Morphological abnormality of white blood cell

This presentation describe the normal WBC normal and abnormal shape.
it can also describe the maturation of different WBC and reactivity of the WBC different infection

1. WHITE BLOOD CELL NORMAL &
ABNORMAL
NAZAR AHMED MOHAMED ABD-ALLA
BSC - OMDURMAN AHLIA
HIGH DOPLOMA DGREE - ELZAEM EL-AZHARY
FORMER HEAD OF HEMATOLOGY & BLOOD BANK
MINISTRY OF HEALTH – LABORATORY ADMINISTRATION
KHARTOUM STATE
MARKETING MANAGER-LAB EQP –DIVISION
ALGAM COMPANY FOR DRUGS & CHEMICAL LTD

1
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

2. Learning Objective
*MAIN OBJECTIVE OF PRESENTATION IS TO
KNOW DIFFERENT TYPE OF NORMAL WHITE
BLOOD CELL AND ABNORMAL CELL AND
CASES WHERE THIS TYPE OS CELL CAN BE
PRESENT
2
NAZAR AHMED MOHAMED ABDALLA
(SANGOOR)2007

3. Normal White Blood Cell
*White blood cell is divided into five categories which are:
-Polymorph neutrophil.
-Polymorph eosinophil.
-Polymorph basophil .
-Monocyte.
-Lymphocyte
*First we will see the characteristics of normal cell then we
will shift to reactive cell and finally to immature WBC.
3
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

4. 1- NORMAL SEGMENTED NEUTROPHIL

*This granulocyte has very tiny light staining granules
(the granules are very difficult to see).
*The nucleus is frequently multi-lobed with lobes
connected by thin strands of nuclear material.
*These cells are capable of phagocytizing:
-Foreign cells.
-Toxins.
-Viruses.

4
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

5. 5
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

6. 2- EOSINOPHIL

*This granulocyte has large granules (A) which are
acidophilic and appear pink (or red) in a stained
preparation.
*The nucleus often has two lobes connected by a band of
nuclear material.
*(Does it look like a telephone receiver?)
*The granules contain digestive enzymes that are
particularly effective against parasitic worms in their
larval form.
*These cells also phagocytize antigen - antibody
complexes.




6
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

7. 7
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

8. 3- BASOPHIL

*The basophilic granules in this cell are:
-Large.
-Stain deep blue to purple .
-Often so numerous they mask the nucleus.
*These granules contain histamines (cause
vasodilatation) and heparin (anticoagulant).
8
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

9. 9
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

10. 4-LYMPHOCYTE
*The lymphocyte is a granular cell with very
clear cytoplasm which stains pale blue.
-Its nucleus is very large for the size of the cell
and stains dark purple.
-These cells play an important role in our
immune response.
-The T-lymphocytes act against virus infected
cells and tumor cells.
-The B-lymphocytes produce antibodies.




10
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

11. 11
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

12. 5-MONOCYTE
*This cell is the largest of the leukocytes and is a
granular.
*The nucleus is most often "U" or kidney bean
shaped; the cytoplasms are abundant and light blue
(more blue than this micrograph illustrates).
*These cells leave the blood stream (diapedesis) to
become macrophages.
*As a monocyte or macrophage, these cells are
phagocytic and defend the body against viruses and
bacteria.


12
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

13. 13
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

14. IMMATURE WBC (MYLOID SERIES) -2

*Myeloblasts are morphologically the most immature cell
in the myeloid series.
*Although there is some variation in shape and size,
myeloblasts are usually 15 to 20 m in diameter and
round to oval.
*The cell nucleus is usually round or oval, but may
sometimes be indented or clefted.
*It often contains one or more nucleoli and the chromatin
is finely reticulated and thereby granular in appearance.
*The nuclear- cytoplasmic ratio (N: C) is high, 7:1 to 5:1.
Some are contain Auer rod
14
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

15. 15
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

16. 16
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

17. 17
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

18. 2-PROMYLOCYTE
*Promyelocytes are round or oval and are generally slightly
larger than myeloblasts, measuring 12 to 24 m in diameter.
*The nucleus is large, round or oval, and is often centrally placed,
but may sometimes be located eccentrically.
*It may contain one or more nucleoli.
*The chromatin is fine with little or no clumping and
parachromatin is sparse.
*The N: C ratio is 5:1 to 3:1.
*The cytoplasm, slightly greater in amount than in the
myeloblast, stains pale blue, and contains a few or many coarse,
reddish-purple, azurophilic (primary) granules, which may or may
not overlie the nucleus.

