Color Plates
Cell Drawings by Dorothy Sturm Photomicrographs by Ann Bell
Smears were given for photomicrographs by the following individuals and institutions: Dr. Luther Burkett Dr. Marion Dugdale Mrs. Janie Gardner, MS, H(ASCP) Ms. Rachel Lehman, MT(ASCP) Dr. Alvin Mauer Mrs. Ioye Thomas, MT(ASCP) Dr. Frank White Centers for Disease Control, Atlanta, GA LeBonheur Children's Medical Center, Memphis, TN St. Jude Children's Research Hospital, Memphis, TN Regional Medical Center, Memphis, TN
Note: The photomicrographs are from the University of Tennessee Division of Hematology teaching file, which was started more than twenty-five years ago. Stains and staining techniques have changed during this period of time and, hence, cell colors may vary and drawing paper used by the artist has darkened.
38
Plate 1. Myelocytic (Granulocytic) System
1A. Myeloblast
1B. Promyelocyte (Progranulocyte)
1C. Basophilic myelocyte
1K. Eosinophilic myelocyte
1D. Basophilic metamyelocyte
1H. Neutrophilic metamyelocyte
1E. Basophilic band
11. Neutrophilic band
~1F. Basophilic segmented
1J. Neutrophilic segmented
1L. Eosinophilic metamyelocyte
1N. Eosinophilic segmented
39
Plate 2. Myelocytic Cells-Normal
2A.
Bone Marrow
2B.
2C.
2E.
2D.
Plate 2. 1. Myeloblast, 2. Promyelocyte, 3. N. Myelocyte, 4. N. Metamyelocyte, 5. N. Band, 6. N. segmented, 7. Eosinophil, 8. Monocyte, 9 Polychromatophilic erythroblast, 10. Orthochromatic erythroblast, 11. Neutrophil-questionable stage
2F. Basophil
2G. Eosinophilic myelocyte
2H. Myeloblast
21. Promyelocyte
Plate 3. Myelocytic Cells-Normal
Bone Marrow
3A.
3C.
3B.
3E.
3D.
3F.
3G.
6 3
3H.
31.
:lJate3.1. Myeloblast, 2. Promyelocyte, 3. N. Myelocyte, 4. N. Metamyelocyte, 5. N. band, 6. N. segmented, 7. Eosinophilic metamyelocyte, 8. Basophil, 3. Monocyte, 10. Polychromatophilic erythroblast, 11. Orthochromatic erythroblast, 12. Lymphocyte, 13. Plasma cell, 14. Smudge
4
Plate 4. Cell Types Found on Blood Smears from Normal Individuals
~
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(
4A. Erythrocytes 4B. Large lymphocyte with purplish-red (azurophil) granules and deeply indented by adjacent erythrocytes 4C. Neutrophilic segmented 40. Eosinophilic segmented 4E. Neutrophilic segmented
4F. Monocyte with gray blue cytoplasm, coarse linear chromatin, blunt pseudopods 4G. Platelets (thrombocytes) 4H. Lymphocyte 41. Neutrophilic band 4J. Basophil
The arrangement is arbitrary and the number of leukocytes in relation to erythrocytes and thrombocytes is greater than would occur in an actual microscopic field.
42
Plate 5. Lymphocytes
~'
5A. Small lymphocyte
5C, Lymphocyte with indented nucleus
58, Lymphocyte of intermediate size
r1;'", A ,
-s= 50, Lymphocyte of intermediate size
5E, Lymphocyte with pointed cytoplasmic projections (frayed cytoplasm)
5F, Spindle-shaped lymphocyte with indented nucleus
..•
: -,
5G, Large lymphocyte with indented nucleus and pointed cytoplasmic projections
5H, Large lymphocyte
51. Large lymphocyte with purplish-red (azurophilic) granules
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5J, Large lymphocyte with irregular cytoplasmic contours
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5K, Large lymphocyte with purplish-red (azurophilic) granules and with indentations caused by pressure of erythrocytes
5L, Large lymphocyte with purplish-red (azurophilic) granules
Plate 6. Lymphocytes from Normal Blood Smears
6B. Small lymphocyte; large Iymphbcyte with azurophilic granules
6A. Small lymphocyte; large lymphocyte with holly-leaf edges
6e. Lymphocyte, large
6F. Lymphocyte, intermediate size; small lymphocyte
6H. Lymphocyte with azurophilic granules; N. segmented
6E. Large lymphocyte
60. Lymphocyte with azurophilic granules
6G. Large lymphocyte with indented nucleus, azurophilic granules; lymphocyte
61. Large lymphocyte with azurophilic granules; N. segmented
(Azurophilic granules in lymphocytes are usually countable)
Plate 7. Monocytes
7A. Monocyte with "ground-glass" appearance, evenly distributed fine granules, occasional azurophilic granules, and vacuoles in cytoplasm
7B. Monocyte with blue granular cytoplasm, lobulation of nucleus with linear chromatin
7C. Monocyte with prominent granules and deeply indented nucleus
7D. Monocyte without nuclear indentations
7E. Monocyte with gray-blue cytoplasm, band type of nucleus, linear chromatin, blunt pseudopods, and fine granules
7F. Monocyte with gray-blue cytoplasm, blunt pseudopods, and multilobulated nucleus
7G. Monocyte with segmentedtype nucleus
7H. Monocyte with multiple blunt nongranular pseudopods, nuclear indentations, and folds
71. Monocyte with vacuoles, nongranular ectoplasm, and granular endoplasm
45
Plate 8. Monocytes from Normal Blood Smears
"\
8A. Monocyte; N. segmented
8B. Monoeytes
\..
80. Monoeytes
8E. Monocyte with phagocytized RBC
8G. Monocyte; lymphocyte
8H. N. segmented; monocyte
8G. Monocyte; N. segmented
8F. Monocytes
81. Monocyte (top); lymphocyte with azure granules
Plate 9. Comparative Morphology: Early Neutrophils, Monocytes, lymphocytes
9A. N. myelocyte with mixture of neutrophilic and dark reddish-purple granules
98. Monocyte with nuclear fold
9C. Large lymphocyte with scalloped shape and absence of folds in nucleus
9D. N. metamyelocyte with light-pink cytoplasmic color and neutrophilic granules
9E. Monocyte with gray-blue cytoplasm, prominent granules, brain-like convolutions in nucleus and linear chromatin strands
9F. Large lymphocyte with nongranular cytoplasm
9G. N. myelocyte
9H. Typical monocyte with lobulated nucleus, gray-blue granular cytoplasm, and blunt pseudopods
91. Large lymphocyte with purplish-red (azurophilic) granules and lumpy nuclear structure
47
••• Plate 10. Lymphocytic, Monocytic, Plasmacytic Systems
10A. Lymphoblast
100. Prolymphocyte
10G. Lymphocyte with clumped chromatin
48
10B. Monoblast
10E. Promonocyte
10H. Monocyte
10C. Plasmablast
10F. Proplasmacyte
101. Plasmacyte
Plate 11. Erythroblastic System
c 11A. 11 B. 11 C. 11 D.
Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthochromatic erythroblast
F
11 E. Polychromatophilic erythrocyte 11 F. Erythrocyte
Erythroblasts in Normal Bone Marrow
11 G. Proerythroblasts (2), N. segmented, N. myelocyte, N. metamyelocyte, orthochromatic erythroblast
111. Basophilic erythroblasts
11 K. Lymphocyte, orthochromatic erythroblast, basophilic erythroblast
11 H. Proerythroblasts (2), polychromatophilic and orthochromatic erythroblasts, N. band, N. segmented, and smudge
11;1. Polychromatophilic (4) and basophilic erythroblasts
11L. Basophilic (center), polychromatophilic, and orthochromatic erythroblasts; smudge
11M. Orthochromatic erythroblast, lymphocyte (right)
49
Plate 12. Comparative Morphology: Plasmacytes, Lymphocytes, Nucleated Red Cells
F
12A. Plasmacyte with intense-blue cytoplasm, eccentric nucleus, clear zone, vacuoles, irregular shape (marrow) 12B. Plasmacyte with foamy and fibrillar reddish-blue cytoplasm (marrow) 12C. Lymphocyte with slightly indented nucleus, unevenly stained bluish cytoplasm
120. Lymphocyte with foamy cytoplasm and frayed (hair-like margins 12E. Basophilic erythroblast with reddish-blue cytoplasm (marrow) 12F. Polychromatophilic erythroblast with reddish cytoplasm (marrow)
Plasma Cell, Lymphocytes, Immature Nucleated Red Cells from Bone Marrow and Blood Smears
12G. Plasma cell (marrow)
50
12H. Lymphocyte; large lymphocyte (blood)
121. Polychromatophilic erythroblasts with reddish cytoplasm in rneqalnblasf anemia (marrow)
Plate 13. Plasma Cell Variants on Bone Marrow Smears
13A. Plasma cell with globular bodies (Matt cell) 13B. Plasma cell with globular bodies (Matt cell)
••
•
'\
13C. Plasma cell showing reticular cytoplasmic structure
13E. Plasma cell with red cytoplasmic border
13G. Plasma cell with globular bodies (Matt cell)
130. Plasma cell with globular bodies in nucleus, reticular cytoplasmic structure, shaggy margins, and red secretions
13F. Plasma cell with "flame" red cytoplasm and two nuclei
13H. Plasma cells with globular bodies (Mott cells)
51
Plate 14. Megakaryocytic System
A
B
c
lb·· •
E 14A. Magakaryoblast with single oval nucleus, nucleoli, and bluish foamy marginal cytoplasmic blebs 14B. Promegakaryocyte with two nuclei, granular blue cytoplasm, and marginal bubbly cytoplasmic blebs 14C. Megakaryocyte with lobulated nucleus, granular cytoplasm, and without platelets
52
F
14D. Megakaryocyte with lobulated nucleus and platelets 14E. Megakaryocytic nucleus with attached platelets 14F. Platelets
Plate 15. Megakaryocytes on Normal Bone Marrow Smears
- -A. Megakaryoblast
15D. Promegakaryocyte
15G. Granular megakaryocytes without platelets
158. Megakaryoblast
15E. Megakaryocyte with lobulated nucleus, granular cytoplasm surrounded by vacuoles, and no platelets
15H. Megakaryocyte with lobulated nucleus and platelets
15C. Promegakaryocyte
15F. Granular megakaryocytes without platelets
151. Megakaryocyte with lobulated nucleus and platelets
53
Plate 16. Macrophages on Bone Marrow Smears
•
16B. Macrophage with phagocytized erythrocytes and dark-staining particles
16A. Macrophage with reticular cytoplasm, vacuoles, and phagocytized particles
.•.
16C. Macrophage with phagocy1ized hemosiderin in cytoplasm
160. Macrophage with phagocytized particles and vacuoles
16E. Macrophage with vacuoles and phagocytized malarial pigment
Plate 17. Macrophages on Bone Marrow Smears
17A. Macrophage with engulfed neutrophil; macrophage with hemosiderin
178, Macrophage with engulfed red cells
17C, Macrophage with pigment
17D, Macrophage with blue pigment
17E, Macrophages with cystine crystals
17F, Plasmacytes around macrophage
17G, Late erythroblasts around macrophage
Plate 18. Early Eosinophils and Mast Cells on Bone Marrow Smears
56
18A. Early eosinophil with nucleoli and tapering cytoplasmic extensions (formerly called tissue eosinophil)
18B. Mast cell (formerly called tissue basophil)
18C. Eosinophilic myelocyte with cytoplasmic extensions
180. Eosinophilic metamyelocyte
18E. Mast cell
18F. Mast cell
18G. Mast cell
18H. Mast cell
Plate 19. Fat Cells on Bone Marrow Smears
19A. Fat cell with small round nucleus, linear chromatin, globular body in nucleus, ample cytoplasm with lipoid globules, wrinkled membrane, reticular stroma, fibrillar marginal structures, and erythrocytes.
198. Fat cell showing cytoplasmic lipoid bodies separated by reticular structures. Mature erythrocytes surround fat cell.
19C. Fat cell
190. Fat cell
19E. Fat cell
19F. Fat cell
Plate 20. Osteoblasts and Osteoclast on Bone Marrow Smears
20A. Osteoblast with prominent light zone in cytoplasm located away from nucleus
20C. Osteoclast: Large multinucleated cell with uneven number of separated oval nuclei with nucleoli, blue granules, and frayed cytoplasmic margins
58
20B. Osteoblast with oval eccentric nucleus, distinct linear chromatin and nucleolus, blue bubbly cytoplasm with prominent light zone adjacent to nucleus, and fibrillar marginal structures
Plate 21. Osteoblasts and Osteoclasts on Bone Marrow Smears
A
!-
G 21 B. Osteoblasts
21 D. Aggregate of osteoblasts
21F. Osteoclast
21 C. Osteoblasts
21 E. Osteoclast
21G. Osteoclasts
21 H. Osteoclast
Plate 22. Endothelial Cells
22A. Endothelial cells
22B. Endothelial cell
22C. Endothelial cells
22D. Endothelial cells
22E. Endothelial cell
22F. Endothelial cells
Plate 23. Shapes of Red Cells
Normal
Crenated
Target
Spherocyte
Burr (echinocyte)
Oat (sickle cell)
Sickled
SC crystal
CC crystal
Elliptocyte (ovalocyte)
Stomatocyte
Folded cell
Marginal achromia (blister)
Helmet
Pinched
Teardrop, pear, pointed
filamented
Triangular
Poikilospherocyte (small, dark, irregular)
Acanthocyte (thorn, spur, spiculated)
Small fragments
,
"Schistocyte" refers to helmet. triangular, and small fragments.
Membranous ghost
Crescent (Semilunar)
Plate 24. Erythrocyte Morphology on Blood Smears in Nutritional Anemias
24A. Iran deficiency anemia
240. Iron deficiency anemia: (red cells: microcytic and smaller than nucleus of a small lymphocyte; hypochromic)
24C. Megaloblastic anemia
24B. Normal erythrocytes
24E. Normal erythrocytes
~ ~
24F. Megaloblastic anemia: (red cells: large and oval; two teardrop cells); hyperlobulated N. segmented
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~
0
, •
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24G. Iron deficiency anemia after transfusion (two populations of red cells)
24H. Iron deficiency anemia after iron therapy (two populations of red cells)
241. Megaloblastic anemia (red cells: oval and larger than nucleus of small lymphocyte; two teardrop cells)
Plate 25, Part 1. Erythrocyte Morphology on Blood Smears in Microangiopathic Hemolytic Anemias
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25A. Thrombotic thrombocytopenic purpura (TTP)
==
"TTP
25B. Chronic nephritis with hypertension
25E. Chronic nephritis with hypertension
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::::'0.TTP
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25H. Chronic nephritis with hypertension
25C. Sickle cell anemia with schistocytes in some cases of pulmonary embolism
25F Sickle cell anemia with schistocytes in some cases of pulmonary embolism
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251. Sickle cell anemia with schistocytes in some cases of pulmonary embolism
Plate 25, Part 2. Erythrocyte Morphology on Blood Smears in Microangiopathic Hemolytic Anemia Due to Heart Valve Dysfunction
Patient 1
r
-
Patient 3
Patient 4
Patient 2
Patient 1
Patient 3
Patient 5
Patient 5
Morphology in five patients
64
Plate 26. Anemias with Abnormal Erythrocyte Morphology on Blood Smears
26A. Spur cell anemia
268. Erythrocytes in paroxysmal nocturnal hemoglobinuria
26C. Microangiopathic hemolytic anemia following liver transplant
26D. Erythrocytes in Hemoglobin Zurich after sulfonamides
26E. Erythrocytes in G-6-PD deficiency
26F. Echinocytes (burr cells) in pyruvate kinase deficiency
26G. Hemolytic anemia (bite cells) after dapsone
26H. Hemolytic anemia (spherocytes) due to bite of Loxosceles reclusa
261. Spherocytic anemia due to Clostridium perfringens
Plate 27. Erythrocyte Morphology on Blood Smears in Sickle Cell Anemia, Sickle Cell-Hemoglobin C, Hemoglobin CC
~
,.
