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Color Plates

Cell Drawings by Dorothy Sturm


Photomicrographs by Ann Bell

Smears were given for photomicrographs by the following individuals and institutions: Dr. Luther Burkett Dr. Marion Dugdale Mrs. Janie Gardner, MS, H(ASCP) Ms. Rachel Lehman, MT(ASCP) Dr. Alvin Mauer Mrs. Ioye Thomas, MT(ASCP) Dr. Frank White Centers for Disease Control, Atlanta, GA LeBonheur Children's Medical Center, Memphis, TN St. Jude Children's Research Hospital, Memphis, TN Regional Medical Center, Memphis, TN

Note: The photomicrographs are from the University of Tennessee Division of Hematology teaching file, which was started more than twenty-five years ago. Stains and staining techniques have changed during this period of time and, hence, cell colors may vary and drawing paper used by the artist has darkened.

38

Plate 1. Myelocytic (Granulocytic) System

1A. Myeloblast

1B. Promyelocyte (Progranulocyte)

1C. Basophilic myelocyte

1K. Eosinophilic myelocyte

1D. Basophilic metamyelocyte

1H. Neutrophilic metamyelocyte

1L. Eosinophilic metamyelocyte

1E. Basophilic band

11. Neutrophilic band

~1F. Basophilic segmented 1J. Neutrophilic segmented

1N. Eosinophilic segmented

39

Plate 2. Myelocytic Cells-Normal

Bone Marrow

2A.

2B.

2C.

2D.

2E.

Plate 2. 1. Myeloblast, 2. Promyelocyte, 3. N. Myelocyte, 4. N. Metamyelocyte, 5. N. Band, 6. N. segmented, 7. Eosinophil, 8. Monocyte, 9 Polychromatophilic erythroblast, 10. Orthochromatic erythroblast, 11. Neutrophil-questionable stage

2F. Basophil

2G. Eosinophilic myelocyte

2H. Myeloblast

21. Promyelocyte

Plate 3. Myelocytic Cells-Normal

Bone Marrow

3A.

3C.

3B.

3D.

3E.

3F.

3G.

6 3

3H.

31.

:lJate3.1. Myeloblast, 2. Promyelocyte, 3. N. Myelocyte, 4. N. Metamyelocyte, 5. N. band, 6. N. segmented, 7. Eosinophilic metamyelocyte, 8. Basophil, 3. Monocyte, 10. Polychromatophilic erythroblast, 11. Orthochromatic erythroblast, 12. Lymphocyte, 13. Plasma cell, 14. Smudge

Plate 4. Cell Types Found on Blood Smears from Normal Individuals

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4A. Erythrocytes 4B. Large lymphocyte with purplish-red (azurophil) granules and deeply indented by adjacent erythrocytes 4C. Neutrophilic segmented 40. Eosinophilic segmented 4E. Neutrophilic segmented

4F. Monocyte with gray blue cytoplasm, coarse linear chromatin, blunt pseudopods 4G. Platelets (thrombocytes) 4H. Lymphocyte 41. Neutrophilic band 4J. Basophil

The arrangement is arbitrary and the number of leukocytes in relation to erythrocytes and thrombocytes is greater than would occur in an actual microscopic field.

42

Plate 5. Lymphocytes

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5A. Small lymphocyte

58, Lymphocyte of intermediate size

5C, Lymphocyte with indented nucleus

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50, Lymphocyte of intermediate size 5E, Lymphocyte with pointed cytoplasmic projections (frayed cytoplasm)

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5F, Spindle-shaped lymphocyte with indented nucleus

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5G, Large lymphocyte with indented nucleus and pointed cytoplasmic projections

5H, Large lymphocyte

51. Large lymphocyte with purplish-red (azurophilic) granules

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5L, Large lymphocyte with purplish-red (azurophilic) granules

5J, Large lymphocyte with irregular cytoplasmic contours

5K, Large lymphocyte with purplish-red (azurophilic) granules and with indentations caused by pressure of erythrocytes

Plate 6. Lymphocytes from Normal Blood Smears

6A. Small lymphocyte; large lymphocyte with holly-leaf edges

6B. Small lymphocyte; large Iymphbcyte with azurophilic granules

6e. Lymphocyte, large

60. Lymphocyte with azurophilic granules

6E. Large lymphocyte

6F. Lymphocyte, intermediate size; small lymphocyte

6G. Large lymphocyte with indented nucleus, azurophilic granules; lymphocyte

6H. Lymphocyte with azurophilic granules; N. segmented

61. Large lymphocyte with azurophilic granules; N. segmented

(Azurophilic granules in lymphocytes are usually countable)

Plate 7. Monocytes

7A. Monocyte with "ground-glass" appearance, evenly distributed fine granules, occasional azurophilic granules, and vacuoles in cytoplasm

7B. Monocyte with blue granular cytoplasm, lobulation of nucleus with linear chromatin

7C. Monocyte with prominent granules and deeply indented nucleus

7D. Monocyte without nuclear indentations

7E. Monocyte with gray-blue cytoplasm, band type of nucleus, linear chromatin, blunt pseudopods, and fine granules

7F. Monocyte with gray-blue cytoplasm, blunt pseudopods, and multilobulated nucleus

7G. Monocyte with segmentedtype nucleus

7H. Monocyte with multiple blunt nongranular pseudopods, nuclear indentations, and folds

71. Monocyte with vacuoles, nongranular ectoplasm, and granular endoplasm

45

Plate 8. Monocytes from Normal Blood Smears

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8A. Monocyte; N. segmented

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8B. Monoeytes

8G. Monocyte; N. segmented

80. Monoeytes

8E. Monocyte with phagocytized RBC

8F. Monocytes

8G. Monocyte; lymphocyte

8H. N. segmented; monocyte

81. Monocyte (top); lymphocyte with azure granules

Plate 9. Comparative Morphology: Early Neutrophils, Monocytes, lymphocytes

9A. N. myelocyte with mixture of neutrophilic and dark reddish-purple granules

98. Monocyte with nuclear fold

9C. Large lymphocyte with scalloped shape and absence of folds in nucleus

9D. N. metamyelocyte with light-pink cytoplasmic color and neutrophilic granules

9E. Monocyte with gray-blue cytoplasm, prominent granules, brain-like convolutions in nucleus and linear chromatin strands

9F. Large lymphocyte with nongranular cytoplasm

9G. N. myelocyte

9H. Typical monocyte with lobulated nucleus, gray-blue granular cytoplasm, and blunt pseudopods

91. Large lymphocyte with purplish-red (azurophilic) granules and lumpy nuclear structure

47


Plate 10. Lymphocytic, Monocytic, Plasmacytic Systems

10A. Lymphoblast

10B. Monoblast

10C. Plasmablast

100. Prolymphocyte

10E. Promonocyte

10F. Proplasmacyte

10G. Lymphocyte with clumped chromatin

10H. Monocyte

101. Plasmacyte

48

Plate 11. Erythroblastic System

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11A. 11 B. 11 C. 11 D. Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthochromatic erythroblast 11 E. Polychromatophilic erythrocyte 11 F. Erythrocyte

Erythroblasts in Normal Bone Marrow

11 G. Proerythroblasts (2), N. segmented, N. myelocyte, N. metamyelocyte, orthochromatic erythroblast

11 H. Proerythroblasts (2), polychromatophilic and orthochromatic erythroblasts, N. band, N. segmented, and smudge

111. Basophilic erythroblasts

11;1. Polychromatophilic (4) and basophilic erythroblasts

11 K. Lymphocyte, orthochromatic erythroblast, basophilic erythroblast

11L. Basophilic (center), polychromatophilic, and orthochromatic erythroblasts; smudge

11M. Orthochromatic erythroblast, lymphocyte (right)

49

Plate 12. Comparative Morphology: Plasmacytes, Lymphocytes, Nucleated Red Cells

12A. Plasmacyte with intense-blue cytoplasm, eccentric nucleus, clear zone, vacuoles, irregular shape (marrow) 12B. Plasmacyte with foamy and fibrillar reddish-blue cytoplasm (marrow) 12C. Lymphocyte with slightly indented nucleus, unevenly stained bluish cytoplasm

120. Lymphocyte with foamy cytoplasm and frayed (hair-like margins 12E. Basophilic erythroblast with reddish-blue cytoplasm (marrow) 12F. Polychromatophilic erythroblast with reddish cytoplasm (marrow)

Plasma Cell, Lymphocytes, Immature Nucleated Red Cells from Bone Marrow and Blood Smears

12G. Plasma cell (marrow)

12H. Lymphocyte; large lymphocyte (blood)

