P27
Sickle cell trait (Hb AS) 22, P28 Sideroblast-ringed 18,19, P34 Sideroblastic anemia 19, P34 Siderocyte 18, F7 (17), P34 Smudge cell 33, P60 Spherocyte 16,24, P23, P26, P29 Spherocytosis, hereditary 24, Pi9 Spider bite on RBC 25, P26 Spur cell P26 Stem cell l , FI (2), F4 (10) Stem cell compartment 1 Stippled red blood cell 16, F7 (17), P32 Stomatocyte 16,24, F9 (24), P23 Stomatocytosis, hereditary 16,24, F9 (24), P23 Sudan black B stain 30, P47, P48 (Part 2) Target cell 16,21,22, P23, P27 Tartrate-resistant acid phosphatase (TRAP) 33, 34, P62 T cell 9, Fl (2), F4 00) T-cell receptor (TCR) 9,10 Terminal deoxynucleotidyl transferose (TdT) 9,30, F4 (10) Teardrop cell 16, P23-P24, P37, P39 (Parts 1-2) Thalassemia alpha 21 beta 21,23 major 21,22, P29, P30 minor 21,22, P30 Thermal injury to RBC 25, P31 Thrombocyte (platelet) satellitosis P73 Thrombocythemia, essential 29, P57 Thrombotic thrombocytopenic purpura (TTP) 25, P25 (Part 1) Thymocyte F4 (10) Thymus FI (2), F4 (10) Tissue basophil PI8 Tissue eosinophil PI8 Toxic granules 26, P40 Venoms on erythrocytes 25, P26 Vitamin B12, Folic Acid deficiency 19, P36-P39 (Parts 1-2)
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