WHITE CELL AND PLATELET MORPHOLOGY

Myeloid series
Myeoblast
These are the most immature cells of
the granulocyte series. They are
usually large (12-20microns).
Cytoplasm: is scanty and stains a
bright blue at the edges/margin.
Granules: there may be none or some
fine azurophilic granules can be
observed.
Nucleus: generally it is round with
delicate lace like chromatin with
nucleoli 1-2+ present.
Promyelocyte
These are usually larger than
myeloblasts (12-23microns). The N:C
ratio decreases.
Cytoplasm: usually there is plentiful
with coarse aurophilic primary granules
Nucleus: is oval and tends to lie
eccemtrically in cytoplasm with a
delicate chromatin and sometime 1
nucleoli. The chromatin however may
be slightly denser than a myeloblast.
Myelocyte
Smaller than promyelocyte (1220microns)
Cytoplasm: is bluish but turns pinker as
it matures. The coarse aurophilic
granules disappear and fine neutrophil
granules are seen.
Nucleus: is smaller and round with the
chromatin clumping. No nucleoli are
seen
Metamyelocyte
The cytoplasm may be similar to the
above the main difference is in the
nucleus where there is slight
indentation (kidney shapped)

Band
Seen in the peripheral blood in
infections and inflammation. When a
large percent of these are present a left
shift term is used for neutrophil
maturation
Neutrophil
They are a phagocytic cell that is
particularly affective at fighting
bacterial infections. They are the first
responders to inflammation migrating
through the blood, blood vessels, into
interstitial tissue
Neutropenia: congenital, aplastic
anaemia, leukaemia, side effect of
medication that causes margination,
sepsis overwhelmed.
Eosinophil
Responsible for combating multicellular
parasites and certain infections. Along
with mast cells they are important and
associated with allergy and asthma.
Love acid and therefore take up eosin.
Their granules are histamine and
proteins.
Eosinophilia: parasitic infection,
collagen vascular disease (rheumatoid
arthritis), malignant disease (hodgkins
diseas), extensive skin disease,
addisons disease, penicillin. asthma
Basophil
Is stained by basic dyes and
functionally has a role in mediating
hypersensitivity reactions of the
immune system. They synthesis
histamine and modulate inflammatory
response. When IgE binds to the
receptors on a basophil the cell
releases histamine, serotonin and
leukotrienes. These constricting,
causing skin flush and hives.

Monocyte
Large mononuclear phagocytes. They
are the immature stage of a
macrophage.
Monocytes are increased in chronic
inflammatory disease, leukaemia,
parasitic infection, TB, and IM
Lymphoid series
Lymphoblast
These are commonly seen in ALL and
morphologically are classified into 3
subtypes.
The nuclei are round-oval with coarse
chromatin, aggregating into masses.
The nucleoliis small and inconspicuous.
The cytoplasm is very basophilice,
sparse in volume without granules
(never ever ever seen auer rods)
Prolymphocyte
In the lymphocytic series it is the
intermediate between the
lymphoblasts and the lymphocyte the
cytoplasm is less blue and the
chromatin is more condensed. However
there are prominent nucleoli still
visible.
Increased prolymphocytes are seen in
leukaemias such as CLL, ALL, PLL
The nucleus has coarser chromatin
structure than lymphoblast however its
chromatin is not clumped like a
lymphocyte, it may be granular.
Lymphocyte
Increased in: chronic bacterial
infections, infectious heapatitis. IM,
lymphocytic leukaemia. Multiple
myeloma, viral infection
Decreased in: chemo, HIV infection,
leukaemia, sepsis, steroid use
Chromatin is clumped and smudgey
Plasma Cell
Plasma cells vary from 8-20microns.
They have round eccentrically placed
nucleus with dense chromatin patterns.

The cytoplasm is basophilic with a perinuclear halo.

Neutrophil Changes
Toxic granulation
This appears as dark blue granules in
the cytoplasm of neutrophils. These
granules are thought to be primary
granules.

Vacuolation
Seen as a toxic change when a person
is infected with a bacterial infection.
This is a common feature of sepsis and
DIC
Dohle Bodies
Are light blue-grey oval basophilic
leukocyte inclusions that are located in
the peripheral cytoplasm of
neutrophils. They are most likely
remnants of rough ER and are seen in
toxic changes

Degranulation
The process of releasing antimicrobial
cytotoxic molecules/ granules into the
surroundings
Auer Rods
They are clumps of azurophilic granular
materal that form elongated needle like
structures in myeloid leukaemic blasts.

Hypersegmentation
Normally the neutrophils have 2-3
lobes however in the case of
hypersegmentatin there are 4-5 +
lobes, This is seen in megaloblastic
anaema, MDS and heavy metal
poisoning.

Pelger-Heut anomaly
The Neutrophils are segmented only
into two lobes and the nuclear
chromatin is condensed forming a large
clump. The lobs are round-oval and are
joined by a thin nuclear connection.
This is seen in the genetic condition
but a pseudo form is seen in MDS.
Intracellular organisms
Abnormal changes/forms in
Lymphoid cells
Hairy cell

Smear cell
Weak cell has smudged in the process
of film making. Seen in IM, leukaemia
and viruses.

Atypical cell
Large cells where the cytoplasm stains
darkly and the nucleus is eccentric.
Sometimes they look to have a nucleoi.
They are often seen scalloping RBC in
cases where the patient is infected with
IM
Reactive cells
Deep blue cells with high N:C ratio

Lymphoma cell

Large granular cell

Platelets
Thrombocytosis
This can be reactive due to surgery or
recent bleeding. It can also be seen in
MPN such as ET and PV

Thrombocytopenia
This can be seen in conjunction with
giant platelets. Need to look out for
dropping platelet counts in pregnant
women. But also can be seen in MDS
(with other cytopenia), viral infections,
DIC, etc
Giant Platelets
Seen when people are pushing out
platelets early due to low platelet
counts, or if there has been a recent
bleed and in some malignancies
Satellitism
This is seen due to EDTA artefact

Platelet clumping
EDTA artefact

Micro-megakaryocyte
They are seen in the blood in MDS