121. Polychromatophilic erythroblasts with reddish cytoplasm in rneqalnblasf anemia (marrow)

50

Plate 13. Plasma Cell Variants on Bone Marrow Smears

13A. Plasma cell with globular bodies (Matt cell) 13B. Plasma cell with globular bodies (Matt cell)

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13C. Plasma cell showing reticular cytoplasmic structure

130. Plasma cell with globular bodies in nucleus, reticular cytoplasmic structure, shaggy margins, and red secretions

13E. Plasma cell with red cytoplasmic border

13F. Plasma cell with "flame" red cytoplasm and two nuclei

13G. Plasma cell with globular bodies (Matt cell)

13H. Plasma cells with globular bodies (Mott cells)

51

Plate 14. Megakaryocytic System

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14A. Magakaryoblast with single oval nucleus, nucleoli, and bluish foamy marginal cytoplasmic blebs 14B. Promegakaryocyte with two nuclei, granular blue cytoplasm, and marginal bubbly cytoplasmic blebs 14C. Megakaryocyte with lobulated nucleus, granular cytoplasm, and without platelets

14D. Megakaryocyte with lobulated nucleus and platelets 14E. Megakaryocytic nucleus with attached platelets 14F. Platelets

52

Plate 15. Megakaryocytes on Normal Bone Marrow Smears

- -A. Megakaryoblast

158. Megakaryoblast

15C. Promegakaryocyte

15D. Promegakaryocyte

15E. Megakaryocyte with lobulated nucleus, granular cytoplasm surrounded by vacuoles, and no platelets

15F. Granular megakaryocytes without platelets

15G. Granular megakaryocytes without platelets

15H. Megakaryocyte with lobulated nucleus and platelets

151. Megakaryocyte with lobulated nucleus and platelets

53

Plate 16. Macrophages on Bone Marrow Smears

16A. Macrophage with reticular cytoplasm, vacuoles, and phagocytized particles

16B. Macrophage with phagocytized erythrocytes and dark-staining particles

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16C. Macrophage with phagocy1ized hemosiderin in cytoplasm

160. Macrophage with phagocytized particles and vacuoles

16E. Macrophage with vacuoles and phagocytized malarial pigment

Plate 17. Macrophages on Bone Marrow Smears

17A. Macrophage with engulfed neutrophil; macrophage with hemosiderin

178, Macrophage with engulfed red cells

17C, Macrophage with pigment

17D, Macrophage with blue pigment

17E, Macrophages with cystine crystals

17F, Plasmacytes around macrophage

17G, Late erythroblasts around macrophage

Plate 18. Early Eosinophils and Mast Cells on Bone Marrow Smears

18A. Early eosinophil with nucleoli and tapering cytoplasmic extensions (formerly called tissue eosinophil)

18B. Mast cell (formerly called tissue basophil)

18C. Eosinophilic myelocyte with cytoplasmic extensions

180. Eosinophilic metamyelocyte

18E. Mast cell

18F. Mast cell

18G. Mast cell

18H. Mast cell

56

Plate 19. Fat Cells on Bone Marrow Smears

19A. Fat cell with small round nucleus, linear chromatin, globular body in nucleus, ample cytoplasm with lipoid globules, wrinkled membrane, reticular stroma, fibrillar marginal structures, and erythrocytes.

198. Fat cell showing cytoplasmic lipoid bodies separated by reticular structures. Mature erythrocytes surround fat cell.

19C. Fat cell

190. Fat cell

19E. Fat cell

19F. Fat cell

Plate 20. Osteoblasts and Osteoclast on Bone Marrow Smears

20A. Osteoblast with prominent light zone in cytoplasm located away from nucleus

20B. Osteoblast with oval eccentric nucleus, distinct linear chromatin and nucleolus, blue bubbly cytoplasm with prominent light zone adjacent to nucleus, and fibrillar marginal structures

20C. Osteoclast: Large multinucleated cell with uneven number of separated oval nuclei with nucleoli, blue granules, and frayed cytoplasmic margins

58

Plate 21. Osteoblasts and Osteoclasts on Bone Marrow Smears

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21 B. Osteoblasts 21 C. Osteoblasts

21 D. Aggregate of osteoblasts

21 E. Osteoclast

21F. Osteoclast

21G. Osteoclasts

21 H. Osteoclast

Plate 22. Endothelial Cells

22A. Endothelial cells

22B. Endothelial cell

22C. Endothelial cells

22D. Endothelial cells

22E. Endothelial cell

22F. Endothelial cells

Plate 23. Shapes of Red Cells

Normal

Crenated

Burr (echinocyte)

Target

Spherocyte Oat (sickle cell)

Sickled

SC crystal

CC crystal

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Elliptocyte (ovalocyte) Stomatocyte Folded cell Marginal achromia (blister) Helmet Pinched

Teardrop, pear, pointed

filamented

Triangular

Poikilospherocyte (small, dark, irregular)

Acanthocyte (thorn, spur, spiculated)

Small fragments

"Schistocyte" refers to helmet. triangular, and small fragments.

Membranous ghost

Crescent (Semilunar)

Plate 24. Erythrocyte Morphology on Blood Smears in Nutritional Anemias

24A. Iran deficiency anemia

24B. Normal erythrocytes

24C. Megaloblastic anemia

240. Iron deficiency anemia: (red cells: microcytic and smaller than nucleus of a small lymphocyte; hypochromic)

24E. Normal erythrocytes

24F. Megaloblastic anemia: (red cells: large and oval; two teardrop cells); hyperlobulated N. segmented

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24G. Iron deficiency anemia after transfusion (two populations of red cells)

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24H. Iron deficiency anemia after iron therapy (two populations of red cells) 241. Megaloblastic anemia (red cells: oval and larger than nucleus of small lymphocyte; two teardrop cells)

Plate 25, Part 1. Erythrocyte Morphology on Blood Smears in Microangiopathic Hemolytic Anemias

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25A. Thrombotic thrombocytopenic purpura (TTP) 25B. Chronic nephritis with hypertension

25C. Sickle cell anemia with schistocytes in some cases of pulmonary embolism

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25E. Chronic nephritis with hypertension

25F Sickle cell anemia with schistocytes in some cases of pulmonary embolism

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25H. Chronic nephritis with hypertension

251. Sickle cell anemia with schistocytes in some cases of pulmonary embolism

Plate 25, Part 2. Erythrocyte Morphology on Blood Smears in Microangiopathic Hemolytic Anemia Due to Heart Valve Dysfunction

Patient 1

Patient 1

Patient 2

Patient 3

Patient 3

Patient 4

Patient 5

Patient 5

Morphology in five patients

64

Plate 26. Anemias with Abnormal Erythrocyte Morphology on Blood Smears

26A. Spur cell anemia

268. Erythrocytes in paroxysmal nocturnal hemoglobinuria

26C. Microangiopathic hemolytic anemia following liver transplant

26D. Erythrocytes in Hemoglobin Zurich after sulfonamides

26E. Erythrocytes in G-6-PD deficiency

26F. Echinocytes (burr cells) in pyruvate kinase deficiency

26G. Hemolytic anemia (bite cells) after dapsone

26H. Hemolytic anemia (spherocytes) due to bite of Loxosceles reclusa

261. Spherocytic anemia due to Clostridium perfringens

Plate 27. Erythrocyte Morphology on Blood Smears in Sickle Cell Anemia, Sickle Cell-Hemoglobin C, Hemoglobin CC

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27C. Hemoglobin CC (Hb CC)

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27A. Sickle cell anemia (Hb SS) 27B. Sickle cell-hemoglobin C (Hb SC)

270. Hemoglobin SS

27E. Hemoglobin SC

27F. Hemoglobin CC

27G. Hemoglobin SS

271. Hemoglobin CC after splenectomy

Plate 28. Moist Unstained Preparations of Blood from Patients with Sickle Cell Trait and Sickle Cell Anemia

28A. Moist unstained preparation of blood from a patient with sickle cell trait showing reversible elongated multipointed red cells

28C. 28B and 28C. Moist unstained preparations of drop of blood from patient with sickle cell anemia mixed with drop of sodium metabisulfite solution showing irreversible elongated sickle cells and a few multipointed erythrocytes

67

Plate 29. Erythrocyte Morphology on Blood Smears in Hereditary Spherocytosis, Hereditary Elliptocytosis, and Thalassemia Major

29A. Hereditary spherocytosis

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298. Hereditary elliptocytosis

29C. Thalassemia maj r (Cooley's anemia)

290. Hereditary spherocytosis

29E. Hereditary elliptocytosis

29F. Thalassemia major (Cooley's _ late erythroblast, Howell-Jolly body

29G. Hereditary spherocytosis

29H. Hereditary elliptocytosis with hemolytic anemia

291. Thalassemia major (Cooley's E.-orthochromatic erythroblasts (4), Howell-Jolly body

Plate 30. Erythrocyte Morphology on Blood Smears from Patients with Thalassemia Minor