I i.·)/. 27A. Sickle cell anemia (Hb SS)
270. Hemoglobin SS
27G. Hemoglobin SS
6
27B. Sickle cell-hemoglobin C (Hb SC)
27E. Hemoglobin SC
27C. Hemoglobin CC (Hb CC)
27F. Hemoglobin CC
271. Hemoglobin CC after splenectomy
Plate 28. Moist Unstained Preparations of Blood from Patients with Sickle Cell Trait and Sickle Cell Anemia
28A. Moist unstained preparation of blood from a patient with sickle cell trait showing reversible elongated multipointed red cells
28C. 28B and 28C. Moist unstained preparations of drop of blood from patient with sickle cell anemia mixed with drop of sodium metabisulfite solution showing irreversible elongated sickle cells and a few multipointed erythrocytes
67
Plate 29. Erythrocyte Morphology on Blood Smears in Hereditary Spherocytosis, Hereditary Elliptocytosis, and Thalassemia Major
•
•• ••• • •
-. ~
29A. Hereditary spherocytosis
-
290. Hereditary spherocytosis
29G. Hereditary spherocytosis
298. Hereditary elliptocytosis
29E. Hereditary elliptocytosis
••
29H. Hereditary elliptocytosis with hemolytic anemia
29C. Thalassemia maj r (Cooley's anemia)
29F. Thalassemia major (Cooley's _ late erythroblast, Howell-Jolly body
291. Thalassemia major (Cooley's E.-orthochromatic erythroblasts (4), Howell-Jolly body
Plate 30. Erythrocyte Morphology on Blood Smears from Patients with Thalassemia Minor
-- ....•
:--:-aJassemia minor
30B. ~+-thalassemia minor-Fetal Hb 4.2%
30C. ~+-thalassemia minor: target cell with stippling (arrow)
~--ihalassemia minor
30E. ~+-thalassemia minor-Fetal Hb 4.2%
30F. ~+-thalassemia minor
30H. Hemoglobin E-~O-thalassemia
301. alpha-thalassemia 1
3:3. ~+-thalassemia minor
Plate 31. Erythrocyte Morphology on Blood Smears from Patients with Burns, Hereditary Pyropoikilocytosis, and Myelofibrosis
31A. Erythrocytes in severely burnedpatient
31D. Severely burned patient
31G. Severely burned patient
31B. Hereditary pyropoikilocytosis
31E. Hereditary pyropoikilocytosis before incubation of blood
31H. Hereditary pyropoikilocytosis after 60 minutes at 45° C Incubation
31C. Myelofibrosis
31F. Myelofibrosis
Plate 32. Stippled Erythrocytes, Polychromatophilic Erythrocytes, and Reticulocytes
32A. Selected stippled erythrocytes in a Wright-stained blood smear from a patient with lead poisoning
32C. Selected reticulocytes containing granulofilamentous structures in a smear from blood mixed with new methylene blue stain. Polychromatophilic red cells and stippled cells stain as reticulocytes in this preparation
328. Selected polychromatophilic erythrocytes in a blood smear, Wright stain
I ,/ ,/ ,/ 320. Stippled cells in Wright-stained smear from lead poisoning
32E. Polychromatophilic erythrocytes (arrows) in a Wright-stained smear of thrombotic thrombocytopenic purpura
32F. Reticulocytes increased in a new methylene blue preparation of blood from sickle cell-thalassemia (Sturm)
• ..-... 32G. Stippled red blood cell; lymphocyte
•
32H. Polychromatophilic erythrocytes (arrows) in a Wright-stained smear of hemolytic anemia
• 321. Reticulocytes increased in hemolytic anemia
Plate 33. Erythrocytes with Inclusions
.. .... ~
338. Stippled orthochromatic erythroblast with Howell-Jolly body and Cabot rings
33C. Erythrocyte containing malarial ring
33D. Thrombocyte on red cell (Note clear area around platelet indicating it is on top of cell)
-.
o 33E. Howell-Jolly bodies in erythrocytes
33G. Cabot ring
33F Cabot rings in erythrocytes; stippling and HowellJolly body in one red cell with Cabot ring
33H. Cabot ring, stippling, Howell-Jolly body
•
33J. Cabot ring in orthochromatic erythroblast
72
••
33K. Howell-Jolly bodies
-
331. Malarial ring (left) versus platelet on red cell (right)
.
r.
e·o . •••••
. 33L. Plasmodium falciparum rings in red cells
Plate 34. Erythrocytes with Siderotic Granules
34A. Wright stain showing one orthochromatic erythroblast and multiple erythrocytes with Pappenheimer bodies (or siderotic granules in iron stain). The granules vary in number, size, shape, and color, and are unevenly distributed.
34B. Prussian blue stain for iron showing one orthochromatic erythroblast with siderotic granules (ringed sideroblast) and erythrocytes containing siderotic granules. The nucleus of the erythroblast stains red with safranin. (Howell-Jolly bodies, Heinz bodies, and stippling do not give a blue color with iron stain).
Erythrocyte Morphology in Blood and Marrow Smears from Sideroblastic Anemia
.-
•
..
.,
..
"
&
.*
.,
.. "
*
.,
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::-:;. Erythrocytes with Pappenheimer ~ 55 in Wright stain (blood)
34D. Sideroblasts (top). Ringed sideroblasts (below). Prussian blue iron stain (marrow)
34E. Ringed sideroblasts in Prussian blue iron stain (marrow)
•
.....t... _--=
:Iythrocytes with Pappenheimer .=r:fE£ in Wright stain (blood)
34G. Erythroblasts with siderotic granules in Prussian blue iron stain (marrow)
34H. Ringed sideroblasts in Prussian Ius iron stain (marrow)
Plate 35. Erythrocytes with Heinz Bodies
Erythrocytes in a moist preparation after four-hour incubation with acetyl-phenylhydrazine followed by staining with crystal violet
• •
•
. -.... ••
• •
4.
#I •••
•
•
•
•
•
,••
••• -
.
•••• •••
.-
•
35A. Normal blood with one to four Heinz bodies in most erythrocytes
.-
\-
35B. Erythrocytes from a patient with G-6-PO deficiency. Majority of red cells have five or more Heinz bodies
•
•
•
•
"..."--l ./J - - * .. .•
•. ••
~
. .•. "-.~.1Ifi-
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•
•
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35C. Heinz body preparation of normal erythrocytes
••
350. Heinz body preparation of erythrocytes in Hemoglobin ZOrich
, c. I
• 35E. Heinz body preparation of normal erythrocytes
35F. Heinz body preparation of erythrocytes in G-6-PO deficiency
Plate 36. Erythrocytic Sequence in Bone Marrow: Megaloblastic Anemia, Normal Marrow, and Iron Deficiency Anemia Left column: Megaloblastic Anemia in B12 and Folic acid deficiencies
Promegaloblast
Basophilic megaloblast
Middle column: Normal Erythroblast Sequence
Proerythroblast
Basophilic erythroblast
Right column: Iron Deficiency Anemia (IDA)
Proerythrobast (small)
Basophilic erythroblast (small)
Polychromatophilic megaloblast
Polychromatophilic erythroblast
Polychromatophilic erythroblast
Orthochromatic megaloblast
Orthochromatic erythroblast
Orthochromatic erythroblast
Polychromatophilic macrocyte
Polychromatophilic erythrocyte
Polychromatophilic erythrocyte
Macrocyte
Normal erythrocyte
Hypochromic microcyte
Plate 37. Comparison of Erythrocyte Morphology in Blood and Bone Marrow: Iron Deficiency Anemia and Megaloblastic Anemia /
.-
JIll!!
37A. Iron deficiency anemia with microcytic hypochromic erythrocytes (blood)
378. Iron deficiency anemia with three late erythroblasts (iron-deficient) having minimal bluish cytoplasm (marrow)
37C. D. Iron deficiency anemia with numerous late erythroblasts (iron-deficient) having minimal bluish cytoplasm (marrow)
o
76
37E. Megaloblastic anemia with large oval and round macrocytes and pear-shaped erythrocytes (blood)
37F. Megaloblastic anemia with large oval and round macrocytes and one orthochromatic megaloblast (blood)
37G. Megaloblastic anemia with three basophilic megaloblasts (marrow)
37H. Megaloblastic anemia with three promegaloblasts (right) and three basophilic megaloblasts (left) (marrow)
Plate 38. Pathological Erythroblasts in Bone Marrow of Megaloblastic Anemia
< 38A. Polychromatophilic megaloblast with two nuclei
38D. Basophilic megaloblast with nuclear fragments; asynchronism
38B. Polychromatophilic megaloblast with fragmentation of nucleus (karyorrhexis)
38C. Basophilic megaloblast with asynchronism between nuclear structure and cytoplasmic color
38E. Basophilic megaloblast
38G. Polychromatophilic erythrocyte (top), polychromatophilic and basophilic megaloblasts
38F. Orthochromatic megaloblast with degenerated nucleus and stippling
38H. Pro,megaloblast, basophilic and orthochromatic megaloblasts, plasma cell (lower left)
•
381. Basophilic megaloblast showing asynchronism
••
38J. Giant orthochromatic megaloblast with Howell-Jolly bodies
77
Plate 39, Part 1. Pathological Erythroblasts and Erythrocytes in Bone Marrow of Megaloblastic Anemia
Selected nucleated and nonnucleated red cells in bone marrow smears of patients with untreated megaloblastic anemia. There is asynchronism between nucleus and cytoplasm with the nucleus less mature than the cytoplasm. Identification of nucleated cells is based primarily on chromatin configuration and not on cytoplasmic coloration. Anisocytosis, poikilocytosis, and anisochromia may be observed in nonnucleated erythrocytes.
39A. Orthochromatic megaloblast showing karyorrhexis and asynchronism 39B. Orthochromatic megaloblast with Howell-Jolly bodies 39C. Teardrop erythrocyte 39D. Basophilic megaloblast with asynchronism 39E. Stippled oval macrocyte 39F. Cabot ring in oval macrocyte 39G. Polychromatophilic macrocyte 39H. Lobulated megaloblastic neutrophil 391. Orthochromatic megaloblast showing karyorrhexis and Howell-Jolly bodies 39J. Promegaloblast with multiple nucleoli 39K. Hypersegmented neutrophil 39L. Pear-shaped erythrocyte 39M. Polychromatophilic megaloblast 39N. Orthochromatic megaloblast with beginning nuclear extrusion
7
390. 39P. 39Q. 39R. 39S. 39T.
