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By Mojgan Talebian
PMN, Segmented, Poly 50- 70% of differential count Size: 9-15 µm Nucleus: 30% of the cell size, segmented to 2-5
lobes connected by strands of nuclear membrane
Chromatin: very coarse, heavily clumped, dark purple to black
Parachromatin is distinct Cytoplasm: fine, indistinct, and plentiful,
occasional small vacuoles
Band, Stab, staff cells
1-6% of leukocytes in the normal DIFF
Size: 10- 16 µm in diameter
Kidney bean-shaped Nucleus with nucleus
indentation
Cytoplasm with secondary granules,
neutrophilic granules, fine , and indistinct
Azurophilic granules, larger and more
distinct
In neutrophils named drumsticks; distinguishing them from Barr bodies in other cells
In neutrophils of normal females; non-pathological Inactivated x chromosomes (lyonization) in cells with
more than one X chromosome
Abnormal Barr bodies:• In males• Absence of or multiple drumsticks in females,
indicative of genetic abnormality In females Turner’s syndrome (XO) In males Kleinfelter syndrome (XXY)
Hypersegmentation of Neutrophils
Shift to the right, presence of more than normal
mature/degenerative and cells
Nuclei with 5 or more lobes
Result of disorders of cellular maturation:
• Megaloblastic anemia, neutrophils also increased in size
(macropolycytes)
• Myelodysplastic syndromes
• Severe infections, degeneration of the cells into necrobiotic forms
• Hypersegmented is applied to neutrophils, but it happens in
eosinophils and basophils
Nuclei of neutrophils with less than 3 lobes:• Shift to the left, increased number of immature neutrophils• Inherited Pelger-Huet anomaly Most of the neutrophils are bi-lobed Benign
• Acquired pseudo Pelger-Huet anomaly: Pelgeroid cells in conditions such as: sepsis, myelodysplastic syndromes, myeloproliferative disorders, leukemias/lymphomas, AML/CML solid organ transplantation
Apoptotic , necrobiotic, or pyknotic
Dying cells as a result of: accelerated
phagocytosis in infections, poisons, burns ,
heatstroke
Karyorrhexis (fragmentation) and
karyolysis (dissolution into a dense
pyknotic mass)
Unstained cytoplasmic vacuoles
Empty phagocytic vesicles in neutrophils• Acute ethanol toxicity
• Acute infections
• Septicemia
• Burns
• Malignancies
• Long term antibiotic therapy
• Exposure to radiation
Small, 1-3 µm It can be seen in Neutrophils or other WBCsDenatured aggregates of free ribosome or
rough endoplasmic reticulum containing RNACoexists with toxic granulationPresents in
• Burns• Infections • Surgery• Pregnancy• Chemotherapy• Inherited May Hegglin Anomaly (Döhle- like bodies)
Presents in the late stage of neutrophils; band
and segmented
Few to many, coarse dark staining granules,
Associated with• Infections
• Burns
• Inflammation
• Malignancies
• Drug intoxication
• Hematopoietic cytokine therapy
Decreased granulation of the cytoplasmPresents in neutrophil dysplasia,
• Myelodysplastic syndromes
• Acute myeloblastic leukemias
• Chronic infections(consumption of granules during the long term phagocytosis
• Megaloblastic anemia
• Inherited deficiencies of neutrophilic granules (rare)
An inherited autosomal dominant disorder
Döhle- like inclusions in the cytoplasm of the
neutrophils;
Along with thrombocytopenia and giant platelets
in May-Hegglin seen in neutrophils and
monocytes, basophils and eosinophils
consist mainly of RNA derived from patches and
remnants of rough ER
MYH9 gene-related disorder
Inherited (autosomal recessive) multi-system
disease
Large inclusion bodies
Originate from azurophil granules
Susceptibility to recurrent and severe infections
Dysfunctional leukocytes and platelets
In all leukocytes including neutrophils
Related with Mucopolysaccharidoses; lack the
lysozymal enzymes necessary to break down
mucopolysaccharides
Accumulation of mucopolysaccharides in lysosomes
of cells
Dense azurophilic granules
WBC count is not elevated
In Lymphocytes: metachromatic granules
surrounded by a clear zone
A very rare congenital immunodeficiency
disorder
Main features: susceptibility to human
papillomavirus (HPV)-induced warts,
hypogammaglobulinemia, bacterial
infections and myelokathexis • Myelokathexis (abnormal retention of mature
neutrophils in the bone marrow leading to severe
neutropenia)
Mature neutrophils show cytoplasmic
vacuolization, nuclear hypersegmentation,
nuclear lobes separated by long strand of
chromatin
http://www.wadsworth.org/chemheme/heme/microscope/pelgerhuet.htm (accessed Feb, 8, 2016)
S Deutsch, A Rideau. MYH9 mutation results. http://www.bloodjournal.org/content/102/2/529 (accessed 8 Feb 2016
T Kawai, H L. Malech. WHIM Syndrome: Congenital Immune Deficiency Disease.
V S Kanwar, R J Arceci,. May-Hegglin Anomaly. http://emedicine.medscape.com/article/956447-overview (accessed ).
E Regan. Mighty Max. http://www.mightymaxbannon.com/2015/07/the-problem-with-neutrophils-aka-all.html (accessed 8 Feb 2016