:--:-aJassemia minor

30B. ~+-thalassemia minor-Fetal Hb 4.2%

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30C. ~+-thalassemia minor: target cell with stippling (arrow)

~--ihalassemia minor

30E. ~+-thalassemia minor-Fetal Hb 4.2%

30F. ~+-thalassemia minor

3:3. ~+-thalassemia minor

30H. Hemoglobin E-~O-thalassemia

301. alpha-thalassemia 1

Plate 31. Erythrocyte Morphology on Blood Smears from Patients with Burns, Hereditary Pyropoikilocytosis, and Myelofibrosis

31A. Erythrocytes in severely burnedpatient

31B. Hereditary pyropoikilocytosis

31C. Myelofibrosis

31D. Severely burned patient

31E. Hereditary pyropoikilocytosis before incubation of blood

31F. Myelofibrosis

31G. Severely burned patient

31H. Hereditary pyropoikilocytosis after 60 minutes at 45 C Incubation

Plate 32. Stippled Erythrocytes, Polychromatophilic Erythrocytes, and Reticulocytes

32A. Selected stippled erythrocytes in a Wright-stained blood smear from a patient with lead poisoning

328. Selected polychromatophilic erythrocytes in a blood smear, Wright stain

32C. Selected reticulocytes containing granulofilamentous structures in a smear from blood mixed with new methylene blue stain. Polychromatophilic red cells and stippled cells stain as reticulocytes in this preparation

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320. Stippled cells in Wright-stained smear from lead poisoning 32E. Polychromatophilic erythrocytes (arrows) in a Wright-stained smear of thrombotic thrombocytopenic purpura 32F. Reticulocytes increased in a new methylene blue preparation of blood from sickle cell-thalassemia (Sturm)

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32G. Stippled red blood cell; lymphocyte 32H. Polychromatophilic erythrocytes (arrows) in a Wright-stained smear of hemolytic anemia

321. Reticulocytes increased in hemolytic anemia

Plate 33. Erythrocytes with Inclusions

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33A. Orthochromatic erythroblast with partial extrusion of portion of nucleus 338. Stippled orthochromatic erythroblast with Howell-Jolly body and Cabot rings 33C. Erythrocyte containing malarial ring 33D. Thrombocyte on red cell (Note clear area around platelet indicating it is on top of cell)

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33E. Howell-Jolly bodies in erythrocytes 33F Cabot rings in erythrocytes; stippling and HowellJolly body in one red cell with Cabot ring

33G. Cabot ring

33H. Cabot ring, stippling, Howell-Jolly body

331. Malarial ring (left) versus platelet on red cell (right)

33J. Cabot ring in orthochromatic erythroblast

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33K. Howell-Jolly bodies

33L. Plasmodium falciparum rings in red cells

72

Plate 34. Erythrocytes with Siderotic Granules

34A. Wright stain showing one orthochromatic erythroblast and multiple erythrocytes with Pappenheimer bodies (or siderotic granules in iron stain). The granules vary in number, size, shape, and color, and are unevenly distributed.

34B. Prussian blue stain for iron showing one orthochromatic erythroblast with siderotic granules (ringed sideroblast) and erythrocytes containing siderotic granules. The nucleus of the erythroblast stains red with safranin. (Howell-Jolly bodies, Heinz bodies, and stippling do not give a blue color with iron stain).

Erythrocyte Morphology in Blood and Marrow Smears from Sideroblastic Anemia

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34D. Sideroblasts (top). Ringed sideroblasts (below). Prussian blue iron stain (marrow) 34E. Ringed sideroblasts in Prussian blue iron stain (marrow)

::-:;. Erythrocytes with Pappenheimer ~ 55 in Wright stain (blood)

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:Iythrocytes with Pappenheimer .=r:fE in Wright stain (blood) 34G. Erythroblasts with siderotic granules in Prussian blue iron stain (marrow) 34H. Ringed sideroblasts in Prussian Ius iron stain (marrow)

Plate 35. Erythrocytes with Heinz Bodies


Erythrocytes in a moist preparation after four-hour incubation with acetyl-phenylhydrazine followed by staining with crystal violet

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35A. Normal blood with one to four Heinz bodies in most erythrocytes

35B. Erythrocytes from a patient with G-6-PO deficiency. Majority of red cells have five or more Heinz bodies

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35C. Heinz body preparation of normal erythrocytes

350. Heinz body preparation of erythrocytes in Hemoglobin ZOrich

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35E. Heinz body preparation of normal erythrocytes 35F. Heinz body preparation of erythrocytes in G-6-PO deficiency

Plate 36. Erythrocytic Sequence in Bone Marrow: Megaloblastic Anemia, Normal Marrow, and Iron Deficiency Anemia
Left column: Megaloblastic Anemia in B12 and Folic acid deficiencies Middle column: Normal Erythroblast Sequence Right column: Iron Deficiency Anemia (IDA)

Promegaloblast

Proerythroblast

Proerythrobast (small)

Basophilic megaloblast

Basophilic erythroblast

Basophilic erythroblast (small)

Polychromatophilic megaloblast

Polychromatophilic erythroblast

Polychromatophilic erythroblast

Orthochromatic megaloblast

Orthochromatic erythroblast

Orthochromatic erythroblast

Polychromatophilic macrocyte

Polychromatophilic erythrocyte

Polychromatophilic erythrocyte

Macrocyte

Normal erythrocyte

Hypochromic microcyte

Plate 37. Comparison of Erythrocyte Morphology in Blood and Bone Marrow: Iron Deficiency Anemia and Megaloblastic Anemia
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37A. Iron deficiency anemia with microcytic hypochromic erythrocytes (blood)

378. Iron deficiency anemia with three late erythroblasts (iron-deficient) having minimal bluish cytoplasm (marrow)

37C. D. Iron deficiency anemia with numerous late erythroblasts (iron-deficient) having minimal bluish cytoplasm (marrow)

37E. Megaloblastic anemia with large oval and round macrocytes and pear-shaped erythrocytes (blood)

37F. Megaloblastic anemia with large oval and round macrocytes and one orthochromatic megaloblast (blood)

37G. Megaloblastic anemia with three basophilic megaloblasts (marrow)

37H. Megaloblastic anemia with three promegaloblasts (right) and three basophilic megaloblasts (left) (marrow)

76

Plate 38. Pathological Erythroblasts in Bone Marrow of Megaloblastic Anemia

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38A. Polychromatophilic megaloblast with two nuclei 38B. Polychromatophilic megaloblast with fragmentation of nucleus (karyorrhexis) 38C. Basophilic megaloblast with asynchronism between nuclear structure and cytoplasmic color

38D. Basophilic megaloblast with nuclear fragments; asynchronism

38E. Basophilic megaloblast

38F. Orthochromatic megaloblast with degenerated nucleus and stippling

38G. Polychromatophilic erythrocyte (top), polychromatophilic and basophilic megaloblasts

38H. Pro,megaloblast, basophilic and orthochromatic megaloblasts, plasma cell (lower left)

381. Basophilic megaloblast showing asynchronism

38J. Giant orthochromatic megaloblast with Howell-Jolly bodies

77

Plate 39, Part 1. Pathological Erythroblasts and Erythrocytes in Bone Marrow of Megaloblastic Anemia

Selected nucleated and nonnucleated red cells in bone marrow smears of patients with untreated megaloblastic anemia. There is asynchronism between nucleus and cytoplasm with the nucleus less mature than the cytoplasm. Identification of nucleated cells is based primarily on chromatin configuration and not on cytoplasmic coloration. Anisocytosis, poikilocytosis, and anisochromia may be observed in nonnucleated erythrocytes.

39A. Orthochromatic megaloblast showing karyorrhexis and asynchronism 39B. Orthochromatic megaloblast with Howell-Jolly bodies 39C. Teardrop erythrocyte 39D. Basophilic megaloblast with asynchronism 39E. Stippled oval macrocyte 39F. Cabot ring in oval macrocyte 39G. Polychromatophilic macrocyte 39H. Lobulated megaloblastic neutrophil 391. Orthochromatic megaloblast showing karyorrhexis and Howell-Jolly bodies 39J. Promegaloblast with multiple nucleoli 39K. Hypersegmented neutrophil 39L. Pear-shaped erythrocyte 39M. Polychromatophilic megaloblast 39N. Orthochromatic megaloblast with beginning nuclear extrusion

Polychromatophilic megaloblast with asynchronism Microcytic poikilocyte Promegaloblast Macrocyte with Howell-Jolly bodies Mitotic figure Orthochromatic megaloblast with one Howell-Jolly body 39U. Oval macrocyte 39V. Basophilic megaloblast 39W. Basophilic erythroblast

390. 39P. 39Q. 39R. 39S. 39T.

