1 | P a g e WHITE BLOOD CELL ANOMALIES NUCLEAR CHANGES • Basket Cells/ Smudge Cells Biconcave Disc • Hypersegmentation • Pelger-Huet Anomaly • Twinning Deformity • Pyknotic Cells 1. BASKET CELL/SMUDGE CELL - APPEARANCE : Represent squashed, degenerative nuclei - Maybe due to poor smear preparation - CLINICAL SIGNIFICANCE : changes in the ratio of plasma lipids ( lecithin and sphingomyelin), alcoholic cirrhosis with hemolytic anemia, post splenectomy and renal absorption 2. HYPERSEGMENTATION - APPEARANCE : Neutrophils with many nuclear lobes - with many reddish granules of flat cell - characterized by 5 or more lobes - CLINICAL SIGNIFICANCE : associated with megaloblastic anemia due to vitamin b12 or folic acid deficiencies, uremia, Gastric cancer, Bleeding peptic ulcers, renal insuffiency and myelopthisic anemia2 | P a g e 3. PELGER-HUET ANOMALY - APPEARANCE : Inherited abnormally of failure of normal nuclear segmentation - 2-lobed nuclei,”pince-nez” - Marked condensation of nuclear chromatin - Maybe congenital or acquired - Seen in result from hereditary or acquired conditions and range from egg shaped or slightly oval two sausage, rod or pencil forms. - 2 types : • TRUE PELGER HUET : congenital abnormality (autosomal dominant ) • PSEUDO-PELGER HUET : acquired abnormality - CLINICAL SIGNIFICANCE : Iron deficiency anemia, Hereditary elliptocytosis and ovalocytosis, myeloid metaplasia, infectious mononucleosis, following myelotoxic therapy and in Fanconi’s anemia 4. TWINNING DEFORMITY - APPEARANCE: Tetraploid neutrophils with diploid nucleus - Twice the size of normal neutrophils and are roundhydrocytes - Apparent hypersegmentation due to presence of two nuclei - CLINICAL SIGNIFICANCE :Imbalance, redistribution of cells and lead poisoning 5. PYKNOTIC CELLS - APPEARANCE: Absence of chromatin bridge between the nuclear lobes - Often mistaken for band and metamyclocyte - Seen in infection and aging cell3 | P a g e - May be due to increased proteins in RBCs - CLINICAL SIGNIFICANCE : transfusion reactions, MAHA,IHA, and may also be seen in banked blood stored for a long time. Cytoplasmic Changes • Alder-Reilly Granulation • Dohle Bodies • Chediak-Higashi • May-Hegglin • Toxic Granulationoncave Disc • Jordan’s Anomaly 1. ALDER-REILLY GRANULATION - APPEARANCE : Due to abnormal polysaccharide metabolismwhich preventsthe formation of secondary granules - Coarse, dark, azurophilic granules in the cytoplasm of PMNs covering the nucleus - Autosomal recessive inheritance - Morphologically abnormal, but functionally normal - Mistaken for toxic granulation - CLINICAL SIGNIFICANCE : Seen in Hurler’s and Hunter’s syndrome, genetic mucopolysaccharidoses 2. DOHLE BODIES - APPEARANCE : Irregular, contracted, triangular cells, horn-shaped - A.k.a Amatocytes4 | P a g e - Irregular, bluestaining cytoplasmic RNA inclusions - Sacks of ergastoplasm appearance in electronmicroscope - Longer than azurophilic granules - CLINICAL SIGNIFICANCE : Usually seen in severe infection, Post chemo therapy, severe burns 3. CHEDIAK-HIGASHI ANOMALY - APPEARANCE : Neutrophils show large inclusions that vary in size and color - - Show chemotactic defects and defective lysosomal emptying into phagocytic vacuoles - Abnormal fusion of primary and secondary neutrophilic granules - Peroxidase positive granules - Morphologically and functionally abnormal : unable to degranulate and kill invading bacteria - CLINICAL SIGNIFICANCE : Seen in albinism ( photophobia and hypopigmentation) 4. MAY-HEGGLIN ANOMALY - APPEARANCE : Irregulary sized, multiple or single blue or pinkish cigar shaped inclusions in PMNs - May also be found in Monocyte - Large, crystalline, Dohle like inclusions - Associated with giant platelet and thronebocytopenia - CLINICAL SIGNIFICANCE : Seen in Bleeding5 | P a g e 5. TOXIC GRANULATION - APPEARANCE : Large,dark staining granules that are abnormally activated and enzyme-containing - Represent autophagosomes - Myeloperoxidase test positive - CLINICAL SIGNIFICANCE : Seen in Chemical poisoning, toxic stages, severe infection 6. JORDAN’S ANOMALY - APPEARANCE : - Vacuoles in granulocytes and monocytes - Represents fatty degeneration or glycogen - CLINICAL SIGNIFICANCE : observed in septicemia, toxic granulation and immune complex disorders6 | P a g e OTHER WHITE BLOOD CELL ANOMALIES • Malignancy-associated changes • Barr Bodies • Tart Cell • LE Cell 1. MALIGNANCY-ASSOCIATED CHANGES - APPEARANCE : Thin, Thread-like pointed, small inclusions surrounded by halos within the cytoplasm of monocytes 2. BARR BODIES - APPEARANCE : Nuclear appendage in 5-10% of human females origin - Contain a special sex chromatin called a drumstick or barr body attached to one lobes of the segmented nucleus 3. TART CELL - APPEARANCE : monocytes that have engulfed nuclear material - Phagocytosed frequently eosinophilic nucleus with and almost intact nuclear pattern, is frequently vacuolated, and has a conspicuous, condensed chromatin, especially around its circumference - CLINICAL SIGNIFICANCE : positive test is usually diagnostic of disseminated lupus erythematosus - Also positive in patients with periarteritis nodosa, dermatomyositis, scleroderma, drug hypersensitivity, RA, Hepatitis and hydralazine syndrome7 | P a g e 4. LE CELL - APPEARANCE : mature neutrophils or eosinophil that have engulfed or surrounded a large purplish hyaline, homogenous mass (lyzed nuclear material) that has been altered by antinuclear antibody - The nucleus of the neutrophil is tightly adjacent to the peripheral portion of the inclusion body - Inclusion body varies from 7-21 to 28 µ and is round or oval, granular, smoky, or pale lavender, homogenous in appearance - CLINICAL SIGNIFICANCE : SLE, some cases of RA 5. DESIGN FORMATION - APPEARANCE : Reflects technical error, bad smear preparation - Presence of fat or oil in the slide - Too much pressure when