 Nuclear Abnormalities
- Found in neutrophils as irregular, round or oval, blue staining
Pelger - Huet Anomaly
- Inherited as a non-sex linked dominant trait
- Failure of nucleus of neutrophils to segment or lobulate
- Cell appear as bilobed or band forms (pince – nez nucleus)
- Do not affect neutrophil function
- Survive normally in circulation and can phagocytize and kill
microorganism
- Acquired form is seen in blood diseases such as chronic
myelocytic leukemia, acute leukemia, agranulocytosis, infectious
mononucleosis
- Not to be mistaken for a severe shift to the left
Hypersegmented Neutrophils
- Also known as macropolycytes and P.A. Poly cell
- Usually larger than normal neutrophil
- Nucleus has 5-10 lobes (normal: 3 lobes)
- Usually present in pernicious anemia
- No. of hypersegmented neutrophils in differential WBC count:
REPORTED under miscellaneous white cells
Rieder Cell
- Lymphocyte with notched, lobulated or segmented or clover leaf like
nucleus
- Can occur in chronic lymphocytic or lymphatic leukemia (CLL)
 Cytoplasmic Abnormalities
Alder - Reilly Bodies
- Inherited as recessive trait
- Presence of larger than normal coarse, dark, azurophilic granules
(Alder bodies & Reilly Bodies) in the cytoplasm of granulocytes,
lymphocytes, monocytes, bone marrow precursor cells that cover the
nucleus
- Granules are larger than toxic granulations seen in infections.
- Abnormal granules contain mucopolysaccharide, reflecting the
general disturbance of metabolism in gargoylism and other disorders
- Associated with skeletal dystrophy
- (Pfaundler – Hurler syndrome, Hurler’s syndrome,
Lipochondrodystrophy) a condition characterized by dwarfism,
skeletal deformities, mental retardation, corneal opacity, and coarse
cretinoid facies – like gargoyle (grotesque representation of animal or
human forms used in medieval times as rain spouts)
Chediak - Higashi Syndrome
- Hereditary autosomal recessive syndrome
- Include albinism, abnormal skin pigmentation, repeated infections that
lead to anemia, neutropenia, thrombocytopenia, and death
- Neutrophils show large Peroxidase (+), Sudan Black B (+), Acid
Phosphatase (+) inclusions that vary in size and color (blue to red) –
resemble Dohle Bodies
- Giant granules also found in all other granulocytes and
agranulocytes
May – Hegglin Anomaly
- Autosomal dominant disorder
- Irregularly sized (2-5mm) multiple or single inclusions (similar
to Dohle Bodies) in polymorphonuclear cells, monocytes and
rarely in lymphocytes
- Inclusions are not related to infections but with abnormal giant
platelets and thrombocythemia
- Infected persons are clinically normal but about 25% lead to bleeding
abnormally (epistaxis, purpura or hematuria)
Dohle - Amato Bodies
cytoplasmic inclusions, size of cocci vary from about 2 u in diameter
- Identified by Electron microscopy to be lamellar aggregates of rough
endoplasmic reticulum
- Found in severe infections, severe burns, and exposure to cytotoxic
agents but disappear as infections subsides
- Similar to May – Hegglin bodies
- They are Periodic acid Shift (PAS) positive
Flame cell
- A plasma cell with intensely eosinophilic or “flaming” cytoplasm
containing glycoprotein globules.
- were regarded as specific for IgA myelomas, but also occur in
Waldenström’s macroglobulinemia.
Toxic Granulation
- Believed to be allered primary granules
- Cell of cytoplasm contain large basophilic dark-blue black
staining granules (toxic granules)
- Seen in severe infections, chemical poisoning, toxic states
Auer Bodies
- Rod-like bodies seen in certain types of acute leukemia
- Linear projections of primary azurophilic granules
- Stain reddish purple in cytoplasm of monoblast and myeloblast in
acute monocytic or actute myelocytic leukemia
Hairy cells
- small lymphocytes w/ little cytoplasmic projections
- Found in Hairy Cell Leukemia
- TRAP +(tartrate-resistant acid phosphatase)
 Functional Abnormalities
Chronic granulomatous disease
- Inability of phagocytes to produce superoxide and reactive oxygen
species
- Predisposition to bacterial and fungal infections
- Formation of granulomas that can obstruct hollow organs
(stomach, intestines, and urinary tract)
- NBT reduction test
o Normal neutro. = forms dark blue formazan
o CGD neutro. = NO formation of dark blue formazan
Miscellaneous Granulocyte Disorders
a) Hyperimmunoglobulinemia E ( Job Syndrome )
- Neutro. have poor directional motiliy
- Char. by: Elevated levels of IgE, Skeletal abnormalities, Recurrent
severe bacterial infections
b) Lazy leukocyte syndrome
- Char. by: Neutropenia, Poor neutrophil response to chemotactic
agents
Monocyte/Macrophage Lysosomal Storage Diseases
a) MUCOPOLYSACCHARIDOSES
- Inherited disorders of GAG degradation
- Examples: Hurler syndrome, Hunter syndrome, Sanfilippo
syndrome
b) LIPID STORAGE DISEASES
- Examples: Gaucher disease, Niemann-Pick disease
Gaucher’s cell
- Found in bone marrow
- Large MAC w/ small, eccentric nuc.
- Cytoplasm: distended by glucocerebrosides (“crumpled tissue
paper” or “onion skin-like”)
- Gaucher’s disease: most common of lipidoses, defect in the
catabolic enzyme β-glucocerebrosidase
Foam cells Turk Irritation Cell
- Found in bone marrow  Common morphologic variant of lymphocytes (immature nucleus
- Macrophages whose cytoplasm is swollen by many small lipid and basophilic cytoplasm) similar to plasma cell
droplets
- Niemann-Pick disease two categories:  Cell in the blood with cytoplasm like plasma cells and a nucleus
o Deficiency in acid sphingomyelinase (ASM) resembling a myeloblast nucleus
o Defective NPC1 and NPC2 genes  Seen in viral infections such as German measles, severe anemia,
and chronic infections
 Uncategorized Abnormalities