Plate 39, Part 2. Pathological Erythroblasts and Erythrocytes in Bone Marrow of Megaloblastic Anemia

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Plate 40. Pathological Leukocytes

40A. N. segmented with toxic granules

40B. N. segmented with vacuoles and toxic granules

40C. N. metamyelocyte with - toxic granules

40D. Degenerated roun . neutrophil nucleus (old E=~ blood); toxic @ranules

40E. Degenerated neutrophil nucleus (old EDTAblood)

40F. Hyperlobulated neutrophil

40G. N. segmented with engulfed dark nuclear mass (LE cell)*

40H. Monocyte with phagocytized nuclear ma "

401. N. myelocyte, metamyelocyte, segmented with toxic granules (marrow)

40J. N. segmented cells with toxic granules

40K. Degenerated neutrophils (old EDTAblood)

40L. Vacuoles in neutrophils

40M. Dohle bodies in neutrophil

40N. Monocyte with phagocytized red cell

400. Dohle body, toxic h~ in N. segmented


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*40G. Neutrophil which contains a phagocytized reddish-purple nuclear mass from another leukocyte following a special technique which is no longer as an aid in diagnosis. This cell was designated as a so-called "LE cell" since it was observed in patients with lupus erythematosus.

80

Plate 41. Cell Types on Blood Smears of Patients with Pelqar-Huet Anomaly
This hereditary anomaly is characterized by hypolobulation of the nuclei of neutrophils. The chromatin structure of the granulocytes with round or indented nucleus is that of mature cells. The size, chromatin structure, and phagocytic function of these cells are normal.

-. Slightly indented nucleus .sanut" shaped)

418. Nucleus with closely approximated round lobes (pince-nez)

41 C. Round nucleus

41 D. "Peanut"-shaped nucleus

Two "peanut"-shaped nuclei

41 F. Pince-nez nucleus; slightly indented nucleus

41G. "Peanut"-shaped nucleus; slightly indented nucleus (bottom)

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":1H. Pseudo-Pelger cell in ;nyelodysplasia 411. Pseudo-Pelger cell in myelodysplasia 41J. Pelqsr-Huet cell with pince-nez nucleus ote: Pseudo-Pelger cells are observed in myelodysplasia and other myeloid dyscrasias. 8-

Plate 42. Cell Types on Blood Smears from Patients with Chediak-Higashi Anomaly

Leukocytes in smears of blood or of bone marrow from patients with Chediak-Higashi anomaly showing abnormal and giant Iysosomes in the cytoplasm.

42A. Lymphocyte (blood) 42C. Promyelocyte (marrow) 42B. Mitotic figure of promyelocyte (marrow)

42D. Eosinophil-large

granules (blood)

42E. Basophil-large

granules (blood)

42F. Neutrophil segmented (blood)

42G. Lymphocytes, N. segmented (blood)

42H. Lymphocyte (blood)

421. Neutrophil (blood)

42J. Basophil (blood)

42K. Mitotic figure (marrow)

42L. Eosinophilic myelocyte (marrow)

Plate 43. Cell Types on a Blood Smear from a Patient with May-Hegglin Anomaly

Each leukocyte has one (or two) large bluish, elongated, irregularly shaped Diihle-like body

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43A. Monocyte with Diihle-like bodies 43B. Eosinophil with Diihle-like body 43C. Basophil with Diihle-like body

430. Neutrophils with Dohle-like bodies 43E. Large abnormal platelets

The number of cells in drawing is greater than occurs in a single oil-immersion field. Note shape variation in erythrocytes of this patient. The platelets are large and abnormal.

43F. Neutrophil with Dohle-like body (arrow); large platelets

43G. Neutrophil with Dohle-like body (arrows); large platelets

43H. Neutrophil with Dahle-like body (arrows); large platelets

Plate 44. Cell Types on Blood and Marrow Smears from a Patient with Alder-Reilly Anomaly

44A. Neutrophilic myelocyte (marrow)

44B. Neutrophilic metamyelocyte (marrow)

44C. Neutrophilic band (marrow)

440. Neutrophilic segmented (blood)

44E. Basophil (blood)

44F. Eosinophil (blood)

44G. Two neutrophils (blood)

44H. Two neutrophils (blood)

441. Lymphocyte, N. segmented, and basophil (blood)

The cytoplasm of neutrophils and basophils in blood or bone marrow of patients with Alder-Reilly anomaly contain multiple deep blue or lilac, round granules in blood and marrow smears. Eosinophil granules are large.

1
Plate 45. Selected Cells from Blood and Marrow Smears of Patients with Acute and Chronic Myelogenous (Myelocytic) Leukemia

45A. Myeloblast with prominent nucleoli, well-defined chromatin structure, blue cytoplasm with no granules

45C. Myeloblast with Auer rod 458. Megakaryoblast with dark coarse nuclear chromatin structure and blunt vacuolated blebs (marrow)

45D, Atypical promyelocyte with a few dark granules

45E. Atypical promyelocyte with prominent purple granules (marrow)

45F. Atypical promyelocyte with fine and coarse granules

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45G. Atypical early neutrophil (simulating a monocyte) with indented nucleus, intermediate nuclear chromatin structure, nonspecific granules and pale cytoplasm

45H. Progranulocyte variant with abundant granular cytoplasm and irregular margin (marrow) (formerly called Ferrata cell)

451. Macrocytic polyploid neutrophil

Plate 46. Chronic Myelogenous (Myelocytic) Leukemia (CML), Blood Smears: Wright stain, and Leukocyte Alkaline Phosphatase (LAP) stain

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.
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46B. Myeloid cells in CML 46C. Myeloid cells in CML

46A. Myeloid cells in CML (see cell numbers below)

460. Myeloid cells in CM L

46E. Myeloid cells in CML

46F. CML, Leukocyte alkaline phosphatase stain (N. segmented and band are negative)

46G. Pseudo-Pelger cells in CML

46H. CML in AML blast crisis with increase in basophils

I entification of cells: yeloblast, 2. Promyelocyte, 3. N. myelocyte, 4. N. metamyelocyte, 5. N. band, 6. N. segmented, 7. Eosinophil, 8. Basophil, ~. seudo-Pelger neutrophil, 10.Early lymphoid cell (lymphoblast)

Plate 47. Acute Myelogenous (Myelocytic) Leukemia (AML): (FAB) M1, M2, M
Acute myelogenous leukemia: M1 without maturation; M2 with some maturation; M3 acute promyelocytic leukemia

Myeloblasts, MI (blood)

47B. Myeloblasts-positive stain, M1 (blood)

Sudan Black

47C. Myeloblasts with Auer rod (arrow), M1 (blood)

- D. Myeloblast, promyelocyte, M2 : od)

47E. Promyelocytes and myelocyte, M2 (marrow)

47F. Positive myeloperoxidase stain, M2 (marrow)

47G. Hypergranular promyelocytes, M3 (marrow)

47H. Auer rods in early myelocytic celis, M3 (marrow)

471. Promyelocyte with multiple Auer rods, M3 (marrow)

Note: 47A and 47B from same patient; O-F same patient; G-I same patient

Plate 48. Cytochemical Stains, Part 1

-.

Myeloperoxidase Stain: The two upper cells (48A) are myeloperoxidase negative (lymphocytes); the two lower cells (48B) are myeloperoxidase positive (neutrophils). The red cells are laked and appear as shadow forms. This stain is of aid in differentiating early cells of the myelocytic and monocytic systems from cells of the lymphocytic system.

