Color Plates

Cell Drawings by Dorothy SturmPhotomicrographs by Ann Bell

Smears were given for photomicrographs by the following individuals and institutions:Dr. Luther BurkettDr. Marion DugdaleMrs. Janie Gardner, MS, H(ASCP)Ms. Rachel Lehman, MT(ASCP)Dr. Alvin MauerMrs. Ioye Thomas, MT(ASCP)Dr. Frank WhiteCenters for Disease Control, Atlanta, GALeBonheur Children's Medical Center, Memphis, TNSt. Jude Children's Research Hospital, Memphis, TNRegional Medical Center, Memphis, TN

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

38

Plate 1. Myelocytic (Granulocytic) System

1C. Basophilic myelocyte

1D. Basophilic metamyelocyte

1E. Basophilic band

~-1F. Basophilic segmented

1A. Myeloblast

1B. Promyelocyte(Progranulocyte)

1H. Neutrophilicmetamyelocyte

11. Neutrophilic band

1J. Neutrophilic segmented

1K. Eosinophilicmyelocyte

1L. Eosinophilicmetamyelocyte

1N. Eosinophilicsegmented

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

3A.

Plate 3. Myelocytic Cells-Normal Bone Marrow

3B.

3C.

3D. 3E.

3F.

3H.

3G.

3

31.

6

4

: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

~ ~G t\;

(

4A. Erythrocytes4B. Large lymphocyte with purplish-red (azurophil) granules and deeply

indented by adjacent erythrocytes4C. Neutrophilic segmented40. Eosinophilic segmented4E. Neutrophilic segmented

4F. Monocyte with gray blue cytoplasm, coarse linear chromatin,blunt pseudopods

4G. Platelets (thrombocytes)4H. Lymphocyte41. Neutrophilic band4J. Basophil

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

42

5A. Small lymphocyte

50, Lymphocyte ofintermediate size

5G, Large lymphocyte with indentednucleus and pointed cytoplasmicprojections

5J, Large lymphocyte with irregularcytoplasmic contours

Plate 5. Lymphocytes

58, Lymphocyte ofintermediate size

5E, Lymphocyte with pointedcytoplasmic projections (frayedcytoplasm)

5H, Large lymphocyte

4/0_ •.• ,

, .\ l.,.!"r

.0 .9

• I

5K, Large lymphocyte with purplish-red(azurophilic) granules and withindentations caused by pressure oferythrocytes

~'

5C, Lymphocyte with indentednucleus

r1;'", A ,-s=5F, Spindle-shapedlymphocyte with indentednucleus

:..-,•

51. Large lymphocyte withpurplish-red (azurophilic)granules

...J fr

5L, Large lymphocyte withpurplish-red (azurophilic)granules

Plate 6. Lymphocytes from Normal Blood Smears

6A. Small lymphocyte; large lymphocyte withholly-leaf edges

6e. Lymphocyte, large

6F. Lymphocyte, intermediate size; smalllymphocyte

6H. Lymphocyte with azurophilicgranules; N. segmented

60. Lymphocyte with azurophilicgranules

6B. Small lymphocyte; large Iymphbcyte withazurophilic granules

6E. Large lymphocyte

6G. Large lymphocyte with indentednucleus, azurophilic granules; lymphocyte

61. Large lymphocyte with azurophilicgranules; N. segmented

(Azurophilic granules in lymphocytes are usually countable)

7A. Monocyte with "ground-glass"appearance, evenly distributed finegranules, occasional azurophilicgranules, and vacuoles in cytoplasm

7D. Monocyte without nuclearindentations

7G. Monocyte with segmented-type nucleus

Plate 7. Monocytes

7B. Monocyte with blue granularcytoplasm, lobulation of nucleuswith linear chromatin

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

7H. Monocyte with multiple bluntnongranular pseudopods, nuclearindentations, and folds

7C. Monocyte withprominent granules anddeeply indented nucleus

7F. Monocyte with gray-bluecytoplasm, blunt pseudopods, andmultilobulated nucleus

71. Monocyte with vacuoles,nongranular ectoplasm, andgranular endoplasm

45

8A. Monocyte;N. segmented

80. Monoeytes

8G. Monocyte; lymphocyte

-

Plate 8. Monocytes from Normal Blood Smears

8B. Monoeytes\..

