Hematology and Clinical Microscopy Glossary - College of American ...
Hematology and Clinical Microscopy Glossary - College of American ...
Hematology and Clinical Microscopy Glossary - College of American ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
adjacent to the nucleus, indicating the location <strong>of</strong> the<br />
Golgi apparatus. The cytoplasm is relatively more abundant<br />
than in earlier precursors <strong>and</strong> is amphophilic. Both<br />
azurophilic <strong>and</strong> specific granules are present in the cytoplasm<br />
with specific granules coming to predominate as<br />
maturation progresses.<br />
Neutrophil, Metamyelocyte<br />
Metamyelocytes are the first <strong>of</strong> the postmitotic<br />
myeloid precursors. They constitute 15% to 20% <strong>of</strong><br />
nucleated cells in the bone marrow <strong>and</strong> may be seen in<br />
the blood in pathologic states <strong>and</strong> in response to stress.<br />
They are approximately 10 to 18 μm in diameter. They<br />
are round to oval with a nuclear-to-cytoplasmic ratio<br />
<strong>of</strong> 1.5:1 to 1:1. The nuclear chromatin is condensed <strong>and</strong><br />
the nucleus is indented to less than half <strong>of</strong> the potential<br />
round nucleus (i.e., the indentation is smaller than half<br />
<strong>of</strong> the distance to the farthest nuclear margin). The<br />
cytoplasm is amphophilic containing rare azurophilic or<br />
pink (primary) granules <strong>and</strong> many fine bluish or specific<br />
granules.<br />
Neutrophil, Giant B<strong>and</strong> or Giant<br />
Metamyelocytes<br />
Myeloid precursors that are a result <strong>of</strong> megaloblastic<br />
hematopoiesis are increased in size <strong>and</strong> have nuclei<br />
that show aberrant maturation where the nuclear<br />
features appear less mature than the cytoplasmic<br />
features. Although these changes are usually discussed<br />
in terms <strong>of</strong> the neutrophil series, they may also be<br />
observed in cells in the eosinophil <strong>and</strong> basophil cell lines.<br />
Larger-than-normal metamyelocytes <strong>and</strong> b<strong>and</strong>s with<br />
decreased chromatin clumping are seen in the marrow.<br />
These cells have diameters 1.5 times those <strong>of</strong> normal<br />
metamyelocytes or b<strong>and</strong>s.<br />
Neutrophil, Segmented or B<strong>and</strong><br />
B<strong>and</strong> neutrophils, also known as stabs, <strong>and</strong> segmented<br />
neutrophils constitute 12% to 25% <strong>of</strong> the nucleated cells<br />
in the bone marrow. B<strong>and</strong> neutrophils constitute 5% to<br />
10% <strong>of</strong> the nucleated cells in the blood under normal<br />
conditions. Increased numbers <strong>of</strong> b<strong>and</strong>s appear in the<br />
blood in a number <strong>of</strong> physiologic <strong>and</strong> pathologic states.<br />
The b<strong>and</strong> is round to oval <strong>and</strong> 10 to 18 μm in diameter.<br />
The nuclear-to-cytoplasmic ratio is 1:1.5 to 1:2 <strong>and</strong> the<br />
nuclear chromatin is condensed. The nucleus is indented<br />
to more than half the distance to the farthest nuclear<br />
margin, but in no area is the chromatin condensed to a<br />
single filament. The nucleus can assume many shapes: it<br />
can be b<strong>and</strong>-like; sausage-like; S, C, or U-shaped; <strong>and</strong><br />
twisted <strong>and</strong> folded on itself. The cytoplasm is similar to<br />
that <strong>of</strong> other postmitotic neutrophilic cells, with specific<br />
granules predominating in the pale cytoplasm.<br />
Bone Marrow Cell Identification<br />
The segmented neutrophil, the mature cell <strong>of</strong> the<br />
myeloid series <strong>and</strong> the predominant white cell in blood,<br />
mimics its immediate precursors in size (10 to 15 μm),<br />
shape (round to oval), <strong>and</strong> cytoplasmic appearance<br />
(pale pink cytoplasm with specific granules). The N:C<br />
ratio is 1:3, the most mature <strong>of</strong> any cell in the<br />
neutrophilic series, <strong>and</strong> the nuclear chromatin is<br />
condensed. The nucleus is segmented or lobated<br />
(two to five lobes normally). The lobes are connected<br />
by a thin filament that contains no internal chromatin,<br />
giving it the appearance <strong>of</strong> a solid, thread-like dark line.<br />
The presence <strong>of</strong> these thread-like filaments is the basis<br />
for distinguishing the segmented neutrophil from its<br />
precursor, the b<strong>and</strong> neutrophil. However, in repeated<br />
pr<strong>of</strong>iciency testing studies, it has not been possible to<br />
achieve consistent differentiation between b<strong>and</strong>s <strong>and</strong><br />
segmented neutrophils. Therefore, for the purposes <strong>of</strong><br />
pr<strong>of</strong>iciency testing it is not required that they be<br />
differentiated. (For a detailed guideline for the<br />
differentiation <strong>of</strong> segmented <strong>and</strong> b<strong>and</strong> neutrophils,<br />
see Glassy, 1998).<br />
Neutrophil, Toxic (Includes Toxic<br />
Granulation <strong>and</strong>/or Döhle Bodies,<br />
<strong>and</strong>/or Toxic Vacuolization)<br />
Toxic changes in neutrophils include toxic granulation,<br />
toxic vacuolization, <strong>and</strong> Döhle bodies. Toxic granulation<br />
<strong>and</strong> Döhle bodies each may be present in an individual<br />
cell without the other finding; either change alone is<br />
sufficient to designate a neutrophil as “toxic.” Toxic<br />
granulation is the presence <strong>of</strong> large purple or dark blue<br />
cytoplasmic granules in neutrophils, b<strong>and</strong>s, <strong>and</strong><br />
metamyelocytes. Vacuoles within the cytoplasm <strong>of</strong><br />
these same cells constitute toxic vacuolization.<br />
The vacuoles are variable in size <strong>and</strong> may coalesce,<br />
sometime distorting the neutrophil cytoplasm to<br />
form pseudopodia. EDTA storage may produce<br />
degenerative vacuolization; in this case, only a few,<br />
small, punched-out appearing vacuoles are found.<br />
However, as it may at times be difficult to distinguish<br />
toxic from degenerative vacuoles, it is best not to<br />
consider neutrophil vacuoles to be toxic unless<br />
accompanied by other toxic changes. Döhle bodies<br />
appear as single or multiple blue or gray-blue<br />
inclusions <strong>of</strong> variable size (0.1 to 5.0 μm) <strong>and</strong> shape<br />
(round, or elongated or crescent shaped) in the<br />
cytoplasm <strong>of</strong> neutrophils, b<strong>and</strong>s, or metamyelocytes.<br />
They are <strong>of</strong>ten found in the periphery <strong>of</strong> the cytoplasm,<br />
near the cell membrane. These inclusions represent<br />
parallel str<strong>and</strong>s <strong>of</strong> rough endoplasmic reticulum. In the<br />
May-Hegglin anomaly, inclusions that resemble Döhle<br />
bodies are seen, but in this heritable condition, the<br />
inclusion is due to accumulation <strong>of</strong> free ribosomes <strong>and</strong><br />
the presence <strong>of</strong> 7 to 10 nm parallel filaments. Toxic<br />
800-323-4040 | 847-832-7000 Option 1 | cap.org<br />
25