48C. Positive myeloperoxidase stain, AML, M1 (blood)

480. Positive myeloperoxidase stain, AML, M1 (marrow)

48E. Blasts: negative myeloperoxidase stain-ALL (L2) marrow (positive neutrophil in center right serves as quality control for adequate stain)

48F. Large Blasts: negative myeloperoxidase stain-ALL (L3) marrow (positive neutrophil myelocyte in lower center serves as control for adequate stain)

88

Plate 48. Cytochemical Stains, Part 2

Periodic Acid Schiff (PAS) Stain: Reaction for the detection of intracellular glycog2r

48G. PAS positive lymphocyteSezary cell (blood)

48H. Negative PAS reactionlymphocyte (normal blood) Sudan Black Stain: For the detection of lipids

481. Strongly positive PAS reactlo segmented neutrophil (blood)

48J. Positive reaction-immature granulocyte (blood)

48K. Negative reaction-lymphocyte (blood)

48L. Strongly positive reaction-No segmented (blood)

Leukocyte Alkaline Phosphatase (LAP) Stain: For detection of LAP in neutrophils

48M. Positive (2+) reactionneutrophil segmented (blood)

48N. Negative reaction-neutrophil segmented in CML

480. Strongly positive (4+) reactionneutrophil segmented (blood)

48P. Positive PAS stain (3 lymphoblasts) (top left)-ALL, L3 (marrow)

48Q. Positive Sudan Black stain in AML M1 (blood)

48R. Positive LAP stain in myelofibrosis (blood)

48S. Negative LAP stain in CML (blood)

Plate 49. Acute Myelogenous Leukemia (AML) (FAB): M4 and M5


Acute myelomonocytic leukemia: M4; Acute monocytic leukemia M5

49A. M4 (blood)

49B. M4 (blood)

49C. M4 (blood)

490. M5: mono blasts (marrow)

49E. M5: monoblasts (marrow)

49F. M5: positive monocytic esterase stain (marrow)

49G M5: monoblasts (marrow)

49H. M5: monocytes (blood)

491. M5: monocytes and promonocytes (marrow)

Identification of Cells: 1. Monocyte; 2. Promonocyte; 3. Monoblast; 4. N. Myelocyte; 5. Basophil; 6. Eosinophil Note: 49A, 49B same patient; 490, 49G same patient; 49H, 491 same patient

Plate 50. Selected Cells from Patients with Acute Monocytic Leukemia: (FAB) M5

50A. Monoblast: prominent nucleoli, indented nucleus, blunt pseudopods

50B. Monoblast: prominent nucleoli

50C. Monocyte: phagocytized red cell

500. Promonocyte: nuclear folds, foamy cytoplasm

50E. Promonocyte: two nuclear lobes, nucleoli, prominent granules, clear ectoplasm

50F. Monocyte: deeply indented nucleus, fine granular cytoplasm

50G. Monocyte: transparent folded nucleus, granules in cytoplasm

50H. Monocyte: folded nucleus, linear chromatin, distinct granules, elongated shape

501. Promonocyte: nucleoli; vacuoles in cytoplasm

Plate 51. Selected Cells from Blood Smear of Acute Erythroleukemia: (FAB) M6

51A. Macrocytic polychromatophilic erythroblast with three nuclei

51 B. Macrocytic basophilic erythroblast with two nuclei and asynchronism

51 C. Macrocytic basophilic erythroblas; with asynchronism

-.

51 D. Macrocytic orthochromatic erythroblast with five nuclei

51E. Nuclear fragmentation in an erythroblast

51 F. Macrocytic orthochromatic erythroblast with asynchronism

4
51G. M6 (See cells below) 51H. M6 (See cells below) 511. M6 (See cells below)

Identification of cells: 1. Proerythroblasts often with vacuoles; 2. Promyelocyte; 3. Pseudo-Pelger neutrophil; 4. Orthochromatic erythroblast; 5. Mitotic figure; 6. Polychromatophilic erythroblast Asynchronism: nucleus less mature than cytoplasm

Plate 52. Selected Erythroblasts from Bone Marrow Smears of Acute Erythroleukemia: (FAB) M6

52A. Macrocytic proerythroblast: nucleoli and small vacuoles in cytoplasm

52B. Macrocytic proerythroblast: nucleoli and prominent cytoplasmic vacuolization

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52C. Macrocytic basophilic erythroblast: two large nuclei

520. Macrocytic polychromatophilic erythroblast: four nuclei of different sizes; asynchronism

52E. Giant late erythroblast: multiple nuclei, fragmentation of nuclei and Howell-Jolly bodies

52F. Large basophilic erythroblast: three nuclei

Plate 53. Pathological Erythroblasts from Bone Marrow Smears of Acute Erythroleukemia: (FAB) M6

53A. Large basophilic erythroblast

53B. Basophilic erythroblast: two nuclei

53C. Proerythroblast: two nuclei

53D. Large polychromatophilic erythroblast: three nuclei

53E. Macrocytic proerythroblast: four nuclei

53F. Giant polychromatophilic erythroblast: multiple nuclei; nuclear fragments

53G. Prussian blue iron stain: ringed sideroblasts

53H. Periodic Acid Schiff stain: positive polychromatophilic erythroblast

531. Periodic Acid Schiff stain: positive lobulated polychromatophilic erythroblast

Plate 54. Micromegakaryoblasts in Blood and Marrow Smears of Megakaryoblastic Crisis of CMl

Selected cells from patient with megakaryoblastic crisis of chronic myelogenous leukemia. Variant forms of micromegakaryoblasts. Nuclei are usually small and single but one cell has two nuclei. In most cells. granular cytoplasmic blebs (which represent early platelet formation) are noted.

Plate 55. Megakaryoblasts in Blood and Marrow Smears of Acute Megakaryoblastic (Megakaryocytic) leukemia: (FAB) M7

55A. Micromegakaryoblasts (blood)

55B. Megakaryoblasts (marrow)

55G. Megakaryoblast with cytoplasmic blebs; mitotic figure (marrow)

55D. Micromegakaryoblast; large platelet (blood)

55E. Megakaryoblast with blebs and long platelet (marrow)

55F. Megakaryoblast with blebs (marrow)

55G. Megakaryoblast with blebs (marrow)

55H. Megakaryoblast with platelets (marrow)

551. Megakaryoblast with blebs (top left); micromegakaryoblast (marrow)

Plate 56. Myelodysplasia: Blood Smears (BS) and Bone Marrow (8M)

56A. Refractory anemia (RA), BS: anisocytosis, poikilocytosis, anisochromia

56B. RA, BS: poikilocytosis, anisocytosis, anisochromia

56C. RA, BS: poikilocytosis, anisocytosis, anisochromia

56D. Prussian blue iron stain: ringed sideroblasts, macrophage with hemosideMn,RARS,BM

56E. RARS, BM: erythroblastic hyperplasia: orthochromatic, polychromatic erythroblasts; and two nuclei in 2 cells

56F. Proerythroblasts with vacuoles, basophilic, and polychromatic erythroblasts, RARS BM

o
56G. Pseudo-Pelger neutrophils (right); N. metamyelocytes (left), MDSBM 56H. RAEB: Three myeloblasts, 2 basophils, BM 561. CMML: Two atypical vacuolated monocytes, BS Myelodysplasia categories: RA: Refractory anemia; RARS: Refractory anemia with ringed sideroblasts; RAEB: Refractory anemia wit excess blasts; CMML: Chronic myelomonocytic leukemia

Plate 57. Myelofibrosis; Essential Thrombocytosis (ET): Blood Smears

57A. Myelofibrosis: teardrop and oval erythrocytes

57C. Myelofibrosis: teardrop, oval and odd shapes

57D. Myelofibrosis: anisocytoss poikilocytosis; large platelets

57E. Myelofibrosis: N. myelocytes (3), N. segmented

57F. Myelofibrosis: leukocyte alkaline phosphatase stain: positive, 3+ and 4+

57G. Myelofibrosis: myeloblast (top); megakaryoblast; large platelets: one giant platelet

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57H. Myelofibrosis: giant platelet, large platelets

~II. ET:Micromegakaryocyte, -: '7c.sed platelets

57J. ET:thrombocytosis, six lobed N. segmented

57K. ET:thrombocytosis

57L. Essential thrornbocytos.s

Plate 58. Selected Cells in Smears of Acute lymphoblastic leukemia (ALL) and Chronic lymphocytic leukemia (Cll)

58A. lymphoblast with nucleolus, All

588, lymphoblast with prominent nucleoli, All

58e, Prolymphocyte with indistinct nucleolus, All

58D, Prolymphocyte: intermediate chromatin structure, rippled cytoplasm, All

58E, Prolymphocyte: double nuclei, immature nuclear chromatin, All

58F, Atypical early lymphocyte: clumping of nuclear chromatin, purplish-red nongranular cytoplasm, All

58G, Prolymphocyte with deep nuclear cleft, All

58H, Atypical lymphocyte with nuclear lobulation, ell

581.lymphocyte with nuclear fragment, ell

58J, Smudge (frequent in ell)

Plate 59. Acute Lymphoblastic Leukemia (ALL): (FAB) Blood Smear (BS), Bone Marrow (BM), Cerebrospinal Fluid (CSF); Pro lymphocytic

59A. ALL, BS. Smaillymphoblasts: little cytoplasm, no or faint nucleoli, thrombocytopenia (L1)

59B. ALL, BS. Larger Iymphoblasts with nucleoli, thrombocytopenia (L2)

59C. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)

590. T cell ALL, BS. Lymphoc cells with prominent azure granules

59E. ALL, BM. Small Iymphoblasts: no or indistinct nucleoli, little cytoplasm (L 1)

59F. ALL, BM. Larger Iymphoblasts with nucleoli (L2)

59G. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)

59H. All, BM. Acid phosphatee positive stain

591. PAS positive stain, BM. Smaillymphoblasts (L 1)

59J. ALL, CSF.Larger Iymphoblasts with nucleoli (L2)

59K. ALL, BM. Large Iymphoblasts (~ lineage) with vacuoles and nucleoli (L3)

59L. Prolymphocytic leukerna =Large Iymphoblasts with nu =-=

Note: 59A, 59E, 591from same patient; 59B, 59F, 59J from same patient; 59C, 59K from same patient FAB L1: Small blasts; L2: Larger blasts; L3: Large blasts with vacuoles and nucleoli


Plate 60. Chronic lymphocytic leukemia (Cll): Blood Smear (BS) and Bone Marrow (BM); Pro lymphocytic Leukemia (Pll)

60A, Cll: lymphocytes (5), smudge cells (3), platelet (1), BS

60B. ClL: many lymphocytes, smudge cell, no platelets, BS

60C, Comparison: hairy cell (top), prolymphocyte (Pll), lymphocyte, BS

500, ClL: lymphocytes, Iymphoblasts (2), smudge cells BM

60E, Cll: lymphocytes, lymphoblast (I), BM

60F. ClL: lymphocytes, Iymphoblasts (2), smudge cell, BM

=::3.

