Nuclear and Cytoplasmic Changes in Leukocytes

Hyposegmentation of neutrophils

image
Figure 14.1A Hyposegmentation: peanut-shaped nucleus.
image
Figure 14.1B Hyposegmentation: bilobed nucleus.
image
Figure 14.1C Non-segmented nucleus.

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 those seen in myeloproliferative or myelodysplastic disorders (see Chapter 17, Myeloproliferative Neoplasms and Chapter 18 Myelodyspastic Syndromes.).

Hypersegmentation of neutrophils

image
Figure 14.2A Hypersegmented neutrophil.
image
Figure 14.2B Hypersegmented neutrophil.

DESCRIPTION: Six or more lobes in granulocyte nucleus

ASSOCIATED WITH: Megaloblastic anemias, chronic infections, myelodysplastic syndrome; rarely inherited

Vacuolation in Neutrophils

image
Figure 14.3A Vacuoles.
image
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: Vacuoles rarely may contain microorganisms or pigment. Vacuoles are seen in normal monocytes and do not suggest infection.

Döhle body

image
Figure 14.4A Döhle body (arrow).
image
Figure 14.4B Döhle body (arrow).

DESCRIPTION: Gray-blue, variably shaped inclusion in 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 14.5B.)

Blue-green inclusion

image
Figure 14.4C Blue-green inclusion of neutrophil (PB×1000). (Courtesy George Girgis, [CLS], IU Health.)
image
Figure 14.4D Blue-green inclusion of monocyte (PB×1000). (Courtesy George Girgis, [CLS], IU Health.)

DESCRIPTION: Amorphous blue-green granules in cytoplasm of neutrophils

COMPOSITION: Lipid-rich, possibly lipofusion-like material

NUMBER: Single or multiple

ASSOCIATED WITH: Severe liver disease, lactic acidosis, sepsis

NOTE: Also known as the blue-green crystals of death.

Toxic granulation

image
Figure 14.5A Toxic granulation.
image
Figure 14.5B Toxic granulation and Döhle body (arrow). Cytoplasm may retain blue color caused by cell’s early release from bone marrow.
image
Figure 14.5C Normal segmented neutrophil for comparison.

DESCRIPTION: Prominent dark purple-black granules in the 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 in Neutrophils

image
Figure 14.6A Hypogranulation.
image
Figure 14.6B Agranulation.
image
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

image
Figure 14.7A Reactive lymphocyte, vacuolated cytoplasm.
image
Figure 14.7B Reactive lymphocyte, peripheral basophilia.
image
Figure 14.7C Reactive lymphocyte, cytoplasm indented by adjacent cells.
image
Figure 14.7D Reactive lymphocyte, radial basophilia.
image
Figure 14.7E Reactive lymphocytes, characteristic of viral diseases, such as infectious mononucleosis (PB×500).

DESCRIPTION: 10 to 30 μm; pleomorphic; easily indented by surrounding cells

NUCLEUS: Irregular

Nucleoli: Occasionally present

Chromatin: When compared with that of a resting lymphocyte, chromatin is 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