8E. Monocyte withphagocytized RBC

8H. N. segmented; monocyte

"\

8G. Monocyte;N. segmented

8F. Monocytes

81. Monocyte (top); lymphocyte withazure granules

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

9A. N. myelocyte with mixture ofneutrophilic and dark reddish-purplegranules

9D. N. metamyelocyte with light-pinkcytoplasmic color and neutrophilicgranules

9G. N. myelocyte

98. Monocyte with nuclear fold

9E. Monocyte with gray-bluecytoplasm, prominent granules,brain-like convolutions in nucleusand linear chromatin strands

9H. Typical monocyte with lobulatednucleus, gray-blue granularcytoplasm, and blunt pseudopods

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

9F. Large lymphocyte withnongranular cytoplasm

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

47

•••

Plate 10. Lymphocytic, Monocytic, Plasmacytic Systems

10A. Lymphoblast 10B. Monoblast

100. Prolymphocyte 10E. Promonocyte

10G. Lymphocyte withclumped chromatin

10H. Monocyte

48

10C. Plasmablast

10F. Proplasmacyte

101. Plasmacyte

11A. Proerythroblast11 B. Basophilic erythroblast11 C. Polychromatophilic erythroblast11 D. Orthochromatic erythroblast

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

111. Basophilic erythroblasts

11 K. Lymphocyte, orthochromaticerythroblast, basophilic erythroblast

Plate 11. Erythroblastic System

c F

11 E. Polychromatophilic erythrocyte11 F. Erythrocyte

Erythroblasts in Normal Bone Marrow

11 H. Proerythroblasts (2), polychromatophilic andorthochromatic erythroblasts, N. band, N. segmented, andsmudge

11;1. Polychromatophilic (4) andbasophilic erythroblasts

11L. Basophilic (center), polychro-matophilic, and orthochromaticerythroblasts; smudge

11M. Orthochromatic erythroblast,lymphocyte (right)

49

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

F

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 stainedbluish cytoplasm

120. Lymphocyte with foamy cytoplasm and frayed (hair-likemargins

12E. Basophilic erythroblast with reddish-blue cytoplasm(marrow)

12F. Polychromatophilic erythroblast with reddish cytoplasm(marrow)

12G. Plasma cell (marrow)

50

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

12H. Lymphocyte; large lymphocyte (blood) 121. Polychromatophilic erythroblastswith reddish cytoplasm in rneqalnblasfanemia (marrow)

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)

'\

•• •

13C. Plasma cell showing reticular cytoplasmic structure 130. Plasma cell with globular bodies in nucleus,reticular cytoplasmic structure, shaggy margins, andred secretions

13E. Plasma cell with red cytoplasmicborder

13F. Plasma cell with "flame" redcytoplasm and two nuclei

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

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

51

Plate 14. Megakaryocytic System

14A. Magakaryoblast with single oval nucleus, nucleoli, andbluish foamy marginal cytoplasmic blebs

14B. Promegakaryocyte with two nuclei, granular bluecytoplasm, and marginal bubbly cytoplasmic blebs

14C. Megakaryocyte with lobulated nucleus, granularcytoplasm, and without platelets

52

A B

c

lb·· •

E F

14D. Megakaryocyte with lobulated nucleus and platelets14E. Megakaryocytic nucleus with attached platelets14F. Platelets

Plate 15. Megakaryocytes on Normal Bone Marrow Smears

- -A. Megakaryoblast

15D. Promegakaryocyte

15G. Granular megakaryocytes withoutplatelets

158. Megakaryoblast

15E. Megakaryocyte with lobulatednucleus, granular cytoplasmsurrounded by vacuoles, andno platelets

15H. Megakaryocyte with lobulatednucleus and platelets

15C. Promegakaryocyte

15F. Granular megakaryocytes without platelets

151. Megakaryocyte with lobulated nucleusand platelets

53

Plate 16. Macrophages on Bone Marrow Smears

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

16C. Macrophage with phagocy1izedhemosiderin in cytoplasm

•

16B. Macrophage with phagocytized erythrocytesand dark-staining particles

.•.