Polychromatophilic megaloblast with asynchronism Microcytic poikilocyte Promegaloblast Macrocyte with Howell-Jolly bodies Mitotic figure Orthochromatic megaloblast with one Howell-Jolly body 39U. Oval macrocyte 39V. Basophilic megaloblast 39W. Basophilic erythroblast
Plate 39, Part 2. Pathological Erythroblasts and Erythrocytes in Bone Marrow of Megaloblastic Anemia
.. Plate 40. Pathological Leukocytes
40A. N. segmented with toxic granules
40B. N. segmented with vacuoles and toxic granules
40E. Degenerated neutrophil nucleus (old EDTAblood)
40F. Hyperlobulated neutrophil
401. N. myelocyte, metamyelocyte, segmented with toxic granules (marrow)
40J. N. segmented cells with toxic granules
40L. Vacuoles in neutrophils
40M. Dohle bodies in neutrophil
40C. N. metamyelocyte with - toxic granules
40G. N. segmented with engulfed dark nuclear mass (LE cell)*
40D. Degenerated roun . neutrophil nucleus (old E=~ blood); toxic @ranules
40H. Monocyte with phagocytized nuclear ma "
40K. Degenerated neutrophils (old EDTAblood)
40N. Monocyte with phagocytized red cell
400. Dohle body, toxic h~ in N. segmented
*40G. Neutrophil which contains a phagocytized reddish-purple nuclear mass from another leukocyte following a special technique which is no longer as an aid in diagnosis. This cell was designated as a so-called "LE cell" since it was observed in patients with lupus erythematosus.
80
US2:
Plate 41. Cell Types on Blood Smears of Patients with Pelqar-Huet Anomaly
This hereditary anomaly is characterized by hypolobulation of the nuclei of neutrophils. The chromatin structure of the granulocytes with round or indented nucleus is that of mature cells. The size, chromatin structure, and phagocytic function of these cells are normal.
-. Slightly indented nucleus .sanut" shaped)
418. Nucleus with closely approximated round lobes (pince-nez)
Two "peanut"-shaped nuclei
41 C. Round nucleus
41 D. "Peanut"-shaped nucleus
41 F. Pince-nez nucleus; slightly indented nucleus
41G. "Peanut"-shaped nucleus; slightly indented nucleus (bottom)
411. Pseudo-Pelger cell in myelodysplasia
41J. Pelqsr-Huet cell with pince-nez nucleus
c ":1H. Pseudo-Pelger cell in ;nyelodysplasia
ote: Pseudo-Pelger cells are observed in myelodysplasia and other myeloid dyscrasias.
8-
Plate 42. Cell Types on Blood Smears from Patients with Chediak-Higashi Anomaly
Leukocytes in smears of blood or of bone marrow from patients with Chediak-Higashi anomaly showing abnormal and giant Iysosomes in the cytoplasm.
42A. Lymphocyte (blood) 42C. Promyelocyte (marrow) 42B. Mitotic figure of promyelocyte (marrow)
42D. Eosinophil-large
granules (blood)
42G. Lymphocytes, N. segmented (blood)
42E. Basophil-large
granules (blood)
42H. Lymphocyte (blood)
42K. Mitotic figure (marrow)
42F. Neutrophil segmented (blood)
421. Neutrophil (blood)
42L. Eosinophilic myelocyte (marrow)
42J. Basophil (blood)
Plate 43. Cell Types on a Blood Smear from a Patient with May-Hegglin Anomaly
Each leukocyte has one (or two) large bluish, elongated, irregularly shaped Diihle-like body
i
-- ,.,.d'
43A. Monocyte with Diihle-like bodies 43B. Eosinophil with Diihle-like body 43C. Basophil with Diihle-like body
430. Neutrophils with Dohle-like bodies 43E. Large abnormal platelets
The number of cells in drawing is greater than occurs in a single oil-immersion field. Note shape variation in erythrocytes of this patient. The platelets are large and abnormal.
43F. Neutrophil with Dohle-like body (arrow); large platelets
43G. Neutrophil with Dohle-like body (arrows); large platelets
43H. Neutrophil with Dahle-like body (arrows); large platelets
Plate 44. Cell Types on Blood and Marrow Smears from a Patient with Alder-Reilly Anomaly
44A. Neutrophilic myelocyte (marrow)
44B. Neutrophilic metamyelocyte (marrow)
440. Neutrophilic segmented (blood)
44E. Basophil (blood)
44G. Two neutrophils (blood)
44C. Neutrophilic band (marrow)
44F. Eosinophil (blood)
44H. Two neutrophils (blood)
441. Lymphocyte, N. segmented, and basophil (blood)
The cytoplasm of neutrophils and basophils in blood or bone marrow of patients with Alder-Reilly anomaly contain multiple deep blue or lilac, round granules in blood and marrow smears. Eosinophil granules are large.
1 Plate 45. Selected Cells from Blood and Marrow Smears of Patients with Acute and Chronic Myelogenous (Myelocytic) Leukemia
45A. Myeloblast with prominent nucleoli, well-defined chromatin structure, blue cytoplasm with no granules
45C. Myeloblast with Auer rod 458. Megakaryoblast with dark coarse nuclear chromatin structure and blunt vacuolated blebs (marrow)
/
45D, Atypical promyelocyte with a few dark granules
.... ... "
45E. Atypical promyelocyte with prominent purple granules (marrow)
45F. Atypical promyelocyte with fine and coarse granules
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45G. Atypical early neutrophil (simulating a monocyte) with indented nucleus, intermediate nuclear chromatin structure, nonspecific granules and pale cytoplasm
45H. Progranulocyte variant with abundant granular cytoplasm and irregular margin (marrow) (formerly called Ferrata cell)
451. Macrocytic polyploid neutrophil
F
Plate 46. Chronic Myelogenous (Myelocytic) Leukemia (CML), Blood Smears: Wright stain, and Leukocyte Alkaline Phosphatase (LAP) stain
•
-6
. ...~.
46A. Myeloid cells in CML (see cell numbers below)
460. Myeloid cells in CM L
46G. Pseudo-Pelger cells in CML
46B. Myeloid cells in CML
46E. Myeloid cells in CML
46C. Myeloid cells in CML
46F. CML, Leukocyte alkaline phosphatase stain (N. segmented and band are negative)
46H. CML in AML blast crisis with increase in basophils
I entification of cells: yeloblast, 2. Promyelocyte, 3. N. myelocyte, 4. N. metamyelocyte, 5. N. band, 6. N. segmented, 7. Eosinophil, 8. Basophil, ~. seudo-Pelger neutrophil, 10.Early lymphoid cell (lymphoblast)
Plate 47. Acute Myelogenous (Myelocytic) Leukemia (AML): (FAB) M1, M2, M Acute myelogenous leukemia: M1 without maturation; M2 with some maturation; M3 acute promyelocytic leukemia
Myeloblasts, MI (blood)
47B. Myeloblasts-positive stain, M1 (blood)
Sudan Black
- D. Myeloblast, promyelocyte, M2 : od)
47E. Promyelocytes and myelocyte, M2 (marrow)
47G. Hypergranular promyelocytes, M3 (marrow)
47H. Auer rods in early myelocytic celis, M3 (marrow)
Note: 47A and 47B from same patient; O-F same patient; G-I same patient
47C. Myeloblasts with Auer rod (arrow), M1 (blood)
47F. Positive myeloperoxidase stain, M2 (marrow)
471. Promyelocyte with multiple Auer rods, M3 (marrow)
•••
Plate 48. Cytochemical Stains, Part 1
••
-.
/
/
Myeloperoxidase Stain: The two upper cells (48A) are myeloperoxidase negative (lymphocytes); the two lower cells (48B) are myeloperoxidase positive (neutrophils). The red cells are laked and appear as shadow forms. This stain is of aid in differentiating early cells of the myelocytic and monocytic systems from cells of the lymphocytic system.
