WBC morphology

specific esterase (CAE) stain

(naphthol AS-D chloroacetate esterase, CAE) is positive in neutrophilic granules and mast cells and helps to differentiate neutrophils from lymphocytes and monocytes. Notice the red stain is positive in some of the cells but negative in most of the other cells. The negative cells are lymphocytes.

hyposegmentation (Pelger-Huet)

The heterozygous form of congenital ______ has mature neutrophils (similar to the one in the picture above) that have a bi-lobed nucleus separated by a thin strand of nuclear material instead of the normal 3-5 lobed nucleus. The shape of the nucleus is often described as "dumbbell" or "pince-nez" (bifocal).

megakaryocyte

The huge cell above is a ______ in a bone marrow preparation. The cytoplasm of _____ fragment off to form thrombocytes (platelets). Notice other developing RBCs and WBCs in the field.

Gaucher cell

The large bi-nucleated cell with the bluish-purple cytoplasm is a ____. It is a histiocyte that may contain one or two nuclei and whose cytoplasm has been described as having a "crumpled paper" appearance. Individuals with _____ disease have a deficiency of beta glucocerebrosidase which results in abnormal accumulations of unmetabolized glucocerebrosides in the reticuloendothelial cells in the bone marrow and other organ

sea-blue histiocyte

The large cell with the eccentric nucleus and pale blue cytoplasm is found in the bone marrow, spleen and liver of individuals with _____

Niemann-Pick cell

The large cells with white, foamy cytoplasm are _____ cells. They are histiocytes filled with lipid dropslets. Individuals with _____ disease have a deficiency of sphingomyelinase and large accumulations of unmetabolized lipid sphingomyelin and cholesterol in their histiocytes

Chediak-Higashi syndrome

The large, dark granules in the neutrophilic segmented cell are abnormal lysosomal granules. These granules are found in granulocytes, lymphocytes, monocytes, platelets and melanocytes of individuals with _________ __________. They are the result of abnormal fusion of primary and secondary lysosomal granules. Abnormal granules result in ineffective enzyme release during phagocytosis

Döhle bodies

The neutrophil above contains a large pale-blue _____ in the lower right portion of its cytoplasm. ______ are collections of RNA that are associated with toxicity in the cell.

toxic granulation

The neutrophil above contains numerous dark purple, cytoplasmic granules that are often seen in toxic situations such as bacterial infections.

hairy cell

The nucleated ______ are found in ____ leukemia. Notice the streaming cytoplasmic processes

thrombocytes (platelets)

The small, purple cytoplasmic fragments are _____. They are normally about 1-2 microns in diameter and represent the smallest circulating formed element in the blood.

neutrophilia

This film shows an increase in the percentage of neutrophils in the blood with a "shift to the left" in the percentage of neutrophilic band forms

plasma cell

are found in multiple myeloma and during B-cell humoral immune responses. Notice the eccentric nucleus and dark-blue cytoplasm. The slightly lighter region in the cytoplasm near the nucleus contains the "hof" region (Golgi apparatus).

monocyte

are the largest leukocytes in peripheral blood. The cytoplasm of _____ is pinkish-gray and may contain azurophilc granules and vacuoles. Psuedopod extensions may also be present. The nucleus in a _____ is not as densely-staining as in a neutrophilic

chronic myelocytic leukemia (CML, CGL)

characterized by many immature stages of granulocytic development in the peripheral blood. These stages include myelocytes, metamyelocytes, bands and segmented forms. Myeloblasts and promyelocytes can be present but are fewer in numbers.

chronic lymphocytic leukemia

characterized by numerous small, dark lymphocytes that produce a "monotonous" blood picture.

infectious mononucleosis

characterized by over 50% lymphocytes in the peripheral blood and a wide variety of lymphocyte morphologies. Many of the lymphocytes are reactive lymphocytes with bluish-pink cytoplasm and darkly staining edges. The cells in this case also have some small azurophilic granules in the cytoplasm.

basophil

contain large purplish-blue cytoplasmic granules which can obscure the nucleus. They are very few in number in peripheral blood.

lymphocyte - medium to large

contain more cytoplasm than the small lymphcytes and can range in size from 10-14 microns. Their cytoplasm can be blue to gray and contain a few azurophilic granules

mature erythrocyte

contain no nucleus and stain pinkish-red with Wright's stain. They have a lighter center reflecting their biconcave morphology.

myeloperoxidase (MPO) stain

enzyme activity is found only in cells of myelocytic and monocytic origin. It is not found in cells of lymphocytic origin. _____stain is used to differentiate myeloblasts from lymphoblasts. Myeloblasts that are positive for the enzyme will contain large amounts of darkly-staining granules

acid phosphatase stain

enzyme is found in all cells. The reddish staining pattern for T cells and lymphoblasts is stippled or dotted

Sudan black B (SBB) stain

phospholipids black in membranes of primary and secondary granules in cells of myelocytic and monocytic origin. ______is the most sensitive stain for myelocytic precursors and is used to differentiate myeloblasts from lymphoblasts

reactive lymphocyte

similar to the large nucleated cell in this field, can be 9-30um in diameter. They have abundant cytoplasm, unevenly stained blue cytoplasm with darkly staining edges, and possible azurophilic granulation (although not seen in this cell). Their single nucleus can be round or slightly oval to indented.

periodic acid-Schiff (PAS) stain

stains stains glycogen red in lymphocytes, granulocytes, and megakaryocytes. It is used for diagnosing erythroleukemia

non-specific esterase (NSE) stain

used to differentiate cells of monocytic origin from other cells. Alpha naphthyl acetate or butyrate is used as a substrate for the stain. Monoblasts will contain diffusely positive orange granules.