160. Macrophage with phagocytizedparticles 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 cytoplasmicextensions (formerly called tissue eosinophil)

18C. Eosinophilic myelocyte withcytoplasmic extensions

18E. Mast cell

18G. Mast cell

56

18B. Mast cell (formerly called tissuebasophil)

180. Eosinophilic metamyelocyte

18F. Mast cell

18H. Mast cell

Plate 19. Fat Cells on Bone Marrow Smears

19A. Fat cell with small round nucleus, linear chromatin, globularbody in nucleus, ample cytoplasm with lipoid globules, wrinkledmembrane, reticular stroma, fibrillar marginal structures, anderythrocytes.

19C. Fat cell

19E. Fat cell

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

190. Fat cell

19F. Fat cell

Plate 20. Osteoblasts and Osteoclast on Bone Marrow Smears

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

20B. Osteoblast with oval eccentric nucleus, distinctlinear chromatin and nucleolus, blue bubbly cytoplasmwith prominent light zone adjacent to nucleus, andfibrillar marginal structures

20C. Osteoclast: Large multinucleated cell with uneven numberof separated oval nuclei with nucleoli, blue granules, and frayedcytoplasmic margins

58

Plate 21. Osteoblasts and Osteoclasts on Bone Marrow Smears

A

!- G21B. Osteoblasts

21D. Aggregate of osteoblasts

21F. Osteoclast

21C. Osteoblasts

21E. Osteoclast

21G. Osteoclasts 21H. Osteoclast

Plate 22. Endothelial Cells

22A. Endothelial cells

22C. Endothelial cells

22E. Endothelial cell

22B. Endothelial cell

22D. Endothelial cells

22F. Endothelial cells

Plate 23. Shapes of Red Cells

Normal Crenated Burr (echinocyte)

Target SpherocyteOat (sickle cell)

Sickled SC crystal CC crystal

,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

240. Iron deficiency anemia: (red cells: 24E. Normal erythrocytesmicrocytic and smaller than nucleus of asmall lymphocyte; hypochromic)

'"24G. Iron deficiency anemia aftertransfusion (two populations of red cells)

".~~ 0~

24H. Iron deficiency anemia after irontherapy (two populations of red cells)

24C. Megaloblastic anemia

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

•,241. Megaloblastic anemia (red cells:oval and larger than nucleus of smalllymphocyte; two teardrop cells)

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

,25A. Thrombotic thrombo-cytopenic purpura (TTP)

== "TTP

::::'0.TTP

25B. Chronic nephritis withhypertension

25E. Chronic nephritis with hypertension

!it. ,.#fIJ

25H. Chronic nephritis with hypertension

-- .•.-.Y.,6) a-/ .• •.~~..., •25C. Sickle cell anemia withschistocytes in some cases ofpulmonary embolism

25F Sickle cell anemia with schistocytes insome cases of pulmonary embolism

Ji&~"

251. Sickle cell anemia with schistocytes insome cases of pulmonary embolism

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

Patient 1

r -

Patient 3

Patient 4

64

Patient 1 Patient 2

Patient 3

Patient 5

Morphology in five patients

Patient 5

Plate 26. Anemias with Abnormal Erythrocyte Morphology on Blood Smears

26A. Spur cell anemia

26D. Erythrocytes in HemoglobinZurich after sulfonamides

26G. Hemolytic anemia (bite cells)after dapsone

268. Erythrocytes in paroxysmalnocturnal hemoglobinuria

26E. Erythrocytes in G-6-PDdeficiency

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

26C. Microangiopathic hemolyticanemia following liver transplant

26F. Echinocytes (burr cells) inpyruvate kinase deficiency

261. Spherocytic anemia due toClostridium perfringens

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

27A. Sickle cell anemia (Hb SS)

270. Hemoglobin SS

27G. Hemoglobin SS

6

~

Ii.·)/.27B. Sickle cell-hemoglobin C(Hb SC)

27E. Hemoglobin SC

,.27C. Hemoglobin CC (Hb CC)

27F. Hemoglobin CC

271. Hemoglobin CC after splenectomy

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

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

28C.