48C. Positive myeloperoxidase stain, AML, M1 (blood)
48E. Blasts: negative myeloperoxidase stain-ALL (L2) marrow (positive neutrophil in center right serves as quality control for adequate stain)
88
480. Positive myeloperoxidase stain, AML, M1 (marrow)
48F. Large Blasts: negative myeloperoxidase stain-ALL (L3) marrow (positive neutrophil myelocyte in lower center serves as control for adequate stain)
Plate 48. Cytochemical Stains, Part 2
Periodic Acid Schiff (PAS) Stain: Reaction for the detection of intracellular glycog2r
48G. PAS positive lymphocyteSezary cell (blood)
48H. Negative PAS reactionlymphocyte (normal blood)
481. Strongly positive PAS reactlo segmented neutrophil (blood)
Sudan Black Stain: For the detection of lipids
48J. Positive reaction-immature granulocyte (blood)
48K. Negative reaction-lymphocyte (blood)
48L. Strongly positive reaction-No segmented (blood)
Leukocyte Alkaline Phosphatase (LAP) Stain: For detection of LAP in neutrophils
48M. Positive (2+) reactionneutrophil segmented (blood)
48N. Negative reaction-neutrophil segmented in CML
480. Strongly positive (4+) reactionneutrophil segmented (blood)
48P. Positive PAS stain (3 lymphoblasts) (top left)-ALL, L3 (marrow)
48Q. Positive Sudan Black stain in AML M1 (blood)
48R. Positive LAP stain in myelofibrosis (blood)
48S. Negative LAP stain in CML (blood)
Plate 49. Acute Myelogenous Leukemia (AML) (FAB): M4 and M5 Acute myelomonocytic leukemia: M4; Acute monocytic leukemia M5
49A. M4 (blood)
490. M5: mono blasts (marrow)
49G M5: monoblasts (marrow)
49B. M4 (blood)
49E. M5: monoblasts (marrow)
49H. M5: monocytes (blood)
49C. M4 (blood)
49F. M5: positive monocytic esterase stain (marrow)
491. M5: monocytes and promonocytes (marrow)
Identification of Cells: 1. Monocyte; 2. Promonocyte; 3. Monoblast; 4. N. Myelocyte; 5. Basophil; 6. Eosinophil Note: 49A, 49B same patient; 490, 49G same patient; 49H, 491 same patient
Plate 50. Selected Cells from Patients with Acute Monocytic Leukemia: (FAB) M5
50A. Monoblast: prominent nucleoli, indented nucleus, blunt pseudopods
500. Promonocyte: nuclear folds, foamy cytoplasm
50G. Monocyte: transparent folded nucleus, granules in cytoplasm
50B. Monoblast: prominent nucleoli
50E. Promonocyte: two nuclear lobes, nucleoli, prominent granules, clear ectoplasm
50H. Monocyte: folded nucleus, linear chromatin, distinct granules, elongated shape
50C. Monocyte: phagocytized red cell
50F. Monocyte: deeply indented nucleus, fine granular cytoplasm
501. Promonocyte: nucleoli; vacuoles in cytoplasm
Plate 51. Selected Cells from Blood Smear of Acute Erythroleukemia: (FAB) M6
-.
51A. Macrocytic polychromatophilic erythroblast with three nuclei
51 B. Macrocytic basophilic erythroblast with two nuclei and asynchronism
51 C. Macrocytic basophilic erythroblas; with asynchronism
51 D. Macrocytic orthochromatic erythroblast with five nuclei
51E. Nuclear fragmentation in an erythroblast
51 F. Macrocytic orthochromatic erythroblast with asynchronism
4 51G. M6 (See cells below)
51H. M6 (See cells below)
511. M6 (See cells below)
Identification of cells: 1. Proerythroblasts often with vacuoles; 2. Promyelocyte; 3. Pseudo-Pelger neutrophil; 4. Orthochromatic erythroblast; 5. Mitotic figure; 6. Polychromatophilic erythroblast Asynchronism: nucleus less mature than cytoplasm
Plate 52. Selected Erythroblasts from Bone Marrow Smears of Acute Erythroleukemia: (FAB) M6
52A. Macrocytic proerythroblast: nucleoli and small vacuoles in cytoplasm
52B. Macrocytic proerythroblast: nucleoli and prominent cytoplasmic vacuolization
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52C. Macrocytic basophilic erythroblast: two large nuclei
52E. Giant late erythroblast: multiple nuclei, fragmentation of nuclei and Howell-Jolly bodies
520. Macrocytic polychromatophilic erythroblast: four nuclei of different sizes; asynchronism
52F. Large basophilic erythroblast: three nuclei
Plate 53. Pathological Erythroblasts from Bone Marrow Smears of Acute Erythroleukemia: (FAB) M6
53A. Large basophilic erythroblast
53B. Basophilic erythroblast: two nuclei
53C. Proerythroblast: two nuclei
53D. Large polychromatophilic erythroblast: three nuclei
53E. Macrocytic proerythroblast: four nuclei
53F. Giant polychromatophilic erythroblast: multiple nuclei; nuclear fragments
53G. Prussian blue iron stain: ringed sideroblasts
53H. Periodic Acid Schiff stain: positive polychromatophilic erythroblast
531. Periodic Acid Schiff stain: positive lobulated polychromatophilic erythroblast
Plate 54. Micromegakaryoblasts in Blood and Marrow Smears of Megakaryoblastic Crisis of CMl
Selected cells from patient with megakaryoblastic crisis of chronic myelogenous leukemia. Variant forms of micromegakaryoblasts. Nuclei are usually small and single but one cell has two nuclei. In most cells. granular cytoplasmic blebs (which represent early platelet formation) are noted.
Plate 55. Megakaryoblasts in Blood and Marrow Smears of Acute Megakaryoblastic (Megakaryocytic) leukemia: (FAB) M7
55A. Micromegakaryoblasts (blood)
55B. Megakaryoblasts (marrow)
55G. Megakaryoblast with cytoplasmic blebs; mitotic figure (marrow)
55D. Micromegakaryoblast; large platelet (blood)
55E. Megakaryoblast with blebs and long platelet (marrow)
55F. Megakaryoblast with blebs (marrow)
55G. Megakaryoblast with blebs (marrow)
55H. Megakaryoblast with platelets (marrow)
551. Megakaryoblast with blebs (top left); micromegakaryoblast (marrow)
•
Plate 56. Myelodysplasia: Blood Smears (BS) and Bone Marrow (8M)
••••
56A. Refractory anemia (RA), BS: anisocytosis, poikilocytosis, anisochromia
56B. RA, BS: poikilocytosis, anisocytosis, anisochromia
56C. RA, BS: poikilocytosis, anisocytosis, anisochromia
56D. Prussian blue iron stain: ringed sideroblasts, macrophage with hemosideMn,RARS,BM
56E. RARS, BM: erythroblastic hyperplasia: orthochromatic, polychromatic erythroblasts; and two nuclei in 2 cells
56F. Proerythroblasts with vacuoles, basophilic, and polychromatic erythroblasts, RARS BM
56H. RAEB: Three myeloblasts, 2 basophils, BM
561. CMML: Two atypical vacuolated monocytes, BS
o 56G. Pseudo-Pelger neutrophils (right); N. metamyelocytes (left), MDSBM
Myelodysplasia categories: RA: Refractory anemia; RARS: Refractory anemia with ringed sideroblasts; RAEB: Refractory anemia wit excess blasts; CMML: Chronic myelomonocytic leukemia
Plate 57. Myelofibrosis; Essential Thrombocytosis (ET): Blood Smears
57A. Myelofibrosis: teardrop and oval erythrocytes
57C. Myelofibrosis: teardrop, oval and odd shapes
j
~.
57D. Myelofibrosis: anisocytoss poikilocytosis; large platelets
57E. Myelofibrosis: N. myelocytes (3), N. segmented
57F. Myelofibrosis: leukocyte alkaline phosphatase stain: positive, 3+ and 4+
57G. Myelofibrosis: myeloblast (top); megakaryoblast; large platelets: one giant platelet
57H. Myelofibrosis: giant platelet, large platelets
~II. ET:Micromegakaryocyte, -: '7c.sed platelets
57J. ET:thrombocytosis, six lobed N. segmented
57K. ET:thrombocytosis
57L. Essential thrornbocytos.s
Plate 58. Selected Cells in Smears of Acute lymphoblastic leukemia (ALL) and Chronic lymphocytic leukemia (Cll)
58A. lymphoblast with nucleolus, All
588, lymphoblast with prominent nucleoli, All
58e, Prolymphocyte with indistinct nucleolus, All
58D, Prolymphocyte: intermediate chromatin structure, rippled cytoplasm, All
58E, Prolymphocyte: double nuclei, immature nuclear chromatin, All
58F, Atypical early lymphocyte: clumping of nuclear chromatin, purplish-red nongranular cytoplasm, All
58G, Prolymphocyte with deep nuclear cleft, All
58H, Atypical lymphocyte with nuclear lobulation, ell
581.lymphocyte with nuclear fragment, ell
58J, Smudge (frequent in ell)
Plate 59. Acute Lymphoblastic Leukemia (ALL): (FAB) Blood Smear (BS), Bone Marrow (BM), Cerebrospinal Fluid (CSF); Pro lymphocytic
59A. ALL, BS. Smaillymphoblasts: little cytoplasm, no or faint nucleoli, thrombocytopenia (L1)
59B. ALL, BS. Larger Iymphoblasts with nucleoli, thrombocytopenia (L2)
59C. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)
590. T cell ALL, BS. Lymphoc cells with prominent azure granules
59E. ALL, BM. Small Iymphoblasts: no or indistinct nucleoli, little cytoplasm (L 1)
59F. ALL, BM. Larger Iymphoblasts with nucleoli (L2)
59G. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)
59H. All, BM. Acid phosphatee positive stain
591. PAS positive stain, BM. Smaillymphoblasts (L 1)
59J. ALL, CSF.Larger Iymphoblasts with nucleoli (L2)
59K. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)
59L. Prolymphocytic leukerna =Large Iymphoblasts with nu =-=
Note: 59A, 59E, 591from same patient; 59B, 59F, 59J from same patient; 59C, 59K from same patient FAB L1: Small blasts; L2: Larger blasts; L3: Large blasts with vacuoles and nucleoli
-
• Plate 60. Chronic lymphocytic leukemia (Cll): Blood Smear (BS) and Bone Marrow (BM); Pro lymphocytic Leukemia (Pll)
60A, Cll: lymphocytes (5), smudge cells (3), platelet (1), BS
500, ClL: lymphocytes, Iymphoblasts (2), smudge cells BM
=::3.