ClL: lymphocytes, Iymphoblasts =.BM

60H, ClL: numerous small lymphocytes, N, band, orthochromatic erythroblast, BM

601 Pll: big prolymphocyte with nucleolus, BS

Plate 61. Hairy Cell Leukemia: Blood Smears

Selected cells in blood smears from a patient with hairy cell leukemia. These cells have veillike cytoplasmic extrusions and delicate threadlike filaments. Hairy cells tend to push neighboring cells away or aside, leaving clear spaces around the hairy cell. One cell has prominent azure granules and a few hairlike projections.

Plate 62. Hairy Cell leukemia:

Blood (BS) and Bone Marrow (BM)

,
62A. Hairy cells, BS

62B. Hairy cells, BS

62C. Comparison: hairy cell (top), prolymphocytes, lymphocyte, BS

620. Hairy cells, 6 lobed N. segmented, BS

62E. Tartrate resistant acid phosphatase stain: positive hairy celis, BS

62F. Hairy cell, BM

62G. Hairy cells-one cell with cytoplasmic extension, BM

62H. Hairy cells, BM

621. Hairy celis, BM

Plate 63. Pathological Plasma Cells; Plasma Cell Myeloma, Bone Marrow (BM)

63C. Plasma cell: red-staining globules (Russell bodies) 63A. Proplasmacyte: three early nuclei and reticular cytoplasm

63B. Plasma cell: nebulous cytoplasmic margin, multiple globules, pink-staining secretory material

630. Flame type of plasma cell

63E. Plasma cell: eccentric nucleus, red staining crystaline bodies and globules, reticulated cytoplasm

63F. Plasma cell myeloma, BM

63G. Plasma cell myeloma, BM (artifact in larger plasmocyte top left)

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63H. Plasma cell myeloma, BM: note nucleoli in 3 cells 631. (a) Rouleaux of erythrocytes, blood (myeloma); vs (b) Agglutination

Plate 64. Selected Cells from Blood Smears of Sazary Syndrome

64A. Vacuolated atypical immature lymphocyte: indented nucleus, swirled chromatin pattern, nucleoli: Sezary cell

648. Vacuolated atypical early lymphocyte: distinct chromatin pattern: Sezary cell

64C. Atypical lymphocyte of intermediate size: brainlike (cerebriform) convolutions and granules: Sezary cell

64D. Atypical lymphocyte with nuclear folds: Sezary cell

64E. Sezary cell

64F. Sezary cell

64G. Sezary cell

64H. Sezary cell

641. Sezary cell with nuclear convolutions and nuclear fragment

64J. PAS positive Sezary cell

Plate 65. Selected Cells from Blood Smears of Patients with Infectious Mononucleosis

65A. Primitive plasma-like cell

658. Early plasma-like cell: indented nucleus

65C. Early plasma-like cell

-.

650. Large reactive lymphocyte: unevenly stained bluish cytoplasm


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65E. Large lymphocyte: vacuolated periphery

65F. Atypical monocyte; fine and coarse granules, pseudopods

65H. Large lymphocyte: prominent azurophilic granules 65G. Large lymphocyte; azure granules, scalloped borders (indented by red cells) 651. Atypical monocyte

65J. Reactive lymphocytes

65K. Reactive lymphocytes, normal small lymphocyte

65L. Reactive lymphocytes

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Plate 66. Reactive Lymphocytes-from Blood Smears

In this color plate leukocytes other than lymphocytes have been left out. Selected lymphocytes reacting to antigenic stimuli and showing heterogeneous forms have been portrayed in increased numbers in order to reveal the marked variation in size and shape and in nucleus and cytoplasmic characteristics. Note large cells with prominent basophilic cytoplasm, granules in one cell and indentation of some lymphocytes by red cells. Red cells and platelets are normal.

Plate 67. Malarial Parasites on Blood Smears (Wright-Giemsa stain)

Plasmodium falciparum

Plasmodium vivax

Plasmodium malariae

Plasmodium ovale

Early ring

Late ring

Early trophozoite /

Late trophozoite

Immature schizont

Mature schizont

Macrogametocyte

Microgametocyte

Plate 68, Part 1. Malarial Parasites, Blood Smears (Wright-Giemsa stain); Thick Drop Preparations (Giemsa stain)

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68B. P. talciparum gametocytes 68C. P. talciparum gametocyte

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68A. Plasmodium talciparum rings (Wright-Giemsa stain)

680. P. talciparum thick dropmany rings (Giemsa stain)

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68E. P. vivax rings

68E P. vivax ring, immature schizont

68G. P. vivax mature schizont

68H, P. vivaxthick droptrophozoites, schizonts (Giemsa stain)

681. P. malariae ring

68J. P. malariae trophozoite

68K. P. malariae trophozoite ("band" form)

68L. P. malariae mature schizont

-.
68N. Platelet on RBC (left) vs Ring in RBC (right) 680, P. vivax trophozoites 68P. P. vivax trophoz "as

Plate 68, Part 2. Protozoan Parasites: Babesia microti; Plasmodium falciparum

68, Part 2 A. Babesia microti, intracellular and extracellular parasites

68, Part 2 B. Plasmodium talciparum, ring forms (one to four parasites per cell)

&-68, Part 2 C. 68, Part 2 D. Plasmodium falciparum rings

68, Part 2 E. Babesia microti tetrad form and rings

68 Part 2 F. Plasmodium talciparum rings

Plate 69. Infections in Hematology: Blood Smears

69A. Ehriichia phagocytophiia in neutrophil (Wright stain)

69B. Ehriichia phagocytophiia in neutrophil

~
69G. Ehriichia caffenesis in monocyte 690. Ehriichia phagocytophiia in neutrophil

'-

69E. Staphylococci in a neutrophil from a burn patient (Wright stain)

69F. Meningococci in a monocyte (Wright stain)

Plate 70. Histoplasma, Leishmania, Microfilariae on Blood and Marrow Smears

-.
70A. Macrophage with phagocytized Histoplasma capsulatum (marrow) 70B. Macrophage with Leishmania donovani (marrow)

70C. Histoplasma capsulatum in neutrophils at feather end of blood smear

700. Macrophage with amastigotes of Leishmania species

70E. Histoplasma capsulatum in macrophage-bone marrow

70F. Macrophage with amastigotes of Leishmania species

70G. Histoplasma capsulatum in disintegrating cell-blood

70H. Microfilaria in thick drop of blood

Plate 71. Giant Proerythroblasts in Bone Marrow from Patient with Parvovirus B19

Giant proerythroblasts with basophilic cytoplasm containing vacuoles in bone marrow smear stained with Wright stain are characteristic of Parvovirus 819. Note large nuclear inclusions (viral).

