Section 5: WBC Variants

Question 1

What features do you look for when identifying toxic granulation?

Answer 1

Dark blue-purple granules in PMNs or bands that are finer, smaller, more numerous than basophils

Question 2

When do you typically see toxic granulation?

Answer 2

• Severe bacterial infection or toxicity
• Toxic vacuoles
• Dohle bodies
• Left shift of neutrophils

Question 3

What features do you look for when identifying toxic vacuoles?

Answer 3

Clear holes in cytoplasm of phagocytic cell (increase vacuolization)

Question 4

When do you typically see toxic vacuoles?

Answer 4

• Toxic granulation
• Dohle bodies
• Left shift of neutrophils

Question 5

What features do you look for when identifying Dohle bodies?

Answer 5

Pale blue translucent bodies of remnant RNA in granulocyte (more common) and monocyte cytoplasms

Question 6

When do you typically see Dohle bodies?

Answer 6

• Severe infections
• Tissue destruction
• With toxic granulation, toxic vacuoles, and WBC left shift

Question 7

What features do you look for when identifying hypersegmentation?

Answer 7

Segmented neutrophils with 6+ nuclear lobes. Cells are often larger than normal

Question 8

What features do you look for when identifying Pelger-Huet cells?

Answer 8

Hyposegmented PMNs

Question 9

What are the two categories of Pelger-Huet cells? Briefly define

Answer 9

1. Pince-nez: Two nuclear lobes that look like glasses
2. Stodtmeister: One nuclear lobe

Question 10

Why should you be careful when calling Pince-nez anomalies? What should you look for before calling them?

Answer 10

Normal PMNs have 2-5 lobes, so 2 lobes can be normal. Call Pince-nez if you see 0 granulocytes with more than 2 lobes and increased bands. If you see normal PMNs with many lobes, likely pseudo Pelger-Huet

Question 11

What features do you look for when identifying reactive lymphs?

Answer 11

• Distinctly blue cytoplasm
• Dark blue periphery (especially when attached to RBCs)
• Coarse nuclear chromatin
• Wandering appearance of cytoplasm

Question 12

Which diseases are reactive lymphs associated with?

Answer 12

Viral infections such has mono, hepatitis…etc

Question 13

What is a plasmacytoid lymph?

Answer 13

Activated B lymph

Question 14

What features do you look for when identifying plasmacytoid lymphs?

Answer 14

• Slightly larger
• Darker royal blue cytoplasm (key identifier!!!)
• Heavily clumped chromatin

Question 15

What are Barr Bodies?

Answer 15

Extra X chromosome expressed as miniature lobe that looks like a drumstick.

Question 16

What features do you look for when identifying Barr Bodies? Are they reported?

Answer 16

See a smaller lobe that protrudes from regular-sized PMN nuclear lobe. Typically not reported

Question 17

Who can demonstrate Barr bodies?

Answer 17

Females because XY
Males who are XXY or XXXY

Question 18

What features do you look for when identifying pyknotic cells? With which cell do you not want to confuse them with?

Answer 18

• Loss of chromatin pattern (the nucleus looks smooth purple with zero texture)
• Loss of filament that usually connects lobes
• Still contain violet-pink granules characteristic of PMNs
• Don’t confuse with nRBCs!

Question 19

What features do you look for when identifying smudge cells?

Answer 19

Only nucleus left. Cell membrane degraded

Question 20

What is septicemia?

Answer 20

When there’s bacteria in the blood. It is considered a critical value. Must report both intracellular and extracellular. Can be confused with stain precipitate

Question 21

Can you tell bacteria morphology and group forming behavior (diplo, chain, grape-cluster…etc) from Wright stain?

Answer 21

NO. May appear different from Gram-stain

Question 23

Identify the abnormal WBC depicted by the arrow

Answer 23

Smudge cell

Question 24

Identify the abnormal WBC depicted in the image

Answer 24

Pyknotic cell

Question 25

Identify the abnormal WBC depicted in the image

Answer 25

Barr body

Question 26

Identify the abnormal WBC depicted on the left side

Answer 26

Plasmacytoid cell (activated B lymph)

Question 27

Identify the abnormal WBC depicted in the image

Answer 27

Reactive lymph

Question 28

Identify the abnormal WBC depicted in the image

Answer 28

Pelger-Huet anomaly: Stodtmeister cell

Question 29

Identify the abnormal WBC depicted in the image

Answer 29

Pelger-Huet anomaly: Pince-nez cell

Question 30

Identify the abnormal WBC depicted in the image

Answer 30

Hypersegmentation

Question 31

Identify the abnormal WBC depicted in the image

Answer 31

Dohle body

Question 32

Identify the abnormal WBC depicted in the image

Answer 32

Toxic vacuoles

Question 33

Identify the abnormal WBC depicted in the image

Answer 33

Toxic granulation

Question 34

Identify the abnormal WBC depicted in the image

Answer 34

Septicemia