1. Practical Hematology Lab WBCs & PLT Abnormal Morphology

2. Platelet Satellitism
Morphology Platelets clumped around neutrophils. Found in EDTA in vitro induced change of no clinical significance except false low platelet count (in vitro).

4. Giant Platelets Morphology Platelet larger than a normal red cell.
Found in
Increased platelet turnover
Myeloproliferative disorders
Myelodysplastic disorders
Myeloproliferative disorders is the name for a group of conditions that cause blood cells, platelets, white blood cells, and red blood cells, to grow abnormally in the bone marrow.
Myelodysplastic Syndromes (MDS) are a group of diverse bone marrow disorders in which the bone marrow does not produce enough healthy blood cells. MDS is often referred to as a “bone marrow failure disorder”.

6. Large Platelets
Morphology Large platelets - larger than one third but less than the size of a red cell.
Found in
Increased turnover of platelets
Myeloproliferative disorders
Myelodysplastic disorders
May Hegglin anomaly
Grey platelet syndrome
Bernard Soulier
Myeloproliferative disorders is the name for a group of conditions that cause blood cells, platelets, white blood cells, and red blood cells, to grow abnormally in the bone marrow
Myelodysplastic Syndromes (MDS) are a group of diverse bone marrow disorders in which the bone marrow does not produce enough healthy blood cells. MDS is often referred to as a “bone marrow failure disorder”.
May–Hegglin anomaly (MHA), also known as Dohle leukocyte inclusions with giant platelets and macrothrombocytopenia with leukocyte inclusions,[1] is a rare genetic disorder of the blood platelets that causes them to be abnormally large.
Gray platelet syndrome (GPS), or platelet alpha-granule deficiency,[1] is a rare congenital autosomal recessive bleeding disorder caused by a reduction or absence of alpha-granules in blood platelets, and the release of proteins normally contained in these granules into the marrow, causing myelofibrosis
Bernard–Soulier syndrome (BSS), also called hemorrhagiparous thrombocytic dystrophy,[2] is a rare autosomal recessive coagulopathy (bleeding disorder) that causes a deficiency of glycoprotein Ib (GpIb), the receptor for von Willebrand factor[3]The incidence of BSS is estimated to be less than 1 case per million persons, based on cases reported from Europe, North America, and Japan. BSS is a giant platelet disorder, meaning that it is characterized by abnormally large platelets

7. Micro Clots
Morphology Fibrin strands, platelets and white cells (in this case - neutrophils) clumped together. Found in In vitro artifact caused by poor venesection technique leads to false low counts - can influence white cell, red cell and platelet counts

8. Platelet Clumping Morphology Small clumps of platelets. Found in
In vitro artifact caused by EDTA or cold and leads to false low platelet count.
Difficult venesection

9. Small plateletes Morphology Small platelets. Found in
Wiskott Aldrich syndrome
Wiskott–Aldrich syndrome (WAS) is a rare X-linked recessive disease characterized by eczema, thrombocytopenia (low platelet count), immune deficiency, and bloody diarrhea (secondary to the thrombocytopenia), includes immunoglobulin M (IgM) deficiency also causes persistent thrombocytopenia and, in its complete form, also causes small platelets, atopy, cellular and humoral immunodeficiency, and an increased risk of autoimmune disease and hematologic malignancy.[

10. Degranulation of Plateletes
Morphology Platelets appear degranulated.
Found in
Grey platelet syndrome
Discharge of platelet granules in vivo (cardiopulmonary bypass, hairy cell leukemia)
Discharge of platelet granules in vitro (poor venesection technique)
Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the body. The CPB pump itself is often referred to as a heart–lung machine or "the pump".
Hairy cell leukemia is a rare, slow-growing cancer of the blood in which your bone marrow makes too many B cells (lymphocytes), a type of white blood cell that fights infection. These excess B cells are abnormal and look "hairy" under a microscope

11. Abnormal WBCs

12. Drumstick
Morphology Drumstick shaped nuclear appendage. ± 1,5 µm in diameter and attached to the nucleus by a filament. Inactive X chromosome of the female.
Found in
Neutrophils of females
Males with Klinefelter syndrome
Klinefelter syndrome (KS) also known as 47,XXY or XXY, is the set of symptoms that result from two or more X chromosomes in males.

13. Sessile Nodule
Morphology Inactive X chromosome found as nodule on neutrophils of females.
Found in
Neutrophils of females

14. Different forms of appendages (arrow): A) form A (drumstick), B) form B (sessile nodules), C) and D) form C (C: tag and D: hook).

15. Hypersegmentation or right shift of neutrophil nuclei
Morphology Average lobe count increased OR increased % of neutrophils with lobes OR > 3% neutrophils with 5 lobes or more. Found in
Megaloblastic anaemia
Iron deficiency
Chronic infection
Liver disease
Uraemia

16. Hypersegmentation

17. Ring shaped nuclei Morphology Nucleus ring or doughnut shaped.
Found in
Acute myeloid leukemia
Chronic granulocytic leukaemia
Megaloblastic anaemia
MDS

18. Detached Nuclear Fragments
Morphology Detached nuclear material in cytoplasm.
Found in
Dysgranulopoiesis
Patients on anti cancer chemotherapy
HIV
Dysgranulopoiesis is characterized primarily by abnormal nuclear configuration (hyposegmented, hypersegmented, or bizarrely segmented nuclei) and abnormal cytoplasmic granulation (hypogranularity or abnormal granules). Dysgranulopoiesis also may occur in a variety of myeloproliferative or myelodysplastic syndromes and in some cases of primary or secondary AML

