WBC DISORDERS

Abnormalities in WBC Morphology:

Nuclear Abnormalities

1. Pelger-huet Anomaly: non-sex linked dominant trait; failure of nucleus of neutrophils to

segment or lobulated so that cells may appear bilobed or band forms.
a. Seen in blood disease such as chronic myelocytic leukemia, acute leukemia,
agranulocytosis, infectious mononucleosis, etc.
2. Hypersegmentation (Hypersegmented Neutrophils) :
a. Known as macropolycytes & P.A. Poly cell.
b. Usually larger than normal neutrophil
c. Usually present in pernicious anemia
3. Barr Body :
a. Sex chromatin of somatic cells in females.
b. Biconcave chromatin mass measuring about 1-1.5 u in width and 1.5-2 u in length
closely applied to the inside of the nuclear membrane

Abnormalities in Granules

1. Alder-Reilly granules
a. Inherited as recessive trait
b. Presence of larger than normal coarse, dark azurophilic granules in the cytoplasm of
granulocytes as well as of lymphocytes and monocytes and bone marrow precursor cells
that cover the nucleus.
2. Auer Rods
a. Rod-like bodies w/c stain reddish purple in the cytoplasm of monoblasts and
myeloblasts in acute monocytic or acute myelocytic leukemia.
3. Czediak (chedial ?)- Higashi granules (syndrome);
a. Usually familial
b. Neutrophils show large Peroxidase (+), Sudan Black B(+), acid phosphatase (+) inclusions
that vary in size and color (blue to red) and somewhat resemble Dohle-bodies
4. Dohle Amato bodies/ Dohle bodies:
a. In neutrophils as irregular, round or oval, blue staining cytoplasmic inclusions that vary
from the size of cocci to about 2 u in diameter
b. In severe infections, severe burns, exposure to cytotoxic agents & in other toxic states
but they disappear as the infection subsides.
5. Toxic Granules: cell cytoplasm may contain large basophilic dark-staining granules different from
abnormal granules of Alder’s anomaly and Czediak-Higashi syndrome and from artifacts
produced by poor staining.
Abnormalities in Function:

1. Job Syndrome:
2. Lazy leukocyte syndrome: characterized by neutropenia
a. Poor neutrophilic response to chemotactic agents
3. CGD ( Chronic granulomatous disease): have neutrophils unable to produce superoxides &
reactive oxygen
a. Tests: chemiluminescence & nitroblue tetrazolium Test

Cell exhibiting Phagocytosis

1. L.E Cell (lupus erythematous)

a. phagocytic WBC that has ingested an altered, homogeneous globular nuclear mass of a
destroyed cell.
b. Nucleus of phagocyte is compressed to one side, appearance is distorted,
2. Tart Cell:
a. Monocyte w/ engulfed nucleus of another cell
b. Ingested nucleus retains its characteristic nuclear structure such as chromatin clumps
c. Seen in drug sensitivity

Abnormal Lymphocyte

1. Downey Classification (Type I, II, III)

a. Transformed, stimulated/ atypical lymphocyte
b. Cytoplasm stains heavily red with pyronine, a red basic dye staining RnA so they are also
called pyroninophilic cells.
c. Type I: Turk’s Irritation Cell / Plasmacytoid
d. Type II: E Barr virus, Epstein virus, infectious mononucleosis
i. Target cell: B-cell
ii. Ballerina skirt appearance
e. Type III: vacuolated, swiss cheese/moth eaten appearance
i. Target cell: B-cell
2. Infectious mononucleosis
a. CA: EBV
b. Affected cell: B Cell
3. Basket case/ Smudge cell: ruptured WBC w/ bare nucleus. Nucleus goes out of ruptured cell.
a. Large no. seen in leukemia & presence may indicate increased fragility of the cells or
abnormal destruction of cells.
4. Hair Cell (MAC or Malignancy Associated Changes)
a. 80% of patients w/ cancer
b. In granulocytes as thin, threadlike, pointed excrescences arising from the nucleus.
c. In monocytes as small (1 u) inclusions surrounded by halos w/in cytoplasm
5. Sezary Cell
 a. Abnormal WBCs w/ a characteristic cerebriform nucleus
b. Seen in Mycosis Fungoides

Abnormalities in Plasma Cell

1. Flame Cell (Thesaurocyte) : plasma cell that is abnormal w/ intensely eosinophilic cytoplasm
a. Seen in IgA myelomas & waldenstom’s macroglobulinemia
b. Found in multiple myeloma
2. Russell Bodies:
3. Grape cell/Berry cell (morula/ mott cell) : abnormal plasma cell where cytoplasm is filled w/
Russell bodies
4. Dutcher’s bodies

Abnormalities in Monocyte/ Macrophage/ Histiocyes:

Lipid storage diseases

1. Gaucher’s Diseases : most common lipidosis

a. Defect of glucocerebrosidase
b. Gaucher’s cell: abnormal macrophage w small, eccentric nucleus found in BM.
c. Cytoplasm: crumpled tissue paper/ onion skin.
2. Niemann –Pick disease : deficiency of acid sphingomyelinase
a. Foam cells (pick cells) : abnormal macrophages in bone marrow whose cytoplasm is
swollen by many small lipid droplets.
3. Tay-sach’s :
4. Sand Hoff
5. Sea Blue histocytosis

N.b: other things to study : Hemoglobinopathies, RBC abnormalities read, etc…