Division of Haematological Pathology

Haematological Atlas - White blood cell morphology

White Cell Morphological Abnormalities

NEUTROPHILS:

Drumstick

Morphology:
Drumstick shaped nuclear appendage. ± 1,5 ?m in diameter and attached to the nucleus by a filament. Inactive X chromosome of the female.

Found in:
Neutrophils of females
Males with Klinefelter syndrome

 

Sessile Nodule

Morphology:
Inactive X chromosome found as nodule on neutrophils of females.

Found in:
Neutrophils of females

 

Hypersegmentation or right shift
of neutrophil nuclei

Morphology:
Average lobe count increased OR increased % of neutrophils with 5 - 6 lobes OR > 3% neutrophils with 5 lobes or more.

Found in:
Megaloblastic anaemia
Iron deficiency
Chronic infection
Liver disease
Uraemia
Hereditary

 

Ring shaped nuclei

Morphology:
Nucleus ring or doughnut shaped

Found in:
Acute myeloid leukemia
Chronic granulocytic leukaemia
Megaloblastic anaemia
MDS

 

Detached nuclear fragments

Morphology:
Detached nuclear material in cytoplasm.

Found in:
Dysgranulopoiesis
Patients on anti cancer chemotherapy
HIV

 

<

MPO deficiency

Morphology:
Neutrophils appear normal on Romanowsky stain but are not counted as neutrophils by the cell counters employing a myeloperoxidase stain.

Found in:
Inherited
Refractory anaemia
Blast crisis of CML

 

 

Toxic Granulation

Morphology:
Increased granulation. Granulation more basophilic and larger than normal.

Found in:
Severe bacterial infection
Non specific finding - seen in tissue damage of various types.
Normal pregnancy
Therapy with cytokines

 

Hypogranulation

Morphology:
Reduced granulation in neutrophil cytoplasm.

Found in:
Myelodysplastic syndromes

 

Vacuoles

Morphology:
Vacuoles in the cytoplasm of granulocytes

Found in:
Infection
Toxic effect of ethanol
Jordan's anomaly


 

 

D?hle Bodies

Morphology:
Small pale blue cytoplasmic inclusions, often in the periphery of the cell.

Found in:
Infective and inflammatory states
Severe burns
Tuberculosis
Post chemotherapy
Pregnancy

 

Phagocytosed Parasites

Morphology:
Malaria - Plasmodium falciparum

Found in:
Severe malaria infection

 

Phagocytosed Organisms

Morphology:
DF2 organism. Rod shaped organism in vacuoles in cytoplasm of neutrophils

Found in:
Dog bite

 

Phagocytosed Platelet

Morphology:
Platelet in vacuole in neutrophil cytoplasm

Found in
Infection

 

Phagocytosed Red blood cell

Morphology:
Red cell in vacuole in cytoplasm of neutrophil

Found in:
Infection
Auto immune haemolytic anaemia
Incompatible blood transfusion

 

Auer Rods

Morphology:
Small azurophil rods in the cytoplasm of myeloblasts and promyelocytes. Sometimes found in mature neutrophils

Found in:
Acute myeloblastic leukemia
Myelodysplastic syndromes

 

Macro Neutrophils

Morphology:
Twice the size of a normal neutrophil with tetraploid DNA content.

Found in:
Occasionally in the blood of healthy subjects
Inherited
Administration of G-CSF
Megaloblastic anaemia
Chronic infection

 

Necrobiotic / Apoptotic neutrophil

Morphology:
Dense homogenous nuclei (pyknotic)

Found in:
Occasionally in healthy subjects
In vitro artefact
AML

 

Shift to the Left

Morphology:
Presence of precursor of granulocytes in the peripheral blood

Found in:
Normal in pregnancy or neonate
Infections
Bone marrow fibrosis
Bone marrow infiltration by malignancies

 

Pseudo Pelger Hüet Anomaly

Morphology:
Bilobed neutrophils with more condensed chromatin.

Found in:
Inherited
Myelodysplastic syndromes
Idiopathic myelofibrosis
Chronic granulocytic leakaemia
Therapy with colchicine, iboprofen
Infectious mononucleosis, malaria, myxoedema
CLL

 

Neutrophil aggregation

Morphology:
Small clumps of neutrophils. Happens in vitro if EDTA anticoagulated blood is allowed to stand. May lead to incorrect WBC

Found in:
In vitro finding
Infectious mononucleosis
Bacterial infections
Auto immune disease


EOSINOPHILS:

 

Eosinophilia

Morphology:

Increase in number of eosinophils in peripheral blood

Found in:

Parasitic infections

Allergic reactions

Drug hypersensitivity

Hodgkin's disease

 

Left shift: Eosinophil

Morphology:

Eosinophil metamyelocyte in peripheral blood

Found in:

Reactive eosinophila

Myeloproliferative disorders

AML


BASOPHILS:

 

Basophilia

Morphology

Increase in the neumber of basophils in the peripheral blood.

Found in:

Myeloproliferative disorders

Myxoedema

Ulcerative colitis

Hyperlipidaemia


LYMPHOCYTES:

 

Atypical Lymphocytes

Morphology:
Pleomorphic. Large with diameter of 15 - 30 ?m. Abundant, strongly basophilic cytoplasm. Basophilia may be confined to the cytoplasmic margins.

Found in:
Viral infections - EBV, CMV, Hep A, Measles
Bacterial infections - brucella, tuberculosis
Protozoa - malaria
Immunization
SLE

 

Plasmacytoid Lymphocyte

Morphology:
Lymphocyte with basophilic cytoplasm and eccentric nucleus.

Found in:
Reactive phenomenon

 

Mott cell

Morphology:
Plasmacytoid lymphocyte with globular inclusions composed of immunoglobulin.

Found in:
Reactive changes in peripheral blood

 

Large Granular Lymphocyte

Morphology:
Small eosinophilic granules in the cytoplasm of large lymphocytes

Found in:
Natural killer cells
Lymphokine activated T cells


MONOCYTES:

 

Monocyte Vacuolization

Morphology:

Vacuoles in the cytoplasm of monocytes

Found in:

Infections