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Morphological abnormality of white blood cell
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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