reactive atypical abnormal morphology of neutrophils
TRANSCRIPT
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By Mojgan Talebian
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PMN, Segmented, Poly 50- 70% of differential count Size: 9-15 µm Nucleus: 30% of the cell size, segmented to 2-5
lobes connected by strands of nuclear membrane
Chromatin: very coarse, heavily clumped, dark purple to black
Parachromatin is distinct Cytoplasm: fine, indistinct, and plentiful,
occasional small vacuoles
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Band, Stab, staff cells
1-6% of leukocytes in the normal DIFF
Size: 10- 16 µm in diameter
Kidney bean-shaped Nucleus with nucleus
indentation
Cytoplasm with secondary granules,
neutrophilic granules, fine , and indistinct
Azurophilic granules, larger and more
distinct
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In neutrophils named drumsticks; distinguishing them from Barr bodies in other cells
In neutrophils of normal females; non-pathological Inactivated x chromosomes (lyonization) in cells with
more than one X chromosome
Abnormal Barr bodies:• In males• Absence of or multiple drumsticks in females,
indicative of genetic abnormality In females Turner’s syndrome (XO) In males Kleinfelter syndrome (XXY)
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Hypersegmentation of Neutrophils
Shift to the right, presence of more than normal
mature/degenerative and cells
Nuclei with 5 or more lobes
Result of disorders of cellular maturation:
• Megaloblastic anemia, neutrophils also increased in size
(macropolycytes)
• Myelodysplastic syndromes
• Severe infections, degeneration of the cells into necrobiotic forms
• Hypersegmented is applied to neutrophils, but it happens in
eosinophils and basophils
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Nuclei of neutrophils with less than 3 lobes:• Shift to the left, increased number of immature neutrophils• Inherited Pelger-Huet anomaly Most of the neutrophils are bi-lobed Benign
• Acquired pseudo Pelger-Huet anomaly: Pelgeroid cells in conditions such as: sepsis, myelodysplastic syndromes, myeloproliferative disorders, leukemias/lymphomas, AML/CML solid organ transplantation
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Apoptotic , necrobiotic, or pyknotic
Dying cells as a result of: accelerated
phagocytosis in infections, poisons, burns ,
heatstroke
Karyorrhexis (fragmentation) and
karyolysis (dissolution into a dense
pyknotic mass)
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Unstained cytoplasmic vacuoles
Empty phagocytic vesicles in neutrophils• Acute ethanol toxicity
• Acute infections
• Septicemia
• Burns
• Malignancies
• Long term antibiotic therapy
• Exposure to radiation
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Small, 1-3 µm It can be seen in Neutrophils or other WBCsDenatured aggregates of free ribosome or
rough endoplasmic reticulum containing RNACoexists with toxic granulationPresents in
• Burns• Infections • Surgery• Pregnancy• Chemotherapy• Inherited May Hegglin Anomaly (Döhle- like bodies)
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Presents in the late stage of neutrophils; band
and segmented
Few to many, coarse dark staining granules,
Associated with• Infections
• Burns
• Inflammation
• Malignancies
• Drug intoxication
• Hematopoietic cytokine therapy
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Decreased granulation of the cytoplasmPresents in neutrophil dysplasia,
• Myelodysplastic syndromes
• Acute myeloblastic leukemias
• Chronic infections(consumption of granules during the long term phagocytosis
• Megaloblastic anemia
• Inherited deficiencies of neutrophilic granules (rare)
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An inherited autosomal dominant disorder
Döhle- like inclusions in the cytoplasm of the
neutrophils;
Along with thrombocytopenia and giant platelets
in May-Hegglin seen in neutrophils and
monocytes, basophils and eosinophils
consist mainly of RNA derived from patches and
remnants of rough ER
MYH9 gene-related disorder
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Inherited (autosomal recessive) multi-system
disease
Large inclusion bodies
Originate from azurophil granules
Susceptibility to recurrent and severe infections
Dysfunctional leukocytes and platelets
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In all leukocytes including neutrophils
Related with Mucopolysaccharidoses; lack the
lysozymal enzymes necessary to break down
mucopolysaccharides
Accumulation of mucopolysaccharides in lysosomes
of cells
Dense azurophilic granules
WBC count is not elevated
In Lymphocytes: metachromatic granules
surrounded by a clear zone
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A very rare congenital immunodeficiency
disorder
Main features: susceptibility to human
papillomavirus (HPV)-induced warts,
hypogammaglobulinemia, bacterial
infections and myelokathexis • Myelokathexis (abnormal retention of mature
neutrophils in the bone marrow leading to severe
neutropenia)
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Mature neutrophils show cytoplasmic
vacuolization, nuclear hypersegmentation,
nuclear lobes separated by long strand of
chromatin
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http://www.wadsworth.org/chemheme/heme/microscope/pelgerhuet.htm (accessed Feb, 8, 2016)
S Deutsch, A Rideau. MYH9 mutation results. http://www.bloodjournal.org/content/102/2/529 (accessed 8 Feb 2016
T Kawai, H L. Malech. WHIM Syndrome: Congenital Immune Deficiency Disease.
V S Kanwar, R J Arceci,. May-Hegglin Anomaly. http://emedicine.medscape.com/article/956447-overview (accessed ).
E Regan. Mighty Max. http://www.mightymaxbannon.com/2015/07/the-problem-with-neutrophils-aka-all.html (accessed 8 Feb 2016