18
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

19. 19
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

20. 3-MYLOCYTE
*Myelocytes are also round or oval in shape and may vary
in size (10 to 18 m In diameter).
*Myelocytes are usually smaller than promyelocytes.
*The large centrally or eccentrically placed nucleus is
round, oval or occasionally either flattened or very
slightly indented on one side, and generally lacks
nucleolus.
*Variable degree of chromatin clumping is evident.
*The N: C ratio is 2:1 to 1:1.
* The cytoplasm is abundant, may stain bluish-pink, light
pink, or may appear colorless, and contains some reddish-
purple azurophilic (primary) granules

20
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

21. 21
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

22. 5- METAMYLOCYTE

*Metamyelocytes are similar in shape to myelocytes but are slightly
smaller (10 to 16 m in diameter).
*The centrally or eccentrically placed nucleus is usual indented (to less
than half the distance form the farthest nuclear margin), giving it a
kidney or bean shape.
*Occasionally it may be flattened.
*The chromatin is usually clumped and there is no nucleolus.
*The N:C ratio is 1.5:1 to 1:1.
*The abundant, pink or colorless cytoplasm may contain a few reddish-
purple azurophilic (primary) granules and/or many fine, lilac,
neutrophilic (secondary or specific) granules.



22
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

23. 23
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

24. 6-BAND FORM

*Small extensions or appendages of the nucleus
may be seen, but the cell still is classified as a
band if a filament is not present.
*The chromatin is coarse and clumpy with very
little parachromatin; however, the arms of the
band may show concentrated areas of
chromatin at each pole.
*There is no nucleolus.
*The N: C ratio is 1:1.5 to 1:2.
*The cytoplasm is abundant and pale pink or
colorless.

24
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

25. 25
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

26. ABNORMAL WBC (MYLOID SERIES) -3
* 1- HYPERSEGMENTED NEUTROPHIL
*Larger than normal (one and one-half times the
normal size or greater) neutrophils, bands.
*Referred to as macropolycytes Such cells are
commonly seen in:
*The blood and bone marrow of patients with
vitamin B12 or folate deficiency.
*Myelodysplasia.
*Patients receiving chemotherapy, such as
hydroxyurea

26
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

27. 27
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

28. 2-Neutrophil, With
(Pelger -Huet Nucleus)
*Neutrophils with bilobed nuclei in the “pince-nez” conformation
(two round or nearly round lobes connected by a distinct thin
filament) are designated as neutrophils with Pelger-Huet nucleus
or Pelger-Huet cells.
*Some of the Pelger-Huet cells may, however, contain unilobed
nuclei.
* The nuclear chromatin is generally denser than normal.
*The presence of hyposegmented neutrophils can be an acquired
phenomenon, as a result of :
-Severe infection.
-Burns.
-Malignancy.
-Chemotherapy .
-Drugs such as sulfonamides.
*When the causative agent has been removed, the cells will return
to normal.
28
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

29. 29
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

30. 3-NEUTROPHIL WITH TOXIC GRANULATION

*Large.
-Purple or dark blue.
-Azurophilic granules.
-Resembling the primary granules of promyelocytes, in
the cytoplasm of neutrophils, bands, and metamyelocytes
are referred to as toxic granules.
*Toxic granulation is associated with :
-Severe infection.
-Chemical poisoning.
-Other toxic states.
30
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

31. 31
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

32. 4-TOXIC VACULATION

*Vacuoles, representing the sites of digestion
of the phagocytosed material, in the
cytoplasm of neutrophils and bands are
designated as toxic vacuoles.
*Toxic vacuolization is frequently noted in
association with toxic granulation.

32
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

33. 33
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

34. 5-Alder-Reilly granules

* Alder-Reilly granules are:
-Large.
-Purple or purplish-black.
-Coarse.
-Azurophilic granules (resembling primary granules of
promyelocytes).
*They are seen in the cytoplasm of virtually all mature
leukocytes and, occasionally, in their precursors.
*The presence of these granules characterizes Alder-
Reilly anomaly.
34
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

35. 35
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

36. 6-May-Hegglin body

*May-Hegglin body can be seen near the
edge of the cytoplasm at the top of the
neutrophil.
*In addition, notice that some of the
platelets appear smaller than normal and
one is larger than normal.

36
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

37. 37
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

38. 7-Chediak -Higashi granules
*Giant.
-Often round.
-Red.
-Blue or greenish-gray granules of variable size are seen in the
cytoplasm of leukocytes (granulocytes, lymphocytes, and
monocytes) and sometimes normoblasts in patients with Chediak-
Steinbrinck-Higashi syndrome and are referred to as Chediak -
Higashi granules.
*These granules, sometimes also called inclusions, represent
abnormal lysosomes.
*These abnormal granules are able to kill bacteria in neutrophils
and monocytes; however, the process is much less effective than
in normal cells in part, because these neutrophils have impaired
locomotion.
*For these reasons, individuals with Chediak-Higashi have
recurrent infections.