ClL: lymphocytes, Iymphoblasts =.BM
60B. ClL: many lymphocytes, smudge cell, no platelets, BS
60C, Comparison: hairy cell (top), prolymphocyte (Pll), lymphocyte, BS
60E, Cll: lymphocytes, lymphoblast (I), BM
60F. ClL: lymphocytes, Iymphoblasts (2), smudge cell, BM
60H, ClL: numerous small lymphocytes, N, band, orthochromatic erythroblast, BM
601 Pll: big prolymphocyte with nucleolus, BS
Plate 61. Hairy Cell Leukemia: Blood Smears
Selected cells in blood smears from a patient with hairy cell leukemia. These cells have veillike cytoplasmic extrusions and delicate threadlike filaments. Hairy cells tend to push neighboring cells away or aside, leaving clear spaces around the hairy cell. One cell has prominent azure granules and a few hairlike projections.
Plate 62. Hairy Cell leukemia:
Blood (BS) and Bone Marrow (BM)
,
•
••
62A. Hairy cells, BS
62B. Hairy cells, BS
62C. Comparison: hairy cell (top), prolymphocytes, lymphocyte, BS
620. Hairy cells, 6 lobed N. segmented, BS
62E. Tartrate resistant acid phosphatase stain: positive hairy celis, BS
62F. Hairy cell, BM
62G. Hairy cells-one cell with cytoplasmic extension, BM
62H. Hairy cells, BM
621. Hairy celis, BM
Plate 63. Pathological Plasma Cells; Plasma Cell Myeloma, Bone Marrow (BM)
63C. Plasma cell: red-staining globules (Russell bodies) 63A. Proplasmacyte: three early nuclei and reticular cytoplasm
63B. Plasma cell: nebulous cytoplasmic margin, multiple globules, pink-staining secretory material
630. Flame type of plasma cell
63F. Plasma cell myeloma, BM
63E. Plasma cell: eccentric nucleus, red staining crystaline bodies and globules, reticulated cytoplasm
63G. Plasma cell myeloma, BM (artifact in larger plasmocyte top left)
~ 63H. Plasma cell myeloma, BM: note nucleoli in 3 cells
631. (a) Rouleaux of erythrocytes, blood (myeloma); vs (b) Agglutination
Plate 64. Selected Cells from Blood Smears of Sazary Syndrome
64A. Vacuolated atypical immature lymphocyte: indented nucleus, swirled chromatin pattern, nucleoli: Sezary cell
64E. Sezary cell
648. Vacuolated atypical early lymphocyte: distinct chromatin pattern: Sezary cell
64F. Sezary cell
641. Sezary cell with nuclear convolutions and nuclear fragment
64C. Atypical lymphocyte of intermediate size: brainlike (cerebriform) convolutions and granules: Sezary cell
64G. Sezary cell
64J. PAS positive Sezary cell
64D. Atypical lymphocyte with nuclear folds: Sezary cell
64H. Sezary cell
Plate 65. Selected Cells from Blood Smears of Patients with Infectious Mononucleosis
65A. Primitive plasma-like cell
650. Large reactive lymphocyte: unevenly stained bluish cytoplasm
658. Early plasma-like cell: indented nucleus
65E. Large lymphocyte: vacuolated periphery
65C. Early plasma-like cell
-.
65F. Atypical monocyte; fine and coarse granules, pseudopods
i ~-
65H. Large lymphocyte: prominent azurophilic granules 65G. Large lymphocyte; azure granules, scalloped borders (indented by red cells)
65J. Reactive lymphocytes
-b
651. Atypical monocyte
65K. Reactive lymphocytes, normal small lymphocyte
65L. Reactive lymphocytes
Plate 66. Reactive Lymphocytes-from Blood Smears
In this color plate leukocytes other than lymphocytes have been left out. Selected lymphocytes reacting to antigenic stimuli and showing heterogeneous forms have been portrayed in increased numbers in order to reveal the marked variation in size and shape and in nucleus and cytoplasmic characteristics. Note large cells with prominent basophilic cytoplasm, granules in one cell and indentation of some lymphocytes by red cells. Red cells and platelets are normal.
Plate 67. Malarial Parasites on Blood Smears (Wright-Giemsa stain)
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
,
Early ring
Late ring
Plasmodium vivax
•
Early trophozoite /
Late trophozoite
Immature schizont
Mature schizont
Macrogametocyte
Microgametocyte
Plate 68, Part 1. Malarial Parasites, Blood Smears (Wright-Giemsa stain); Thick Drop Preparations (Giemsa stain)
, "
68A. Plasmodium talciparum rings (Wright-Giemsa stain)
.. 68B. P. talciparum gametocytes
68C. P. talciparum gametocyte
,
...
680. P. talciparum thick dropmany rings (Giemsa stain)
...,. .
,.
68E. P. vivax rings
68E P. vivax ring, immature schizont
68G. P. vivax mature schizont
68H, P. vivaxthick droptrophozoites, schizonts (Giemsa stain)
681. P. malariae ring
68J. P. malariae trophozoite
68K. P. malariae trophozoite ("band" form)
68L. P. malariae mature schizont
-. 68N. Platelet on RBC (left) vs Ring in RBC (right)
680, P. vivax trophozoites
68P. P. vivax trophoz "as
Plate 68, Part 2. Protozoan Parasites: Babesia microti; Plasmodium falciparum
68, Part 2 A. Babesia microti, intracellular and extracellular parasites
68, Part 2 B. Plasmodium talciparum, ring forms (one to four parasites per cell)
&-68, Part 2 C.
68, Part 2 D. Plasmodium falciparum rings
68, Part 2 E. Babesia microti tetrad form and rings
68 Part 2 F. Plasmodium talciparum rings
Plate 69. Infections in Hematology: Blood Smears
69A. Ehriichia phagocytophiia in neutrophil (Wright stain)
69B. Ehriichia phagocytophiia in neutrophil
69G. Ehriichia caffenesis in monocyte
690. Ehriichia phagocytophiia in neutrophil
69E. Staphylococci in a neutrophil from a burn patient (Wright stain)
69F. Meningococci in a monocyte (Wright stain)
~
'-
Plate 70. Histoplasma, Leishmania, Microfilariae on Blood and Marrow Smears
-. 70A. Macrophage with phagocytized Histoplasma capsulatum (marrow)
70C. Histoplasma capsulatum in neutrophils at feather end of blood smear
70B. Macrophage with Leishmania donovani (marrow)
700. Macrophage with amastigotes of Leishmania species
70E. Histoplasma capsulatum in macrophage-bone marrow
70F. Macrophage with amastigotes of Leishmania species
70G. Histoplasma capsulatum in disintegrating cell-blood
70H. Microfilaria in thick drop of blood
Plate 71. Giant Proerythroblasts in Bone Marrow from Patient with Parvovirus B19
r
Giant proerythroblasts with basophilic cytoplasm containing vacuoles in bone marrow smear stained with Wright stain are characteristic of Parvovirus 819. Note large nuclear inclusions (viral).
PLate 72. Lipid Histiocytes: Bone Marrow Smears
:i·:.
