By Mojgan Talebian

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

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

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)

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

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

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)

Unstained cytoplasmic vacuoles

Empty phagocytic vesicles in neutrophils• Acute ethanol toxicity

• Acute infections

• Septicemia

• Burns

• Malignancies

• Long term antibiotic therapy

• Exposure to radiation

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)

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

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)

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

Inherited (autosomal recessive) multi-system

disease

Large inclusion bodies

Originate from azurophil granules

Susceptibility to recurrent and severe infections

Dysfunctional leukocytes and platelets

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

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)

Mature neutrophils show cytoplasmic

vacuolization, nuclear hypersegmentation,

nuclear lobes separated by long strand of

chromatin

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