38
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

39. 39
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

40. 8-Dohle Body
*Dohle bodies appear as:
-Single or multiple.
-Blue.
-Grayish-blue or greenish inclusions of variable size
(0.1 to 2.0 m) and shape (round, elongated, or
triangular) in the cytoplasm of neutrophils, bands,
and metamyelocytes.
*These inclusions represent remnants of free
ribosomes or rough endoplasmic reticulum.
*Dohle bodies are often seen in association with
toxic granules and vacuoles.

40
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

41. 41
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

42. 9-Auer body (Auer rod)

*Auer bodies are pink or red.
-Round or rod-shaped, cytoplasmic inclusions that are
seen mostly in immature granulocytes and occasionally in
monocyte precursors in patients with acute non-
lymphocytic leukemia's.
*These inclusions represent agglomeration of azurophilic
granules.
*A cell containing multiple Auer rods clumped together
in the form of a bundle is referred to as a fagot cell.
*Such cells are most often seen in acute promyelocytic
leukemia.

42
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

43. 43
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

44. IMMATURE LYMPHOID SERIES: -4*
LYMPHOBLAST-1*
*The blasts show dense, irregular nuclear Structure and narrow cytoplasm


44
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

45. 2- HAIRY CELL WICH SEEN IN HAIRY CELL
LEUKEMIA
45
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

46. 3- REACTIVE LYMPHOCYTE SEEN IN SEVER
INFECTION
*It indicates that although the cells are
functioning normally, they are reacting
to a stimulus.
*Indicating the presence of such cells
may aid in determining the diagnosis or
monitoring the course of disease once
a diagnosis has been made.

46
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

47. 47
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

48. 4- SMEAR CELL SEEN IN LEUKEMIA
48
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

49. 1- MONOCYTE LIKE BAND
49
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

50. 2- MATURE MONOCYE
50
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

51. 3- MONOCYE WITH AZUROPHILIC GRANUL
51
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

52. 4- MONOBLAST (SEE THE VACULATION IN THE NEUCLUSE & CYTOPLASM)
52
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

53. 2-PROMONCYTE
53
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

54. 6- PLATLETS MATURATION
1- MEGAKARYOBLAST

*Megakaryoblasts, morphologically the most
immature cells of the megakaryocytic series,
are round or ovoid cells of variable size (7 to
35 m in diameter).
*Those measuring less than 15 m in
diameter are often designated as
micromegakaryoblasts.

54
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

55. 55
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

56. 2- MEGAKARYOCYTE

*The megakaryocyte is the largest (40 to 100
m in diameter ) normal nucleated
hematopoietic cell in the marrow.
* At times, however, it may be relatively
small (micromegakaryocyte), measuring 15
to 30 m in diameter.

56
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

57. 57
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

58. 3- METAMEGALOCYTE

*Usually found only in the bone marrow.
*Nucleus is multinucleated.
*Nuclear chromatin is course and
condensed.


58
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

59. 59
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

60. 4- MICROMEGAKARYOCYTE

*Micromegakaryocytes are usually seen in
myeloproliferative conditions, such as :
*Chronic myelogenous leukemia.
*Agnogenic myeloid metaplasia with
myelofibrosis.
*Acute megakaryocytic leukemia .
*Some cases of myelodysplasia.

60
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

61. 61
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

62. 5- BAZZAR SHAPE PLATLETS
*In some disease state platelets can become
mutated.
*This most commonly seen in
mylelodysplastic disorders and thrombotic
thrombocytopenia purpura.

62
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

63. 63
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

64. 6- NORMAL PLATLETS
* Light blue staining cytoblasmic material
measuring 1-3 microns in diameter.
*Cytoplasm usually has azurophilic (red-
purple) granules present
64
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

65. 65
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

66. 7-PLATLETS CLUMBING

*When specimen has been improperly mixed
or collected often the specimens will begin to
clot.
*During clotting process platelets begin to
aggregate.
*When this occur the platelets count will be
falsely decrease and cannot be reported

66
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

67. 67
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

68. 8- Platelet satellitism

*Platelet satellitism has been reported in a
variety of clinical conditions including Behcet’s
disease.
*However, its occurrence is not known to be
associated with specific disorders.
*When pronounced, platelet satellitism may
cause spuriously reduced platelet counts
(Pseudo-Thrombocytopenia).

68
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

69. 69
NAZAR AHMED MOHAMED
ABDALLA(ANGOOR)2007

70. ANY QUESTION ?

NAZAR AHMED MOHMED
ABDALLA(SANGOOR)
70

71. Learning Outcome
*KNOW DIFFERENT TYPE OF NORMAL WHITE
BLOOD CELL AND ABNORMAL CELL AND
CASES WHERE THIS TYPE OS CELL CAN BE
PRESENT

NAZAR AHMED MOHMED
ABDALLA(SANGOOR)
71

72. THANK YOU FOR GOOD ATTENTION
NAZAR AHMED MOHMED
ABDALLA(SANGOOR)
72