Smudge Cell (Basket Cell) Downey Cell

 Thumbprint appearance
 ruptured WBC with bare nucleus
 nucleus goes out of the ruptured cell
 few in normal blood smear due to improper and forceful smearing
(heavy pressure)
 Associated with abnormally fragile lymphocytes in disorders such as
chronic lymphocytic leukemia (C11)
 Can also be seen in degenerating samples, in which case, their
origin may not be lymphocytic.
 Presence may indicate increased fragility or abnormal
destruction of cells
Pyknotic Cell
LE Cell (Lupus Erythematousus Cell)
 Phagocytic WBC (usually a neutrophil) that has ingested an altered,
homogenous globular nuclear mass of a destroyed cell
 Nucleus of a Phagocytic is compressed to one side,
appearance is distorted
 Ingested nuclear material is homogenous and redder
Twinning Deformity (Tetraploid neutrophils with diploid nuclei)
Jordan’s Anomaly
 Presence of fat containing vacuoles in granulocytes and
monocytes
 Seen in Muscular dystrophy and ichthyosis
Drumstick
 Sex chromatin of polymorphs
 Solid nuclear appendage shaped like drumstick (1-2 u in diameter)
attached by a narrow segment to one of the main lobes of nucleus
in 1-8% neutrophils in females
 Seen in eosinophils and basophils but its granules obscure it
 Transformed, stimulated, reactive lymphocytes or atypical
lymphocytes with denser or more opaque cytoplasm
 Increased no. of cytoplasmic granules
 Cytoplasm stains heavily with red pyronine(red basic dye staining
RNA)
 Also called pyroninophilic cells
 Cytoplasm at times is vacuolated and foamy
 Associated with viral infections such as Acute infectious
mononucleosis
 Nucleus becomes smaller and denser
 Chromatin bridges between the nuclear segments disappear leaving
several small balls of dense chromatin.
 May be seen in infections and aging cells
 Segmented neutrophil are twice the size of normal
neutrophils
 Usually round
 Apparent hypersegmentation due to presence of 2 nuclei in 1 cell
occurs in pernicious anemia and myeloproliferative state

Vacuolated Cell
 With holes or vacuoles in the cytoplasm(signs of
degeneration)
 If seen in smears made from fresh blood, must be counted and
reported under miscellaneous white blood cells
 May be found in normal blood smears if the smear is made from
oxalated blood which is over 2 hours old
 May be seen in severe infections, chemical poisoning and leukemia

Tart Cell
 First described in a patient named Tart
 Phagocytic WBC, usually monocytic with engulfed nucleus of another
cell
 Usually, the ingested nucleus retains its characteristic nuclear structure
such as chromatin clumps, nucleoli, or nuclear membrane
 Generally seen in effusion fluid (independent cause of effusion)
 Seen in bone-marrow aspiration material, synovial fluid,
cerebrospinal fluid, and pericardial fluid of SLE patients
 Presence of LE cell contribute to diagnosis of SLE
PandaMT13