HAEMATOLOGY

WHITE BLOOD CELL ABNORMALITIES ( INCLUSIONS) MR. SAFARI Normal peripheral blood smear WBC inclusions • They are either congenital or acquired. • Routinely the acquired abnormalities are the ones we come across. Acquired • Dohle bodies • Toxic granulation • Hypersegmented neutrophils • Plasma cell • Auer rods • Döhle bodies appear as single or multiple light blue or gray staining areas in the cytoplasm of a neutrophil.

• They are rough endoplasmic reticulum containing ribonucleic acid (RNA) and may represent localized failure of the cytoplasm to mature.

• Döhle bodies are found in infections, poisoning, burns, and following chemotherapy. • They may also be seen during a normal pregnancy. Dohle body Toxic Granulation: • large dark blue granules in the cytoplasm, associated with severe infection, chemical poisoning, and other toxic states

• When a patient has an infection or a severe inflammatory disorder there is an increase in the neutrophil count (neutrophil leucocytosis or neutrophilia) and the neutrophils also show toxic granulation - coarse granules which are more deeply coloured than normal

Hypersegmentation • neutrophils with 6 or more nuclear segments (lobes). • The better known causes is B12 and folic acid deficiency (megaloblastic anemias). failure of bone marrow blood-forming cells to make DNA,

often caused by vitamin B12 or folate deficiencies, or DNA-replication poisons) . • hypersegmentation Plasma cells plasma cells are more clearly malignant. In addition to large nuclei, they have fine chromatin, occasional nucleoli, and poor cytoplasmic features. Its not normally seen in peripheral blood circulation . The cytoplasm is blue due to immunoglobulin synthesis. They are found in circulation in cases of plasma cell leukaemia. • Plasma cell Auer rods (Auer Bodies) • are needle shaped azurophilic intracytoplasmic inclusion bodies.

• They contain peroxidase and lysosomal enzymes. • They are seen in acute leukaemia (myeloblastic, promyelocytic, monomyelocytic and monocytic), myelodysplastic syndromes (RAEB-2) and chronic monomyeloid leukemia.

Congenital abnormalities chediak-higashi Its inherited and affects infants, children and young adult. It is characterized by grear enlargement of the granules in the leucocyte which at times resemble dohle bodies. white blood cells contain abnormally giant granules. Are found in semi albinos,hepatomegally, adenopathy and lymphodenopathy

Aldes reilly anomaly • Inherited and affects both granulocytes and non granulocytes .

• Characterized by the presence of large azurophilic granules which may be either rod or comma shaped.

• May hide or cover the whole nucleus of the cell. Found in patient with glycolipid disorders.

• These inclusions represent partially degraded mucopolysaccharides within lysosomes. • Images Pelger–Huet anomaly • Pelger-Huët anomaly (PHA) is a rare, inherited blood condition in which the nuclei of several types of white blood cells (neutrophils and eosinophils) have unusual shape (bilobed or dumbbell-shaped) and structure (coarse and lumpy). It may also be called Pelger’s nuclear anomaly, or Pelger-Huët nuclear anomaly. • three neutrophils, all demonstrating the Pelger–Huet anomaly. May Hegglin • demonstrates a characteristic giant platelet with poorly defined granulation. A normal-sized platelet is also present