72A. Gaucher cell
4
72B. Nieman-Pick cell
72C. Gaucher cell
72D. Nieman-Pick cell
72E. Two Gaucher cells
72F. Three Nieman-Pick cells
Plate 73. Platelets on Blood Smears
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73A. Platelets-idiopathic thrombocytopenic purpura (ITP)
73B. Platelets-May-Hegglin anomaly
a
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73E. Platelets-May-Hegglin anomaly
.~
73H. Giant platelet syndrome
731. Platelet satellitosis (EDTAblood smear)
73C. Platelets-myelofibrosis
Plate 74. Origin and Development of Blood Cells
/ Myeloblast Monoblast
Basophilic myelocyte
Neutrophilic myelocyte
Eosinophilic myelocyte Promonocyte
Basophilic metamyelocyte
Neutrophilic metamyelocyte
Eosinophilic metamyelocyte
Basophilic band
Neutrophilic band
Eosinophilic band
3£5 . nillc segmented
Neutrophilic segmented
Eosinophilic segmented
Monocyte
--------
Plasmablast
proerytl1roblast MegaKaryoblast
ast
\3asopl1iliCerytl1robl promegaKarvOcyte
proplasmacyte
POlyc\lromatoPl1iliC ervtl1roblast
MegaKaryocyte wit\1Out platelets
ort\1Ocl1romatic ervtl1roblast
roc POlyCl1rOmatoPl1iliCerytl1 yte
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Index Figures are indicated by a bold face "F" and the figure number, followed by the page number in parentheses. Page is indicated by number only. . Plates are indicated by a bold face "P" and the plate number. Tables are indicated by a bold face "T" and the table number, followed by the page number in parentheses.
Acanthocyte (spur, thorn) 15, P23, P26 Acid phosphatase stain P59 Acute erythroleukemia P52, P53 Acute lymphoblastic leukemia (ALL) 35, P58-P59 Acute megakaryocytic leukemia P54, P55 Acute myelogenous leukemia 30,31, P45, P47-P49 Acute myelomonocytic leukemia (AML) P30, P49 Alder-Reilly Anomaly 27, P44 Anemia aplastic 20 heart valve dysfunction P25 (Part 2) hemolytic due to burns, venoms 25, P31 hemolytic uremic syndrome 25 iron deficiency 18, P24, P36-P37 megaloblastic 19, P36-P39 (Parts 1-2) microangiopathic hemolytic anemias 25, P25 (Parts 1-2) sickle cell 22, P23, P27-P28 sideroblastic 19, P34 Thalassemia major 22, P29 Thalassemia minor 21,22, P30 Thrombotic thrombocytopenic purpura 25, P25 (Part 1) Anisocytosis 15 Aplastic anemia 20 Auerrod(body) 30,P45,P47 B cell 9, FI (2), F4 (10) Babesiosis 36, P68 (Part 2) Band neutrophil 1-3, FI (2), F2 (3), PI-P3, P74, Tl-T2 (1) Basophil 1,2,5, FI (2), PI-P4, P46, P74, Tl-T2 (1) band 5, FI (2), PI, P74 metamyelocyte 5, FI (2), PI, P74 myelocyte 5, FI (2), PI, P74 segmented 5, FI (2), PI, P74 Basophilic erythroblast 1,7, F1 (2), F7 (17), PH, P36, P74, T2 (1) Basophilic stippling 16, F7 (17), P32 Bite cell 15, P26 Blister cell P23 Blood cells, normal values TI (1) Bone cells l3, P20-P21 Bone marrow cells, normal values T2 (1) Burned patients, erythrocytes in 25, P31 Burr cell 15, P23, P26
118
Cabot ring 16, F8 (17), P33, P39 (Parts 1-2) CALLA (Common acute lymphoblastic antigen) 9 CD (Cluster designation) Markers 9, F4 (10) Chediak-Higashi anomaly 27, P42 Chronic lymphocytic leukemia (CLL) 33, P58, P60 Chronic myelogenous leukemia (CML) 27, P45-P46 Classification of ALL 35, P58-P59 Classification of AML 30, P45, P47-P55 Classification ofMD5 31, P56, T6 (31) Clostridium perfringens P26 Cooley's anemia 22, P29 Crescent body (semilunar body) P23 Degenerated neutrophil 26, P40 D6We body 26, P40, P43 Drepanocyte (sickle cell) 16 Echinocyte 15, P23, P26 Ehrlichiosis 36, P69 Electrophoresis Hb 22, 23 Elliptocyte 24, P23, P29 Elliptocytosis 24, P23, P29 Endothelial cell 14, P22 Eosinophil 1,4, FI (2), PI-P4, PI8, P74, Tl (1), T2 (1) band 4, FI (2), PI-P2, P74 metamyelocyte 4, FI (2), PI-P3, PI8, P74 myelocyte 4, FI (2), PI-P2, PI8, P74 segmented 4, Fl (2), PI, P4, P74 Erythrocyte acanthocyte (spur, thorn) 15, P23 basophilic erythroblast 7, FI (2), PH, P36, P74, T2 (1) basophilic stippling 16, F7 (17), P32 bite 15, P26 blister (marginal achromia) P23 burn patient 25, P31 burr 15, P23, P26 Cabot ring in 16, F8 (17), P33, P39 (Part 1) crenated P23 crescent (semilunar body) P23 crystals (Hb 55, 5C, CC) 23, P23, P27 echinocyte 15, P23, P26 elliptocyte 24, P23, P29 filamented P23 folded P23 fragment (schistocyte) 16, 25, P23, P25 (Parts 1-2)
The Morphology of Human Blood Cells
helmet 15, P23, P25-(Parts 1-2) Heinz body 16, F7 (17), P35 Howell-Jollybody 16,F7 (17),P33,P39 (Parts 1-2) hypochromic 16, P24, P37 inclusions in 7, F7 (17), P32-P35 keratocyte 15 leptocyte 16, P24 macrocyte 15, P24, P36-P37, P39 (Parts 1-2) malaria in 36, P67-P68 membranous ghost P23 microcyte 15, 18, P24, P36-P37, P39 (Parts 1-2) normal 7, 15, P23-P24 orthochromatic erythroblast 7, FI (2), PH, P36, P74, T2 (1) oval (ovalocyte, elliptocyte) 24, P23, P29 pear 20, P23 pinched (pinchered) P23 poikilospherocyte P23 polychromasia 18 polychromatophilic erythroblast 7, FI (2), PH, P36, P74, Tl (1) polychromatophilic erythrocyte 7, 18, FI (2), Pll, P32,P36,P74 proerythroblast 6, FI (2), Pll, P36, P74, T2 (1) ringed sideroblast 18, P34 rouleaux 16,34, P63 schistocyte (fragment) 16,25, P23, P25 (Part 1) semilunar body (crescent) P23 sickle cell (drepanocyte) 16,22, P23, P27, P28 sideroblast 18, P34 siderocyte 18, P34, F7 (17) siderotic granules in 18, F7 (17), P34 spherocyte 16, P23, P26, P29 stippled 16, F7 (17), P32 stomatocyte 16, F9 (24), P23 target 16, P23, P27, P29-P30 teardrop 16, P23, P24, P39 (Parts 1-2), P56-P57 triangular 16, P23, P25 (Part 1) venoms.nn 25, P26 Erythropoiesis 2,6, F1 (2), Pll, P36 Esterase stains monocytic 31 myelocytic 30 FAB classification of ALL 35, P58-P59, T8 (35) FAB classification of AML 30, P45, P47-P55, T5 (30) FAB classification ofMDS 31, P56, T6 (31) Fat cell (lipocyte) 13, PI9 Ferrata cell P45 Fibroblast 15 Folic acid deficiency 19, P24, P36-P39 (Parts 1-2) Fragmented cell (schistocyte) 16,24,25, P23
Gaucher cell P72 G-6-PD Deficiency 15, P26 Granule(s) primary 1,3 secondary 1,3 siderotic (iron-containing)
18, P34