19. Toxic Granulation
Morphology Increased granulation. Granulation more basophilic and larger than normal.
Found in
Severe bacterial infection.
Non specific finding - seen in tissue damage of various types.
Normal pregnancy.
Therapy with cytokines

20. Toxic Granulation

21. Hypogranulation
Morphology Reduced granulation in neutrophil cytoplasm.
Found in
Myelodysplastic syndromes

22. Dohle Bodies
Morphology Small pale blue cytoplasmic inclusions, often in the periphery of the cell.
Consist of ribosomes and endoplasmic reticulum
Found in
Infective and inflammatory states.
Severe burns
Tuberculosis
Post chemotherapy
Pregnancy
May-Heggling Anomaly
May–Hegglin anomaly (MHA), also known as Dohle leukocyte inclusions with giant platelets and macrothrombocytopenia with leukocyte inclusions, is a rare genetic disorder of the blood platelets that causes them to be abnormally large.

23. Russell bodies Morphology Found in
Are eosinophilic, large, homogenous immunoglobulin-containing inclusions
Found in
a plasma cell undergoing excessive synthesis of immunoglobulin; the Russell body is characteristic of the distended endoplasmic reticulum
This is one cell variation found in chronic inflammation and malignant disorders e.g. multiple myeloma.

24. Phagocytosed Parasites
Morphology Malaria - Plasmodium falciparum
Found in
Severe malaria infection

25. Phagocytosed Platelet
Morphology Platelet in vacuole in neutrophil cytoplasm
Found in
Infection

27. Phagocytosed Red blood cell
Morphology Red cell in vacuole in cytoplasm of neutrophil
Found in
Infection
Auto immune haemolytic anaemia
Incompatible blood transfusion

28. Vaculization

29. Auer Rods
Morphology Small azurophil rods in the cytoplasm of myeloblasts and promyelocytes. Sometimes found in mature neutrophils.
Found in
Acute myeloblastic leukemia.
Myelodysplastic syndromes.

30. Auer Bodies(auer Rod)

31. Macro Neutrophils
Morphology Twice the size of a normal neutrophil with tetraploid DNA content.
Found in
Occasionally in the blood of healthy subjects.
Inherited
Administration of G-CSF
Megaloblastic anaemia
Chronic infection

32. Necrobiotic / Apoptotic neutrophil
Morphology Dense homogenous nuclei (pyknotic)
Found in
Occasionally in healthy subjects In vitro artifact.
AML

33. Shift To The Left
Morphology Presence of precursor of granulocytes in the peripheral blood
Found in
Normal in pregnancy or neonate.
Infections.
Bone marrow fibrosis.
Bone marrow infiltration by malignancies.

34. Pseudo Pelger Huet Anomaly
Morphology Bilobed neutrophils with more condensed chromatin
Found in
Inherited Myelodysplastic syndromes.
Idiopathic myelofibrosis.
Chronic granulocytic leukemia.
Therapy with colchicine, ibuprofen.
Infectious mononucleosis, malaria, myxedema.
CLL
Pelger–Huët anomaly (pronunciation: [pel′gər hyo̅o̅′ət]) is a blood laminopathy associated with the lamin B receptor.[1]
It is characterized by a white blood cell type known as a neutrophil whose nucleus is hyposegmented.[citation needed]
Pelger–Huët anomaly has an autosomal dominant pattern of inheritance.
It is a genetic disorder with an autosomal dominant inheritance pattern. Heterozygotes are clinically normal, although their neutrophils may be mistaken for immature cells which may cause mistreatment in a clinical setting. Homozygotes tend to have neutrophils with rounded nuclei that do have some functional problems

35. Neutrophil aggregation
Morphology Small clumps of neutrophils. Happens in vitro if EDTA anticoagulated blood is allowed to stand. May lead to incorrect WBC.
Found in
In vitro finding.
Infectious mononucleosis.
Bacterial infections.
Auto immune disease.

36. Atypical Lymphocytes
Morphology Pleomorphic. Large with diameter of µm. Abundant, strongly basophilic cytoplasm. Basophilia may be confined to the cytoplasmic margins.
Found in
Viral infections - EBV, CMV, Hep A, Measles.
 Bacterial infections - brucella, tuberculosis.
Protozoa – malaria.
Immunization.
SLE.

37. Plasmacytoid Lymphocyte
Morphology Lymphocyte with basophilic cytoplasm and eccentric nucleus.
Found in
Reactive phenomenon

38. Mott cell
Morphology Plasmacytoid lymphocyte with globular inclusions composed of immunoglobulin.
Found in
Reactive changes in peripheral
blood.

39. Large Granular Lymphocyte
Morphology Small eosinophilic granules in the cytoplasm of large lymphocytes.
Found in
Natural killer cells.
Lymphokine activated T cells.

40. Monocyte Vacuolization
Morphology
Vacuoles in the cytoplasm of monocytes.
Found in
Infections

41. Chediak-Steinbrink-Higashi Anomaly
Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by recurrent pyogenic infections, partial oculocutaneous albinism, progressive neurologic abnormalities, mild coagulation defects.

42. Dohle Body

43. Anisocytosis Of Neutrophils

44. Degeneration Of Nucleus