TYPE OF WBCS

Normal
Normal   HL in
Type AC Life span
RC (x109/L) (x109/L) blood
(x109/L)
Neutrophil 50-70% 2.7-7.5 >7 <2 7 hrs 2-3 days
>5 (adults) <1 (adults)
Lymphocyte 18-42% 1.0-3.2
>10 (children) <2 (children)
Monocyte 2-11% 0.1-1.3 >1 <0.2 3 days
18
Eosinophil 1-3% 0-0.3 >0.4 <0.09 2-5 days
hrs
Basophil 0-2% 0-0.2 >0.15 60 hours

GRANULOCYTES
Stage Granules Other comments
Myeloblast
Promyelocyte 1º granules (+) paranuclear hof
Myelocyte 2º granules (-) last stage with mitosis
(+) nuclear indentation
Metamyelocyte 3º granules
(Kidney-shaped nucleus)
Band/Stab neutrophil Secretory granules Sausage-shaped nucleus

JENNIE LIZA OCAMPO HEMATOLOGY: WBC

 Segmented neutrophil Secretory granules 3-5 lobes
LYMPHOCYTES
Type of Lymphocyte % Role in immunity
T cells 60-70% Cell-mediated immunity
B cells 10-20% Humoral-mediated immunity
NK cells 10-15% Destruction of tumor and virus-infected cells

CLUSTER OF DIFFERENTIATION
CD2 “E-rosette” receptor
CD3 T cell antigen receptor
CD4 Helper / Inducer T cell
CD5 / CD6 Early stages of T cell
CD8 Cytotoxic / Suppressor T cell
CD19 Part of B cell coreceptor
CD20 Found on all stages of B cell
CD21 Receptor for C3d and EBV
CD22 Mostly on mature B cells
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
 CD10 Early stages of B cells / CALLA
Stages of B cell maturation Stages of T cell maturation
1 Pro-B cell Double negative stage
2 Pre-B cell Double positive stage
3 Immature B cell Mature T cell
4 Mature B cell Activated T cell
5 Activated B cell
6 Plasma cell

MONOCYTES
Nomenclature of Macrophages
Kupffer cells Liver
Alveolar macrophage / Dust cells Lungs
Microglial cells Brain / Nervous tissue
Histocytes Connective tissue
Langerhans cells Skin / Mucosa
Splenic macrophage Spleen
Littoral cells Lymph nodes
Hofbauer cells Placenta
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
 Osteoclasts Bones
Mesangial cells Kidneys
NON-MALIGNANT WBC DISORDERS
Disorder Comments
Severe combined  X-linked (gamma chain deficiency)
immunodeficiency  Acquired (ADA deficiency)
 WAS gene mutation
Wiskott-Aldrich syndrome
 : T cells, platelets
 Includes DiGeorge syndrome, Opitz GBBB,
22Q11 deletion syndrome Sedlackova syndrome
 : T cells, size of thymus (congenital thymus aplasia)
 X-linked agammaglobulinemia
Bruton tyrosine kinase deficiency
 : B cells, serum Ig
 LARGE LYSOSOMES
Chediak Higashi syndrome
 Dysfunctional granules
Leukocyte adhesion disorder  Defective chemotaxis
 Neutrophils can phagocytize but can’t digest
Chronic granulomatous disease
 (-) NBT test
WHIM syndrome  Includes Warts, Hypogammaglobulinemia, Infections,
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
 and Myelokathexis syndrome

MORPHOLOGIC ABNORMALITIES OF WBC

Disorder Comments
 “Pince-nez” morphology
Pelger-Huet Anomaly
 Normal neutrophil function, abnormal morphology
Hypersegmentation of
 Associated with megaloblastic anemia and MDS
neutrophils
 Reilly bodies
Alder-Reilly Anomaly  Mucopolysaccharidoses (Hurler sydrome, Hunter
syndrome, Sanfilippo syndrome)
 Reddish purple, (+) peroxidase
Auer Rods  Faggot cells = bundle of Auer rods
 Present in AML (APL)
 TRIAD: Dohle-like bodies, thrombocytopenia, GIANT
May-Hegglin Anomaly
PLATELETS
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
 LYMPHOCYTE ABNORMAL MORPHOLOGIC CHANGES
Comments
Downey cell / Turk cell  Cytoplasm indented by surrounding RBCs
 Caused by nuclear fragility during smear prep with
Basket cell / Smudge cell increased pressure
 Seen in CLL
 Irregular cytoplasmic projections
Flame cell
 Has more Ig than normal; seen in MM
Grape cell / Russel bodies  Plasma cell with round globules
 Cerebriform “brain-like” nucleus
Sezary cell
 Seen in Sezary syndrome and Mycoses fungoides

JENNIE LIZA OCAMPO HEMATOLOGY: WBC

 NEUTROPHIL ABNORMAL MORPHOLOGIC CHANGES
Comments
 Acid mucosubstance inside 1º granules
Toxic granulation
 Seen in reactive conditions
 Pale blue remnants of RNA or free ribosomes
Dohle bodies
 Seen in bacterial infections, burns, pregnancy