Hairy cell leukemia 33, P60-P62 Heinz body 16, F7 (17), P35 Helmet cell 15, P23, P25 (Parts 1-2) Hematopoiesis 1, FI (2) Hematopoietic stem cell 1, FI (2), F4 (10) Hemoglobin A 22, 23 Hemoglobin Az 23 Hemoglobin AC 23 Hemoglobin AE 23 Hemoglobin AS 22, P28 Hemoglobin ~o thalassemia 22, P29 Hemoglobin ~ + thalassemia 22, P30 Hemoglobin Bart's 21, T4 (21) Hemoglobin concentration 16 Hemoglobin CC 23, P27 Hemoglobin E 23 Hemoglobin E-I3-thalassemia 23, P30 Hemoglobin electrophoresis 22, 23 Hemoglobin H 21 Hemoglobin 0 23 Hemoglobin SC 23, P23, P27 Hemoglobin SS 23, P23, P27-P28 Hemoglobin ZUrich P26 Hereditary elliptocytosis 24, P23, P29 Hereditary pyropoikilocytosis 24, P31 Hereditary spherocytosis 24, P23, P29 Hereditary stomatocytosis 24, F9 (24), P23 Histioplasma capsulatum 37, FH (37), P70 Histoplasmosis 37, P70 HLA-DR 10 Hodgkin's disease 32 Howell-Jolly body 16, F7 (17), P33, P39 (Parts 1-2) Hydropsfetalis 21, T4 (21) Hyperlobulated neutrophil P24, P39-P40 Immunologic classification of adult ALL 35, T7 (35) Inclusions in erythrocytes 16, P33 Infectious mononucleosis 36, P65-P66 Iron deficiency anemia 18, P24, P36-P37 Iron Stain P34, P53-P56 Iron studies 19 Keratocyte 15
The Morphology of Human Blood Cells
L.E. cell P40 Leishmaniasis 37, P70 Leptocyte 16 Leukemia basophilic 5 erythroleukemia (erythroblastic) P51- P53, T5 (30) hairy cell 33, P60-P62 lymphoblastic, acute 35, P58, P59, T7-T8 (35) lymphocytic, chronic 33, P58, P60 megakaryoblastic, acute 30, P54-P55 monocytic, acute 30, P49-P50 myelocytic, chronic 27, P45-P46 myelogenous, acute 30, P45, P47-P55, T5 (30) myelogenous, chronic 27, P45-P46 myelomonocytic, acute 30, P49 myelomonocytic with eosinophilia 30 plasma cell 34 promyelocytic 30, P47, T5 (30) prolymphocytic 11, P59-P60 Leukocyte alkaline phosphatase (LAP) stain 28, P46, P48 (Part 2) Lipocyte (fat cell) 13, Pl9 Lymphoblast 9,35, PIO, P58-P59 Lymphocyte Tl-T2 (1) B cell 9, FI (2), F4 (10) cell markers 9, F4 (10) reactive 36, P65-P66 T cell 9, FI (2), F4 (10) Lymphopoiesis 9, FI (2), F4 (10) Macrocyte 15,20, P24, P37-P39 (Parts 1-2) Macrophage 12, PI6-PI7, P56 Malaria 36, P67-P68 (Parts 1-2) Mast cell 12, Pl8 May Hegglin anomaly 26, P43 Mean corpuscular hemoglobin (MCH) 19,22 Mean corpuscular values 19,20 Mean corpuscular hemoglobin concentration (MCHC) 19,22 Mean corpuscular volume (MCV) 19,20,22 Megakaryoblast 8, FI (2), Pl4-PI5, P74 Megakaryocyte 8, FI (2), PI4-PI5, P74 Megaloblastic anemia 19, P36-P39 (Parts 1-2) Metamyelocyte basophilic 1,5, FI (2), PI-P3, P74 eosinophilic 1,4, FI (2), PI-P3, P74 neutrophilic 1, FI (2), F2 (3),3, F3 (4), PI-P3, P74, T2 (1) Microangiopathic hemolytic anemia (MAHA) 25, P25 (Parts 1-2)
120
Microcyte 8, 15, 18, P24, P36-P37 Micromegakaryoblasts 8, P54-P55 Monoblast 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30) Monocyte 5,FI (2),P4,P7-IO,P74, Tl-T2 (1) Monocytic leukemia 6,30, P49-P50, T5 (30) Myeloblast 1, FI (2), PI-P3, P45-P47, P74 Myelocyte basophilic 1,5, FI (2), PI-P3, P74 eosinophilic 1,4, FI (2), PI-P3, P74 neutrophilic 1,3, FI (2), PI-P3, P74 Myelodysplastic syndrome 31, P56 Myelofibrosis 29, P57, P73 Myelogenous leukemia P45-P48 acute 30, P45-P55, T5 (30) chronic 27, P45-P46, P48 Myeloid: Erythroid ratio 1, T2 (1) Myeloma 34, FIO (34), P63 Myeloperoxidase stain (MPO) 30, P48 (Part 1) Myelopoiesis 1, FI (2) Neiman-Pick disease P72 Neutrophilic band 1-3, FI (2), F2 (3), PI-P4, P74, Tl-T2 (1) degenerated 26, P40 hypersegmented 26, P39-P40 hyposegmented (Pelger-Huet) 26, P41 metamyelocyte 1-3, FI (2), F2 (3), PI-P3, P74, T2 (1) myelocyte 1-3, FI (2), F2 (3), PI-P3, P74, T2 (1) segmented 1-4, FI (2), F2 (3), F3 (4), PI, P74, Tl-T2 (1) Non-Hodgkin's lymphoma 32 Normal values bone marrow 1, T2 (1) peripheral blood 1, Tl (1) MCH 19 MCHC 19,22 MCV 19,20,22 RDW 19,20,22 Orthochromatic erythroblast 7, FI (2), P11, P36, P74, T2 Osteoblast 13, F5 (14), P20-P21 Osteoclast 14, F6 (14), P20-P21 Pappenheimer body (siderocyte) 18, F7 (17), P34 Parvovirus B 19 37, P71 Pelger-Huet anomaly 26, P41 Periodic Acid Schiff (PAS) stain P48 (Part 2), P53, P59,P64
The Morphology of Human Blood Cells
Peroxidase stain 30, P48 (Part 1) Plasmablast 12, PlO, P63, P74 Plasma cell (Plasmacyte) 11, P10, P74 Plasma cell leukemia 12 Plasmodium falciparum 36, P67-P68 (Parts 1-2) malariae 36, P67-P68 (Part 1) ovale 36, P67 vivax 36, P67-P68 (Part 1) Platelet (thrombocyte) 8, Fl (2), P4, PI4-PI5, P73, P74 Pluripotent stem cell F4 (10) Poikilocytosis 15 Polychromasia 18 Polychromatophilic erythroblast 7, Fl (2), Pll, P36, P74 Polychromatophilic erythrocyte 7, 18, Fl (2), PI I, P32, P36,P74 Polycythemia vera 27,28 Precursor compartment 1, FI (2) Pre-B cell 9, FI (2), F4 (10) Pre- T cell FI (2) Pro-B cell 9, F4 (10) Pro- T cell F4 (10) Proerythroblast 6, F1 (2), PIl, P36, P74, T2 (1) Progenitor compartment 1, FI (2) Prolymphocyte ll, PIO, P58-P60, P74 Pro megakaryocyte 8, FI (2), PI4-PI5, P74 Promonocyte 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30) Promyelocyte (progranulocyte) 3, FI (2), PI-P3, P46-P47, P74 Proplasmacyte 12, PlO, P74 Prothymocyte F4 (10) Prussian blue iron stain on erythrocytes P34, P53, P56 macrophage P56 Pseudo-Pelger Huet cell 31, P56 Pyropoikilocytosis, hereditary 24, P3I Red cell distribution width (RDW) 19,20, T3 (19) Reactive lymphocyte 36, P65-66 Reticulocyte 18, F7 (17), P32 Ringed sideroblast 18, 19, P34 Rouleaux 12,34, P63 Russell body (plasma cell) 11, P63
Sickle cell trait (Hb AS) 22, P28 Sideroblast-ringed 18,19, P34 Sideroblastic anemia 19, P34 Siderocyte 18, F7 (17), P34 Smudge cell 33, P60 Spherocyte 16,24, P23, P26, P29 Spherocytosis, hereditary 24, Pi9 Spider bite on RBC 25, P26 Spur cell P26 Stem cell l , FI (2), F4 (10) Stem cell compartment 1 Stippled red blood cell 16, F7 (17), P32 Stomatocyte 16,24, F9 (24), P23 Stomatocytosis, hereditary 16,24, F9 (24), P23 Sudan black B stain 30, P47, P48 (Part 2) Target cell 16,21,22, P23, P27 Tartrate-resistant acid phosphatase (TRAP) 33, 34, P62 T cell 9, Fl (2), F4 00) T-cell receptor (TCR) 9,10 Terminal deoxynucleotidyl transferose (TdT) 9,30, F4 (10) Teardrop cell 16, P23-P24, P37, P39 (Parts 1-2) Thalassemia alpha 21 beta 21,23 major 21,22, P29, P30 minor 21,22, P30 Thermal injury to RBC 25, P31 Thrombocyte (platelet) satellitosis P73 Thrombocythemia, essential 29, P57 Thrombotic thrombocytopenic purpura (TTP) 25, P25 (Part 1) Thymocyte F4 (10) Thymus FI (2), F4 (10) Tissue basophil PI8 Tissue eosinophil PI8 Toxic granules 26, P40 Venoms on erythrocytes 25, P26 Vitamin B12, Folic Acid deficiency 19, P36-P39 (Parts 1-2)
Satellitosis (platelets around neutrophil) 9, P73 Schistocyte 16,25, P23, P25 (Parts 1-2) Semilunar (crescent) body P23 Sezary syndrome 34, P48, P64 Sickle cell 22, P23, P27, P28 Sickle cell anemia (Hb SS) 22, P23, P27-P28 Sickle cell-hemoglobin SC disease (Hb SC) 23, P23, P27
12
