Septicemia

Severe Left Shift Univ of Minn, Hematography case 10

Toxic granulation is found in severe inflammatory states Toxic granulation is found in severe inflammatory states. The toxic granules are azurophilic, usually found in the promyelocyte, metamyelocyte, band, and segmented stages. The toxic granulation is thought to be due to impaired cytoplasmic maturation,in the effort to rapidly generate large numbers of granulocytes.       Virginia med edu

Toxic Granulation Hemosurf Demo

L Dohle bodies are single or multiple blue cytoplasmic inclusions L Dohle bodies are single or multiple blue cytoplasmic inclusions. They represent remnants of rough endoplasmic reticulum from earlier maturational stages. They are associated with myeloid "left shifts" and are seen in conjunction with toxic granulation.                                                                                                                                     Avirginia med ed.edu

DÖHLE Bodies

DÖHLE Bodies

DÖHLE Bodies

Toxic Vacuoles

Intracellular Yeast UAB Hematopathology

Phagocytized yeast

Rickettsia Infection Univ of Minn, Hematography case 15 Note: Human granulocytic ehrlichiosis (HGE) is a tick-borne illness caused by rickettsia-like coccobacilli of the genus Ehrlichia. The organisms infect the patient's neutrophils, forming characteristic cytoplasmic inclusions known as morulae.

Pelger Huet Anomaly

Pelger-Huet or Band? No toxic vacuoles, Dohle bodies, or toxic granulation. “Hypermature” nuclear chromatin pattern. Virtually all PMNs are “bands”

Pelger Huet mednet

Variations in Pelger Huet

Eosinophilia

Monocyte The Crookston Collection

Eosinophilia allergic disorders -asthma, seasonal rhinitis, eczema, atopic dermatosis, pemphigus and dermatitis herpetiformis. parasitic infections - trichinosis, tapeworm, roundworm, schistosomiasis.MBP (major basic protein) released from the eosinophilic granules coats the Schistosoma organism prior to antibody-complement independent killing. other infections - scarlet fever, TB, leprosy Loeffler's syndrome PIE (pulmonary infiltration with eosinophilia) tropical pulmonary eosinophilia drug induced - sulfonamides, PCN, digitalis, nitrofurantoin neoplastic - CML, tumors, (particularly involving serous linings, occasionally Hodgkin's disease).

Basophilia Basophilia ( > 0.2 X 109/L ) is seen in allerigic reactions and is common in chronic myelocytic leukemia. Increased basophils are associated with polycythemia vera and extramedullary hematopoiesis. Basophilia is also reported in hypothyroidism.

Monocytosis TB, convalescense from infections. Remove debris. Monocytosis (monocytes > 1.0 x109/L in adults occurs in a number of disorders, most frequently in the recovery phase of infection, but may be seen in a variety of neoplastic lesions especially myeloproliferative disorders. Monocytosis may result from viral, fungal, rickettsial, and protozoal infections.

Lymphocytosis

Infectious Mononucleosis Univ of Minn Hematography case 1. Kissing disease. Lethargy. Epstein Barr virus

Atypical Lymphocytes - Peripheral Blood Copyright © 1999 by W. B. Saunders Company

Atypical Lymphs v. Monocytes Copyright © 1999 by W. B. Saunders Company

Reactive or Atypical Lymphs

Lymphocytosis Lymphocytoses occur most frequently during viral infections and only rarely in bacterial infection except pertussis. Pertussis or whooping cough is frequently accompanied by a lymphocytosis ( usually 20.0-30.0 x109/L, but may exceed 50.0 x109/L ) of small mature appearing lymphocytes.

The Alder-Reilly anomaly is associated with the genetic mucopoly- saccharidoses. Patients with mucopolysaccharidoses lack the lysozymal enzymes necessary to break down mucopolysaccharides. Dense azurophilic granules, resembling toxic granulation in neutrophils, are seen in all leukocytes. Most characteristic of these disorders are the metachromatic granules surrounded by a clear zone seen in lymphocytes.                                                                                                                                     

Alder Reilly Syndrome

May Hegglin Anomaly Dohle like inclusions and Giant Platelets. Inclusions also found in cells other than neutrophils. Abnormal bleeding.

The Chediak-Higashi syndrome is a rare autosomal recessive condition associated with abnormally large leukocyte granules resulting from fusion of lysozymes. This disorder may affect granulocytes, leukocytes, and monocytes. Chemotaxis and phagocytosis is defective. Platelets lack dense granules and platelet function is abnormal. Giant melanosomes in occular and skin tissues result in hypopigmentation.                                                                                               

Chediak-Higashi Syndrome Univ of Minn, Hematography case 25 Chediak-Higashi Syndrome. Large lysosome like organelles. Defective granules and abnormal fusion of granules. Albinism. Susceptability to pyogenic infections. Death in infancy or childhood. Photophobia and abnormal bleeding.

IM 3/97: atypical or reactive lymphs ↑ Lymphs: large # of lymphs, some may be reactive ↑ Mono: large # of monocytes 75% Eos: large # of eosinophils EOS 3/95: large # of eosinophils Normal P-H: pelger huet, appear as bands, bilobed (pince nez), hypermature nuclear chromatin, normal WBC count pelger huet 7/83: another case of pelger huet, more bilobed Toxic granulation: toxic granulation, increased bands, possible vacuoles and Dohle Toxic left shift: left shift with meta and myelocytes, toxic granulation, etc Toxic vacuoles: small vacuoles in neutrohils Döhle: Döhle bodies (may be faded out) Döhle 12/95: Döhle bodies (may be faded out) Pneumonia: increased bands Leuk rxn WBC 60K: left shift (bands), high WBC count