1. Septicemia

2. Severe Left Shift
Univ of Minn, Hematography case 10

3. 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

4. Toxic Granulation
Hemosurf Demo

5. 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

6. DÖHLE Bodies

7. DÖHLE Bodies

8. DÖHLE Bodies

9. Toxic Vacuoles

10. Intracellular Yeast
UAB Hematopathology

11. Phagocytized yeast

12. 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.

14. Pelger Huet Anomaly

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

16. Pelger Huet
mednet

17. Variations in Pelger Huet

18. Eosinophilia

19. Monocyte
The Crookston Collection

20. 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).

21. 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.

22. 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.

23. Lymphocytosis

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

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

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

27. Reactive or Atypical Lymphs

28. 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 x109/L, but may exceed 50.0 x109/L ) of small mature appearing lymphocytes.

29. 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.
                                                                
                                                                   

30. Alder Reilly Syndrome

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

32. 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.
                                              
                                               

33. 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.

34. 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