PLate 72. Lipid Histiocytes: Bone Marrow Smears

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72A. Gaucher cell

72B. Nieman-Pick cell

72C. Gaucher cell

72D. Nieman-Pick cell

72E. Two Gaucher cells

72F. Three Nieman-Pick cells

Plate 73. Platelets on Blood Smears

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73A. Platelets-idiopathic thrombocytopenic purpura (ITP)

73B. Platelets-May-Hegglin anomaly

73C. Platelets-myelofibrosis

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73E. Platelets-May-Hegglin anomaly

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73H. Giant platelet syndrome

731. Platelet satellitosis (EDTAblood smear)

Plate 74. Origin and Development of Blood Cells

/
Myeloblast Monoblast

Basophilic myelocyte

Neutrophilic myelocyte

Eosinophilic myelocyte Promonocyte

Basophilic metamyelocyte

Neutrophilic metamyelocyte

Eosinophilic metamyelocyte

Basophilic band

Neutrophilic band

Eosinophilic band

35 . nillc segmented

Neutrophilic segmented

Eosinophilic segmented

Monocyte

-------proerytl1roblast MegaKaryoblast

Plasmablast

\3asopl1iliCerytl1robl promegaKarvOcyte

ast

proplasmacyte

POlyc\lromatoPl1iliC ervtl1roblast

MegaKaryocyte wit\1Out platelets

ort\1Ocl1romatic ervtl1roblast

roc POlyCl1rOmatoPl1iliC erytl1 yte

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----------~~~~-------------------------

Index
Figures are indicated by a bold face "F" and the figure number, followed by the page number in parentheses. Page is indicated by number only. . Plates are indicated by a bold face "P" and the plate number. Tables are indicated by a bold face "T" and the table number, followed by the page number in parentheses.

Acanthocyte (spur, thorn) 15, P23, P26 Acid phosphatase stain P59 Acute erythroleukemia P52, P53 Acute lymphoblastic leukemia (ALL) 35, P58-P59 Acute megakaryocytic leukemia P54, P55 Acute myelogenous leukemia 30,31, P45, P47-P49 Acute myelomonocytic leukemia (AML) P30, P49 Alder-Reilly Anomaly 27, P44 Anemia aplastic 20 heart valve dysfunction P25 (Part 2) hemolytic due to burns, venoms 25, P31 hemolytic uremic syndrome 25 iron deficiency 18, P24, P36-P37 megaloblastic 19, P36-P39 (Parts 1-2) microangiopathic hemolytic anemias 25, P25 (Parts 1-2) sickle cell 22, P23, P27-P28 sideroblastic 19, P34 Thalassemia major 22, P29 Thalassemia minor 21,22, P30 Thrombotic thrombocytopenic purpura 25, P25 (Part 1) Anisocytosis 15 Aplastic anemia 20 Auerrod(body) 30,P45,P47 B cell 9, FI (2), F4 (10) Babesiosis 36, P68 (Part 2) Band neutrophil 1-3, FI (2), F2 (3), PI-P3, P74, Tl-T2 (1) Basophil 1,2,5, FI (2), PI-P4, P46, P74, Tl-T2 (1) band 5, FI (2), PI, P74 metamyelocyte 5, FI (2), PI, P74 myelocyte 5, FI (2), PI, P74 segmented 5, FI (2), PI, P74 Basophilic erythroblast 1,7, F1 (2), F7 (17), PH, P36, P74, T2 (1) Basophilic stippling 16, F7 (17), P32 Bite cell 15, P26 Blister cell P23 Blood cells, normal values TI (1) Bone cells l3, P20-P21 Bone marrow cells, normal values T2 (1) Burned patients, erythrocytes in 25, P31 Burr cell 15, P23, P26

Cabot ring 16, F8 (17), P33, P39 (Parts 1-2) CALLA (Common acute lymphoblastic antigen) 9 CD (Cluster designation) Markers 9, F4 (10) Chediak-Higashi anomaly 27, P42 Chronic lymphocytic leukemia (CLL) 33, P58, P60 Chronic myelogenous leukemia (CML) 27, P45-P46 Classification of ALL 35, P58-P59 Classification of AML 30, P45, P47-P55 Classification ofMD5 31, P56, T6 (31) Clostridium perfringens P26 Cooley's anemia 22, P29 Crescent body (semilunar body) P23 Degenerated neutrophil 26, P40 D6We body 26, P40, P43 Drepanocyte (sickle cell) 16 Echinocyte 15, P23, P26 Ehrlichiosis 36, P69 Electrophoresis Hb 22, 23 Elliptocyte 24, P23, P29 Elliptocytosis 24, P23, P29 Endothelial cell 14, P22 Eosinophil 1,4, FI (2), PI-P4, PI8, P74, Tl (1), T2 (1) band 4, FI (2), PI-P2, P74 metamyelocyte 4, FI (2), PI-P3, PI8, P74 myelocyte 4, FI (2), PI-P2, PI8, P74 segmented 4, Fl (2), PI, P4, P74 Erythrocyte acanthocyte (spur, thorn) 15, P23 basophilic erythroblast 7, FI (2), PH, P36, P74, T2 (1) basophilic stippling 16, F7 (17), P32 bite 15, P26 blister (marginal achromia) P23 burn patient 25, P31 burr 15, P23, P26 Cabot ring in 16, F8 (17), P33, P39 (Part 1) crenated P23 crescent (semilunar body) P23 crystals (Hb 55, 5C, CC) 23, P23, P27 echinocyte 15, P23, P26 elliptocyte 24, P23, P29 filamented P23 folded P23 fragment (schistocyte) 16, 25, P23, P25 (Parts 1-2)

118

The Morphology of Human Blood Cells

helmet 15, P23, P25-(Parts 1-2) Heinz body 16, F7 (17), P35 Howell-Jollybody 16,F7 (17),P33,P39 (Parts 1-2) hypochromic 16, P24, P37 inclusions in 7, F7 (17), P32-P35 keratocyte 15 leptocyte 16, P24 macrocyte 15, P24, P36-P37, P39 (Parts 1-2) malaria in 36, P67-P68 membranous ghost P23 microcyte 15, 18, P24, P36-P37, P39 (Parts 1-2) normal 7, 15, P23-P24 orthochromatic erythroblast 7, FI (2), PH, P36, P74, T2 (1) oval (ovalocyte, elliptocyte) 24, P23, P29 pear 20, P23 pinched (pinchered) P23 poikilospherocyte P23 polychromasia 18 polychromatophilic erythroblast 7, FI (2), PH, P36, P74, Tl (1) polychromatophilic erythrocyte 7, 18, FI (2), Pll, P32,P36,P74 proerythroblast 6, FI (2), Pll, P36, P74, T2 (1) ringed sideroblast 18, P34 rouleaux 16,34, P63 schistocyte (fragment) 16,25, P23, P25 (Part 1) semilunar body (crescent) P23 sickle cell (drepanocyte) 16,22, P23, P27, P28 sideroblast 18, P34 siderocyte 18, P34, F7 (17) siderotic granules in 18, F7 (17), P34 spherocyte 16, P23, P26, P29 stippled 16, F7 (17), P32 stomatocyte 16, F9 (24), P23 target 16, P23, P27, P29-P30 teardrop 16, P23, P24, P39 (Parts 1-2), P56-P57 triangular 16, P23, P25 (Part 1) venoms.nn 25, P26 Erythropoiesis 2,6, F1 (2), Pll, P36 Esterase stains monocytic 31 myelocytic 30 FAB classification of ALL 35, P58-P59, T8 (35) FAB classification of AML 30, P45, P47-P55, T5 (30) FAB classification ofMDS 31, P56, T6 (31) Fat cell (lipocyte) 13, PI9 Ferrata cell P45 Fibroblast 15 Folic acid deficiency 19, P24, P36-P39 (Parts 1-2) Fragmented cell (schistocyte) 16,24,25, P23

Gaucher cell P72 G-6-PD Deficiency 15, P26 Granule(s) primary 1,3 secondary 1,3 siderotic (iron-containing)

18, P34

Hairy cell leukemia 33, P60-P62 Heinz body 16, F7 (17), P35 Helmet cell 15, P23, P25 (Parts 1-2) Hematopoiesis 1, FI (2) Hematopoietic stem cell 1, FI (2), F4 (10) Hemoglobin A 22, 23 Hemoglobin Az 23 Hemoglobin AC 23 Hemoglobin AE 23 Hemoglobin AS 22, P28 Hemoglobin ~o thalassemia 22, P29 Hemoglobin ~ + thalassemia 22, P30 Hemoglobin Bart's 21, T4 (21) Hemoglobin concentration 16 Hemoglobin CC 23, P27 Hemoglobin E 23 Hemoglobin E-I3-thalassemia 23, P30 Hemoglobin electrophoresis 22, 23 Hemoglobin H 21 Hemoglobin 0 23 Hemoglobin SC 23, P23, P27 Hemoglobin SS 23, P23, P27-P28 Hemoglobin ZUrich P26 Hereditary elliptocytosis 24, P23, P29 Hereditary pyropoikilocytosis 24, P31 Hereditary spherocytosis 24, P23, P29 Hereditary stomatocytosis 24, F9 (24), P23 Histioplasma capsulatum 37, FH (37), P70 Histoplasmosis 37, P70 HLA-DR 10 Hodgkin's disease 32 Howell-Jolly body 16, F7 (17), P33, P39 (Parts 1-2) Hydropsfetalis 21, T4 (21) Hyperlobulated neutrophil P24, P39-P40 Immunologic classification of adult ALL 35, T7 (35) Inclusions in erythrocytes 16, P33 Infectious mononucleosis 36, P65-P66 Iron deficiency anemia 18, P24, P36-P37 Iron Stain P34, P53-P56 Iron studies 19 Keratocyte 15