promonocyte

(#2) is the stage of monocyte development following the monoblast stage (#1). The cytoplasm in the _____ is less blue than in the monoblast and represents a larger portion of the cell size. The nucleus is young in appearance with fine chromatin.

eosinophil

Mature ______ segmented cells contain bi-lobed nuclei and large reddish-granules in the cytoplasm.

neutrophilic band

(#3) is the stage of development after the neutrophliic metamyelocyte (#2). The nucleus has indented and forms a "band" without any segmentation. The edges of the nucleus are practically parallel with each other. The cytoplasm contines to increase in the amount of specific granules with fewer azurophilic granules.

rubricyte (polychromatophilic erythroblast)

(#3) is the stage of development between the prorubricyte (#2) and the metarubricyte (#4). The ______ cytoplasm contains a mixture of both red and blue colors which gives it a more gray appearance. The ______ in this image is in the early stages of rubricyte development

neutrophilic metamyelocyte

(#2) is the stage of development between the neutrophilic myelocyte (#1) and the neutrophilic band (#3). The nucleus in the metamyelocyte has started to indent but not as much as the band stage. _____ contains many specific granules with fewer numbers of azurophilic granules. The nuclear chromatin becomes more condensed as the cells mature.

rubriblast (proerythroblast)

(labeled #1) is the earliest recognizable stage in red blood cell development

prorubricyte (basophilic erythroblast)

(labeled #2) is the cell stage of development between the rubriblast (#1) and the rubricyte (#3). Notice its dark blue cytoplasm

lymphoblast

(#1) has a very high N:C ratio with minimal bluish-staining cytoplasm surrounding a very young appearing nucleus. Several nucleoli may be present in the nucleus. This cell stage is the earliest recognizable form of lymphocyte development.

metarubricyte (orthochromatic erythroblast)

(#1) has cytoplasm that is pinkish-blue and similar to the cytoplasm in the diffusely basophilic erythrocyte (#2). The nucleus in a ______ has a very dense chromatin pattern and is extruded at this stage of differentiation

promyelocyte (progranulocyte)

(#1) is a large cell that contains many purplish-red azurophilic granules in its blue cytoplasm. Its nucleus can be round or slightly indented and usually contains nucleoli.

prolymphocyte

(#1) is seen in this film with many mature lymphocytes (#2). ______ are the stage of lymphocyte development following the lymphoblast stage. The nucleus of the _____ is younger in appearance than the nuclei of the mature lymphocytes. A large nucleolus is also seen in the ______.

monoblast

(#1) is the earliest recognizable form of monocyte development. It precedes the promonocyte stage (#2). The ___ has a high N:C ratio with varying amounts of blue-gray cytoplasm surrounding a nucleus filled with fine, lacy chromatin. Nucleoli are often visible in the nucleus.

neutrophilic myelocyte

(#1) is the stage of development between the promyelocyte and the neutrophilic metamyelocyte (#2). It usually has a 1:1 N:C ratio with a round to slightly indented nucleus. This stage may also have a few nucleoli and is the last cell stage to divide in granulocytic development. A light area in the cytoplasm near the nucleus is the "hof" (Golgi) region. The cytoplasm of ______ stains bluish-gray and contains specific granules

lymphocyte - small

(#2) are a little larger than a normal RBCs (7-9 microns). They have a very high N:C ratio and sometimes it is very difficult to see any cytoplasm. If present, the cytoplasm is usually dark blue or gray. The nucleus is very dense with clumped chromatin.

diffusely basophilic erythrocyte

(#2) has no nucleus and contains some RNA which gives its cytoplasm a slightly blue appearance with Wright's stain. It is the same cell as a reticulocyte when specially stained with new methylene blue supravital stain.

acute lymphocytic leukemia

ALL is characterized by lymphoblasts in the bone marrow and peripheral blood. Notice the immature chromatin, nucleoli, and high N:C ratio.

tartrate-resistant acid phosphatase (TRAP) stain

Acid phosphatase isoenzyme activity in hairy cells (staining red-orange) is resistant to incubation with tartrate. Acid phosphatase isoenzyme activity in other cells is destroyed during incubation with tartrate. The _____ stain is used in the diagnosis of hairy cell leukemia (leukemic reticuloendotheliosis)

Alder's anomaly

Leukocytes in ______ have dark-staining, purplish-red granules that contain precipitated mucopolysaccharides. These granules are sometimes confused with toxic granules, which are not as large and usually stain a darker blue. _____ inclusions are seen in Hurler's disease.

neutrophilic segmented

Mature ______ cells have dense nuclei that contain 3-5 segments connected by thin filaments of nuclear chromatin. Their cytoplasm is filled with pinkish-gray specific granules.

leukocyte alkaline phosphatase (LAP) stain

for alkaline phosphatase enzyme activity in the cytoplasm of neutrophils. It is colored dark green/black in the preparation above. The stain is used to help differentiate between a leukemoid reaction and chronic myelocytic (granulocytic) leukemia

eosinophilia

is an increase in the number of eosinophils in the blood. This film shows 3 eosinophils in this one field. Normally there are only 0-4 eosinophilis/100 WBCs and not one in every field.

May-Hegglin anomaly

neutrophils and monocytes contain large, blue-staining granules similar to Döhle bodies (RNA). A Döhle body can be seen in the cytoplasm of the segmented neutrophil near its inferior rim. Individuals with _______ anomaly also have thrombocytopenia with giant platelets. Four giant platlets are seen in this case.

hypersegmentation

occurs in neutrophlis when there are more than 5 connected segments in the nucleus. The lower cell is a neutrophil that contains one nucleus with 8 segments connected by thin filaments of nuclear material. The upper cell is a normal neutrophil with 4 segments in the nucleus.