Morphologic Abnormalities Associated with Granulocytes

NUCLEAR ABNORMALITIES OF NEUTROPHIL

Hypersegmentation
-characterized by 5 or more lobes in the neutrophil; (> 6 lobes (normal: 2-5)
associated with megaloblastic anemia (due to vitamin B12 or folic acid deficiencies).
Note!
 Abnormality in the maturation
 Inherited (Undritz anomaly
 Acquired Hypersegmentation
Example: Megaloblastic Anemia

Hyposegmentation
-refers to a tendency in neutrophils to have 1-2 lobes; may indicate an anomaly or a shift to the left.
Note!
 Neutrophil: Single or Bilobed (dumbell, spectacle- like, peanut)
Examples:
 Pelger-Huet Anomaly (Pince Nez)
 Acquired Pseudo Pelger-Huet
- Myeloproliferative Disorder Ex.
Ex. CML

Pelger-Huet Anomaly

 Single or bilobed nucleus

 Hyposegmentation
 Decreased segmentation
 Autosomal dominant inheritance
 Nucleus dumbbell or peanut shaped; referred to as "pince-nez"
 Morphologically abnormal but functionally normal
 Nucleus is hypêrclumped, and it does not mature past the two-fold stage
 Must differentiate from a shift to the left associated with an infection
(toxic changes); infection requires treatment but Pelger-Huet
anomaly (no toxic changes) does not.

Pseudo Pelger-Huet

 Acquired abnormality associated with myeloproliferative disorders and myelodysplastic syndromes; can also be
induced.
 Nucleus is usually round instead of the dumbbell shaped that is seen in the anomaly.
 Frequently accompanied by hypogranulation.
INHERITED CYTOPLASMIC ANOMALIES

May-Hegglin Anomaly

 Autosomal dominant inheritance

 Large, Cystalline, Dohle-like inclusions in the cytoplasm of neutrophils on
Wright's stain; gray blue and spindle (cigar) shaped.
 Pale blue inclusions derived from RNA
 Morphologically abnormal but functionally normal
 Giant platelets, thrombocytopenia, and clinical bleeding are also associated
with this anomaly.
 M.H inclusions resembles as Dohle Boddies

Alder-Reilly Anomaly
 Autosomal recessive inheritance
 Large azurophilic granules appear in the cytoplaśm of all or
only one cell line. Granules contain degraded mucopolysaccharide
due an enzyme defect.
 Mucopolysaccharidosis
o -Hurler's syndrome
o -Hunter's syndrome
 Morphologically abnormal, but functionally normal
 Must differentiate from toxic granulation present in neutrophils
only in infectious condition

Auer Rods
 Pink or red rod shaped cytoplasmic structures
 Fused Primary Granules
 AML, AMML, Found in myeloid and monocytic series only
Peroxidase Positive

Note!!
Faggot cells = with mass of auer rods
= Present in DIC
DIC is associated with M3(APL)

Dohle Bodies
 -Seen as single or multiple light blue inclusions on Wright stain
 Seen near the periphery of the cytoplasm
 -Represent aggregates of rough endoplasmic reticulum (RNA)
 -Associated with viral infections, burns or certain drugs
 -Resembles as May hegglin anomaly.
Toxic Granules

 Found in acute infection, drug poisoning and burns

 Azurophilic (primary) granules that are peroxidase positive
 Represent the precipitation of ribosomal protein (RNA) caused by
metabolic toxicity within the cell

FUNCTIONAL DISORDERS OF NEUTROPHILS

Chronic Granulomatous Disease (CGD)

 Both sex linked and autosomal inheritance with the ratio of affected males to females being 6:1.
 Morphologically normal, but functionally abnormal because of enzyme deficiency that results in an inability to
degranulate, which causes inhibited bactericidal function.
 Fatal early in life.
Note!
 inability of phagocytes to kill ingested microorganism
 impaired NADH oxidase
 impaired oxidative metabolism
 Resp. burst
 Test for CGD NBT dye (Nitro Blue Tetrazolium Dye)

Chediak-Higashi syndrome

 Autosomal recessive disorder causes large, gray green, peroxidase positive granules in the cytoplasm of
leukocytes; abnormal fusion of primary and secondary neutrophilic granules
 Both morphologically and functionally abnormal leukocytes, WBC unable to degranulate and kill invading
bacteria.
 Patients will present with photophobia and skin hypopigmentation
 Fatal early in life

Note!

 Albinism
 Peroxidase and Sudan black positive
 Seen in lymphocyte, neutrophil and monocytes

Jobs Syndrome
 Abnormal in chemotaxis-activity

Lazy Leukocyte Syndrome

 Poor neutrophil response to chemotactic agents
CELLS EXHIBITING PHAGOCYTOSIS

LE Cells
 Neutrophil.or macrophage phagocytized a denatured nuclear
material of another cell.

Tart cell

 Monocyte with ingested lymphocyte

 Rough and unevenly stained

ABNORMALITIES INVOLVED IN LYMPHOCYTES

Atypical lymphocytes
 Lymphocytes whose altered morphology includes stormy blue
cytoplasm and lobular or irregular nuclei.
 Variant lymphocytes indicate stimulation by a virus, particularly
Epstein Barr virus, which causes infectious mononucleosis.

-Reactive/Stimulated Variant Lymphocytes

-Downey Cells Type
 Type l - Turks irritation cell or plasmatoid lymphocyte with block of chromatin
 Type II -I.M.
-W/ round mass of chromatin
- "Ballerina Skirt App."
 Type lll – vacuolated
- "Swiss Cheese App"
- "Moth Eaten App'

Basket Cells
-Smudge cell (thumbprint)
-Disintegrating nucleus of a ruptured WBC
-Pressure in smear preparation
* remedy: Adds of Bovine Albumin
-CLL

Hairy Cells
 Lymphocytes seen in the peripheral blood and bone marrow characterized
by delicate gray cytoplasm with projections resembling as hairs.
 These cells are seen in Hairy Cell Leukemia
 TRAP positive (Tartrate Resistant Acid Phosphatase)