28B and 28C. Moist unstained preparations of drop of blood from patient with sickle cell anemia mixed with drop of sodiummetabisulfite 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

-290. Hereditary spherocytosis

29G. Hereditary spherocytosis

298. Hereditary elliptocytosis

29E. Hereditary elliptocytosis

••29H. Hereditary elliptocytosis withhemolytic anemia

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

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

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

~--ihalassemia minor

3:3. ~+-thalassemia minor

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

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

30H. Hemoglobin E-~O-thalassemia

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

30F. ~+-thalassemia minor

301. alpha-thalassemia 1

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

31A. Erythrocytes in severelyburnedpatient

31D. Severely burned patient

31G. Severely burned patient

31B. Hereditary pyropoikilocytosis

31E. Hereditary pyropoikilocytosis beforeincubation of blood

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

31C. Myelofibrosis

31F. Myelofibrosis

Plate 32. Stippled Erythrocytes, Polychromatophilic Erythrocytes, and Reticulocytes

32A. Selected stippled erythrocytesin a Wright-stained blood smear froma patient with lead poisoning

320. Stippled cells in Wright-stainedsmear from lead poisoning

32G. Stippled red blood cell;lymphocyte

328. Selected polychromatophilicerythrocytes in a blood smear,Wright stain

I,/

32C. Selected reticulocytes containinggranulofilamentous structures in a smearfrom blood mixed with new methyleneblue stain. Polychromatophilic red cellsand stippled cells stain as reticulocytes inthis preparation

32F. Reticulocytes increased in a newmethylene blue preparation of bloodfrom sickle cell-thalassemia(Sturm)

,/,/

32E. Polychromatophilic erythrocytes(arrows) in a Wright-stained smear ofthrombotic thrombocytopenic purpura

••

•..-...32H. Polychromatophilic erythrocytes(arrows) in a Wright-stained smear ofhemolytic anemia

321. Reticulocytes increased inhemolytic anemia

33A. Orthochromaticerythroblast with partialextrusion of portion ofnucleus

o

Plate 33. Erythrocytes with Inclusions

..~....

<tJ338. Stippled orthochromaticerythroblast with Howell-Jollybody and Cabot rings

33E. Howell-Jolly bodies in erythrocytes

33G. Cabot ring

33J. Cabot ring in orthochromaticerythroblast

72

33H. Cabot ring, stippling, Howell-Jollybody

• -e·o•••••••33K. Howell-Jolly bodies

33C. Erythrocytecontaining malarial ring

33D. Thrombocyte on red cell(Note clear area around plateletindicating it is on top of cell)

-.

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

331. Malarial ring (left) versus plateleton red cell (right)

r....

33L. Plasmodium falciparum rings inred cells

Plate 34. Erythrocytes with Siderotic Granules

34A. Wright stain showing one orthochromatic erythroblastand multiple erythrocytes with Pappenheimer bodies (orsiderotic 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 orthochromaticerythroblast with siderotic granules (ringed sideroblast) anderythrocytes containing siderotic granules. The nucleus of theerythroblast stains red with safranin. (Howell-Jolly bodies,Heinz bodies, and stippling do not give a blue color withiron stain).

Erythrocyte Morphology in Blood and Marrow Smears from Sideroblastic Anemia

• .- .. "., ..

&

.,.." * . ,

'f

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

•

_--= :Iythrocytes with Pappenheimer.=r:fE£ in Wright stain (blood)

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

.....t...34G. Erythroblasts with siderotic granules inPrussian blue iron stain (marrow)

.*

34E. Ringed sideroblasts in Prussian blueiron stain (marrow)

34H. Ringed sideroblasts in Prussian Iusiron 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

••

• •• •

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

••,

-".•

•• •

•

35C. Heinz body preparation of normal erythrocytes

,

•35E. Heinz body preparation of normal erythrocytes

•• •• 4.. -....#I •••• • \- .-

••• -.

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

•

• ••~ .

.~.1Ifi-

"..•. --""..../J --l

- - * .•..'~

••.. ."

350. Heinz body preparation of erythrocytes inHemoglobin ZOrich

c.I

35F. Heinz body preparation of erythrocytesin G-6-PO deficiency

Plate 36. Erythrocytic Sequence in Bone Marrow: Megaloblastic Anemia, Normal Marrow,and Iron Deficiency Anemia

Left column: Megaloblastic Anemia inB12 and Folic acid deficiencies

Middle column: NormalErythroblast Sequence

Right column: IronDeficiency Anemia (IDA)

Promegaloblast Proerythroblast Proerythrobast (small)

Basophilic megaloblast Basophilic erythroblast Basophilic erythroblast (small)

Polychromatophilicmegaloblast

Polychromatophilicerythroblast

Polychromatophilicerythroblast

Orthochromatic megaloblast Orthochromatic erythroblast Orthochromatic erythroblast

Polychromatophilic macrocyte Polychromatophilic erythrocyte Polychromatophilicerythrocyte

Macrocyte Normal erythrocyte Hypochromic microcyte

Plate 37. Comparison of Erythrocyte Morphology in Blood and Bone Marrow:Iron Deficiency Anemia and Megaloblastic Anemia

/

.- JIll!!

