Nuclear and cytoplasmic changes in leukocytes

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 22/04/2025

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14 Nuclear and cytoplasmic changes in leukocytes

Hyposegmentation of neutrophils

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Figure 14–1A Hyposegmentation—peanut-shaped nucleus (PB ×1000).

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Figure 14–1B Hyposegmentation—bilobed nucleus (PB ×1000).

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Figure 14–1C Non-segmented nucleus (PB ×1000)

Description:

Peanut-shaped, bilobed or non-segmented, granulocyte nucleus with the coarse chromatin of a mature cell.

Associated with:

Pelger-Hüet anomaly, pseudo-Pelger-Hüet anomaly

Note:

Pelger-Hüet anomaly is inherited and affects the majority of granulocytes. Pseudo-Pelger–Hüet is acquired, affects less than 50% of granulocytes and is usually accompanied by other morphologic indications of malignancy such as seen in myeloproliferative or myelodysplastic disorders (see Chapters 17 and 18).

Hypersegmentation of neutrophils

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Figure 14–2A Hypersegmented neutrophil (PB ×1000).

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Figure 14–2B Hypersegmented neutrophil (PB ×1000).

Description:

Six or more lobes in granulocyte nucleus

Associated with:

Megaloblastic anemias; chronic infections; myelodysplastic syndrome; rarely inherited

Vacuolation

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Figure 14–3A Vacuoles.

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Figure 14–3B Vacuoles.

Description:

Unstained circular area within the cytoplasm.

Number:

Few to many

Associated with:

Bacterial or fungal infection, poisoning, burns, chemotherapy, artifact

Note:

Rarely may contain micro-organisms or pigment.

DÖHLE BODY

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Figure 14–4A Döhle body.

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Figure 14–4B Döhle body

Description:

Gray-blue, variably shaped

Location:

Cytoplasm

Composition:

Ribosomal RNA

Number:

Single or multiple

Associated with:

Wide range of conditions, including bacterial infection, sepsis and normal pregnancy

Note:

May be seen in cells with toxic granulation or on same slide with toxic granulation. (see Figure 14-5, B)

Toxic granulation

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Figure 14–5A Toxic granulation.

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Figure 14–5B Toxic granulation and Döhle body (arrow). Cytoplasm may retain blue color due to cell’s early release from bone marrow.

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Figure 14–5C Normal segmented neutrophil for comparison.

Description:

Prominent dark purple-black granules

Location:

Cytoplasm of neutrophils, unevenly distributed

Composition:

Primary granules

Number:

Few to many

Associated with:

Wide range of conditions including bacterial infection, sepsis and following administration of granulocyte colony-stimulating factor.

Hypogranulation/agranulation

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Figure 14–6A Hypogranulation.

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Figure 14–6B Agranulation.

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Figure 14–6C Normal segmented neutrophil for comparison.

Description:

Decreased number or absence of specific granules giving the cytoplasm a colorless appearance

Associated with:

Myelodysplastic syndrome, myeloproliferative neoplasms, infection

Reactive lymphocytes

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Figure 14–7A Reactive lymphocyte, vacuolated cytoplasm.

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Figure 14–7B Reactive lymphocyte, peripheral basophilia.

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Figure 14–7C Reactive lymphocyte, cytoplasm indented by adjacent cells.

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Figure 14–7D Reactive lymphocyte, radial basophilia.

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Figure 14–7E Reactive lymphocytes, characteristic of viral diseases, such as infectious mononucleosis (PB ×500).

Shape:

Pleomorphic; easily indented by surrounding cells

Size:

10-30 μm

Nucleus:

Irregular

Nucleoli:

Occasionally present

Chromatin:

When compared with that of a resting lymphocyte, chromatin coarse to fine and dispersed.

Cytoplasm:

Pale blue to deeply basophilic, may stain unevenly with peripheral or radial basophilia

Granules:

May have increased numbers of azurophilic granules

Vacuoles:

Occasional

Associated with:

Viral infections and other antigenic stimulation, including organ transplantation

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Figure 14–8A Monocyte. Note the blue-gray cytoplasm with fine red granules. Nucleus has brainlike convolutions. Cell “pushes away” surrounding cells. Vacuoles are present in both of these figures.

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Figure 14–8B Reactive lymphocyte. Note the blue cytoplasm with darker blue periphery. Cell is indented by surrounding cells. Nucleus is elongated. Vacuoles are present in both of these figures.

TABLE 14-1 Monocyte versus Reactive Lymphocyte

  Monocyte Reactive Lymphocyte
Shape Pleomorphic; may have pseudopodia, which tend to “push away” surrounding cells Pleomorphic, easily indented by surrounding cells
Size 12-20 μm 10-30 μm
Nucleus Round, oval, horseshoe, or kidney shaped, may have brainlike convolutions Irregular, elongated, stretched, occasionally round
Nucleoli Absent Occasionally present
Chromatin Loosely woven, lacy Variable; coarse to fine and dispersed
Cytoplasm Blue-gray Pale blue to deeply basophilic, may stain unevenly
Granules Many fine red—may give ground glass appearance May be a few prominent azurophilic granules
Vacuoles Absent to numerous Occasional

Use as many criteria as possible to identify cells. It is often difficult to differentiate cells in isolation; multiple fields should be examined for nuclear and cytoplasmic characteristics. Consider “the company they keep.”

All photomicrographs are ×1000 with Wright-Giemsa stain unless stated otherwise.

Related posts:

Variations in size and color of erythrocytes Introduction to peripheral blood smear examination Microorganisms Erythrocyte maturation Diseases affecting erythrocytes Variations in shape and distribution of erythrocytes