LYSOSOMAL LIPID STORAGE DISEASES

Comments
 ß-glucocerebrosidase deficiency
Gaucher disease  (+) PAS stain
 Striated cytoplasm (“onion-like”)
 Sphingomyelinase deficiency
Niemann-Pick disease
 BM contains foam cells and sea blue histocytes
Tay Sach’s disease  Hexosaminidase A deficiency
Sand Hoff’s disease  Hexosaminidase A and B deficiency
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
 LEUKEMIA

JENNIE LIZA OCAMPO HEMATOLOGY: WBC

 LEUKEMIA

MYELOID LYMPHOID

Myeloproliferative Acute Myeloid Myelodysplastic Acute Lymphoid

Chronic Lymphoid
Syndrome Leukemia (AML) Syndrome Leukemia (ALL)

Chronic Myelogenous Non-Hodgkin

Hodgkin's Lymphoma
Leukemia (CML) Lymphoma

Mature B Cell Mature T Cell Plasma Cell

Polycythemia vera Classic HL
Neoplasma Lymphoma Neoplasms
(PV)
Chronic Lymphocytic Monoclonal Lymphocyte-
Essential Mycosis Fungoides
Leukemia (CLL) Gammopathy of Predominant HL
Thrombocythemia Undertermined
(ET) Significance (MGUS)
Hairy Cell Leukemia Sezary Syndrome
Primary Myelofibrosis
(PMF) Plasma Cell Myeloma /
Burkitt Lymphoma Multiple Myeloma
(MM)

Mantle Cell Waldenstrom's

Lymphoma Macroglobulinemia

Diffused Large B-cell

Lymphoma

ACUTE LEUKEMIA

JENNIE LIZA OCAMPO HEMATOLOGY: WBC

  Adult leukemia
Acute Myeloid Leukemia (AML)
 WBC ct.: 1-200 x 109/L
Acute Lymphocytic Leukemia (ALL)  Childhood leukemia
MYELOPROLIFERATIVE NEOPLASMS
 Philadelphia chromosome (t9:22)
 Formation of BCR-ABL1 gene
Chronic Myelogenous Leukemia
 : mature granulocytes
 : LAP score
 : Hgb, Hct
 Absolute:  red cell mass
Polycythemia Vera  Relative: normal red cell mass
 Primary absolute PV:  EPO
 Secondary absolute PV:  EPO
 Increased megakaryopoiesis and
Essential Thrombocythemia
thrombocytosis
 Panmyelosis, collagen overproduction
Primary Myelofibrosis
 Presence of dacryocytes
 Progressive cytopenia, dyserythropoiesis,
Myelodysplastic syndrome
dysmyelopoiesis, dysmegakaryopoiesis
LYMPHOPROLIFERATIVE DISORDERS
JENNIE LIZA OCAMPO HEMATOLOGY: WBC
  Soccer ball appearance
Chronic Lymphocytic Leukemia
 Presence of smudge cell
 Hairy projections
Hairy Cell Leukemia
 (+) TRAP stain
Burkitt Lymphoma  Starry sky appearance
Mantle Cell Lymphoma
Diffuse Large B-cell Lymphoma
Mycosis Fungoides  Presence of Sezary cell
Sezary syndrome  Sezary cell >1x109/L
Plasma Cell Neoplasms
MGUS  Absence of end organ damage
 Bence Jones protein in urine
Plasma Cell Myeloma
 Presence of flame cells
Waldenstrom’s Macroglobulinemia  : IgM, viscosity
Classic Hodgkin’s Lymphoma  Presence of Reed-Sternberg cells
Lymphocyte-Predominant HL  Presence of popcorn cells

JENNIE LIZA OCAMPO HEMATOLOGY: WBC

 FAB Classification of AML Comments
M0 AML, minimally differentiated (-) MPO, SBB
No Auer rods
M1 AML, without maturation (+) MPO, SBB
M2 AML with maturation With Auer rods
Assoc. with DIC
M3 Acute Promyelocytic Leukemia (APL) (+) Faggot cells
M4 Acute Myelomonocytic Leukemia Naegeli Leukemia
Acute Myelomonocytic Leukemia with
M5Eo
Eosinophilia
Acute Monocytic Leukemia,
M5a Schilling’s Leukemia
poorly differentiated
Acute Monocytic Leukemia,
M5b
well differentiated
Di Guglielmo’s syndrome
M6 Acute Erythroleukemia With erythroid precursors: (+) PAS
M7 Acute Megakaryocytic Leukemia With megakaryocytes

JENNIE LIZA OCAMPO HEMATOLOGY: WBC

 FAB Classification of ALL
L1 L2 L3
Cell size Small Large Large
Chromatin Homogenous Heterogenous Homogenous
Nuclear shape Regular Irregular Regular
Nucleoli Rare Present Prominent
Cytoplasm Scanty Moderate Moderate, deeply basophilic
Leukemic phase of Burkitt’s
Occurrence CHILDREN ADULT
lymphoma

 CYTOCHEMICAL STAINS FOR AML AND ALL

AML ALL
MPO
Sudan black B Positive Negative
Naphthol AS-D CAE
TdT
Negative Positive
PAS

JENNIE LIZA OCAMPO HEMATOLOGY: WBC