The Morphology of Human Blood Cells

L.E. cell P40 Leishmaniasis 37, P70 Leptocyte 16 Leukemia basophilic 5 erythroleukemia (erythroblastic) P51- P53, T5 (30) hairy cell 33, P60-P62 lymphoblastic, acute 35, P58, P59, T7-T8 (35) lymphocytic, chronic 33, P58, P60 megakaryoblastic, acute 30, P54-P55 monocytic, acute 30, P49-P50 myelocytic, chronic 27, P45-P46 myelogenous, acute 30, P45, P47-P55, T5 (30) myelogenous, chronic 27, P45-P46 myelomonocytic, acute 30, P49 myelomonocytic with eosinophilia 30 plasma cell 34 promyelocytic 30, P47, T5 (30) prolymphocytic 11, P59-P60 Leukocyte alkaline phosphatase (LAP) stain 28, P46, P48 (Part 2) Lipocyte (fat cell) 13, Pl9 Lymphoblast 9,35, PIO, P58-P59 Lymphocyte Tl-T2 (1) B cell 9, FI (2), F4 (10) cell markers 9, F4 (10) reactive 36, P65-P66 T cell 9, FI (2), F4 (10) Lymphopoiesis 9, FI (2), F4 (10) Macrocyte 15,20, P24, P37-P39 (Parts 1-2) Macrophage 12, PI6-PI7, P56 Malaria 36, P67-P68 (Parts 1-2) Mast cell 12, Pl8 May Hegglin anomaly 26, P43 Mean corpuscular hemoglobin (MCH) 19,22 Mean corpuscular values 19,20 Mean corpuscular hemoglobin concentration (MCHC) 19,22 Mean corpuscular volume (MCV) 19,20,22 Megakaryoblast 8, FI (2), Pl4-PI5, P74 Megakaryocyte 8, FI (2), PI4-PI5, P74 Megaloblastic anemia 19, P36-P39 (Parts 1-2) Metamyelocyte basophilic 1,5, FI (2), PI-P3, P74 eosinophilic 1,4, FI (2), PI-P3, P74 neutrophilic 1, FI (2), F2 (3),3, F3 (4), PI-P3, P74, T2 (1) Microangiopathic hemolytic anemia (MAHA) 25, P25 (Parts 1-2)

Microcyte 8, 15, 18, P24, P36-P37 Micromegakaryoblasts 8, P54-P55 Monoblast 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30) Monocyte 5,FI (2),P4,P7-IO,P74, Tl-T2 (1) Monocytic leukemia 6,30, P49-P50, T5 (30) Myeloblast 1, FI (2), PI-P3, P45-P47, P74 Myelocyte basophilic 1,5, FI (2), PI-P3, P74 eosinophilic 1,4, FI (2), PI-P3, P74 neutrophilic 1,3, FI (2), PI-P3, P74 Myelodysplastic syndrome 31, P56 Myelofibrosis 29, P57, P73 Myelogenous leukemia P45-P48 acute 30, P45-P55, T5 (30) chronic 27, P45-P46, P48 Myeloid: Erythroid ratio 1, T2 (1) Myeloma 34, FIO (34), P63 Myeloperoxidase stain (MPO) 30, P48 (Part 1) Myelopoiesis 1, FI (2) Neiman-Pick disease P72 Neutrophilic band 1-3, FI (2), F2 (3), PI-P4, P74, Tl-T2 (1) degenerated 26, P40 hypersegmented 26, P39-P40 hyposegmented (Pelger-Huet) 26, P41 metamyelocyte 1-3, FI (2), F2 (3), PI-P3, P74, T2 (1) myelocyte 1-3, FI (2), F2 (3), PI-P3, P74, T2 (1) segmented 1-4, FI (2), F2 (3), F3 (4), PI, P74, Tl-T2 (1) Non-Hodgkin's lymphoma 32 Normal values bone marrow 1, T2 (1) peripheral blood 1, Tl (1) MCH 19 MCHC 19,22 MCV 19,20,22 RDW 19,20,22 Orthochromatic erythroblast 7, FI (2), P11, P36, P74, T2 Osteoblast 13, F5 (14), P20-P21 Osteoclast 14, F6 (14), P20-P21 Pappenheimer body (siderocyte) 18, F7 (17), P34 Parvovirus B 19 37, P71 Pelger-Huet anomaly 26, P41 Periodic Acid Schiff (PAS) stain P48 (Part 2), P53, P59,P64

120

The Morphology of Human Blood Cells

Peroxidase stain 30, P48 (Part 1) Plasmablast 12, PlO, P63, P74 Plasma cell (Plasmacyte) 11, P10, P74 Plasma cell leukemia 12 Plasmodium falciparum 36, P67-P68 (Parts 1-2) malariae 36, P67-P68 (Part 1) ovale 36, P67 vivax 36, P67-P68 (Part 1) Platelet (thrombocyte) 8, Fl (2), P4, PI4-PI5, P73, P74 Pluripotent stem cell F4 (10) Poikilocytosis 15 Polychromasia 18 Polychromatophilic erythroblast 7, Fl (2), Pll, P36, P74 Polychromatophilic erythrocyte 7, 18, Fl (2), PI I, P32, P36,P74 Polycythemia vera 27,28 Precursor compartment 1, FI (2) Pre-B cell 9, FI (2), F4 (10) Pre- T cell FI (2) Pro-B cell 9, F4 (10) Pro- T cell F4 (10) Proerythroblast 6, F1 (2), PIl, P36, P74, T2 (1) Progenitor compartment 1, FI (2) Prolymphocyte ll, PIO, P58-P60, P74 Pro megakaryocyte 8, FI (2), PI4-PI5, P74 Promonocyte 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30) Promyelocyte (progranulocyte) 3, FI (2), PI-P3, P46-P47, P74 Proplasmacyte 12, PlO, P74 Prothymocyte F4 (10) Prussian blue iron stain on erythrocytes P34, P53, P56 macrophage P56 Pseudo-Pelger Huet cell 31, P56 Pyropoikilocytosis, hereditary 24, P3I Red cell distribution width (RDW) 19,20, T3 (19) Reactive lymphocyte 36, P65-66 Reticulocyte 18, F7 (17), P32 Ringed sideroblast 18, 19, P34 Rouleaux 12,34, P63 Russell body (plasma cell) 11, P63 Satellitosis (platelets around neutrophil) 9, P73 Schistocyte 16,25, P23, P25 (Parts 1-2) Semilunar (crescent) body P23 Sezary syndrome 34, P48, P64 Sickle cell 22, P23, P27, P28 Sickle cell anemia (Hb SS) 22, P23, P27-P28 Sickle cell-hemoglobin SC disease (Hb SC) 23, P23, P27

Sickle cell trait (Hb AS) 22, P28 Sideroblast-ringed 18,19, P34 Sideroblastic anemia 19, P34 Siderocyte 18, F7 (17), P34 Smudge cell 33, P60 Spherocyte 16,24, P23, P26, P29 Spherocytosis, hereditary 24, Pi9 Spider bite on RBC 25, P26 Spur cell P26 Stem cell l , FI (2), F4 (10) Stem cell compartment 1 Stippled red blood cell 16, F7 (17), P32 Stomatocyte 16,24, F9 (24), P23 Stomatocytosis, hereditary 16,24, F9 (24), P23 Sudan black B stain 30, P47, P48 (Part 2) Target cell 16,21,22, P23, P27 Tartrate-resistant acid phosphatase (TRAP) 33, 34, P62 T cell 9, Fl (2), F4 00) T-cell receptor (TCR) 9,10 Terminal deoxynucleotidyl transferose (TdT) 9,30, F4 (10) Teardrop cell 16, P23-P24, P37, P39 (Parts 1-2) Thalassemia alpha 21 beta 21,23 major 21,22, P29, P30 minor 21,22, P30 Thermal injury to RBC 25, P31 Thrombocyte (platelet) satellitosis P73 Thrombocythemia, essential 29, P57 Thrombotic thrombocytopenic purpura (TTP) 25, P25 (Part 1) Thymocyte F4 (10) Thymus FI (2), F4 (10) Tissue basophil PI8 Tissue eosinophil PI8 Toxic granules 26, P40 Venoms on erythrocytes 25, P26 Vitamin B12, Folic Acid deficiency 19, P36-P39 (Parts 1-2)

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