37A. Iron deficiency anemia with microcytic hypochromicerythrocytes (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)

o

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

37G. Megaloblastic anemia with three basophilicmegaloblasts (marrow)

76

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

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

-

Plate 38. Pathological Erythroblasts in Bone Marrow of Megaloblastic Anemia

38A. Polychromatophilicmegaloblast with two nuclei

38D. Basophilic megaloblast withnuclear fragments; asynchronism

<38B. Polychromatophilicmegaloblast with fragmentationof nucleus (karyorrhexis)

38C. Basophilic megaloblast withasynchronism between nuclearstructure and cytoplasmic color

38E. Basophilic megaloblast 38F. Orthochromatic megaloblastwith degenerated nucleus andstippling

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

381. Basophilic megaloblast showing asynchronism

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

•••

38J. Giant orthochromatic megaloblast with Howell-Jollybodies

77

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

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

39A. Orthochromatic megaloblast showing karyorrhexis andasynchronism

39B. Orthochromatic megaloblast with Howell-Jolly bodies39C. Teardrop erythrocyte39D. Basophilic megaloblast with asynchronism39E. Stippled oval macrocyte39F. Cabot ring in oval macrocyte39G. Polychromatophilic macrocyte39H. Lobulated megaloblastic neutrophil391. Orthochromatic megaloblast showing karyorrhexis and

Howell-Jolly bodies39J. Promegaloblast with multiple nucleoli39K. Hypersegmented neutrophil39L. Pear-shaped erythrocyte39M. Polychromatophilic megaloblast39N. Orthochromatic megaloblast with beginning

nuclear extrusion

390. Polychromatophilic megaloblast with asynchronism39P. Microcytic poikilocyte39Q. Promegaloblast39R. Macrocyte with Howell-Jolly bodies39S. Mitotic figure39T. Orthochromatic megaloblast with one

Howell-Jolly body39U. Oval macrocyte39V. Basophilic megaloblast39W. Basophilic erythroblast

7

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

..

40A. N. segmented with toxicgranules

40E. Degenerated neutrophilnucleus (old EDTAblood)

401. N. myelocyte,metamyelocyte, segmented withtoxic granules (marrow)

40L. Vacuoles in neutrophils

Plate 40. Pathological Leukocytes

40B. N. segmented withvacuoles and toxic granules

40F. Hyperlobulated neutrophil

40C. N. metamyelocyte with- toxic granules

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

40J. N. segmented cells withtoxic granules

40M. Dohle bodies inneutrophil

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

40H. Monocyte withphagocytized nuclear ma "

40K. Degenerated neutrophils (old EDTAblood)

40N. Monocyte withphagocytized red cell

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

*40G. Neutrophil which contains a phagocytized reddish-purple nuclear mass from another leukocyte following a special technique which is no longer US2:

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 granulocyteswith round or indented nucleus is that of mature cells. The size, chromatin structure, and phagocytic function of these cells arenormal.

-. Slightly indented nucleus.sanut" shaped)

Two "peanut"-shaped nuclei

":1H. Pseudo-Pelger cell in;nyelodysplasia

418. Nucleus with closelyapproximated round lobes(pince-nez)

c

41C. Round nucleus

41 F. Pince-nez nucleus; slightly indentednucleus

411. Pseudo-Pelger cell in myelodysplasia

ote: Pseudo-Pelger cells are observed in myelodysplasia and other myeloid dyscrasias.

41 D. "Peanut"-shaped nucleus

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

41J. Pelqsr-Huet cell with pince-neznucleus

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 giantIysosomes 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)

42K. Mitotic figure (marrow)

421. Neutrophil (blood) 42J. Basophil (blood)

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

i -- ,.,.d'

43A. Monocyte with Diihle-like bodies43B. Eosinophil with Diihle-like body43C. Basophil with Diihle-like bodyThe number of cells in drawing is greater than occurs in a single oil-immersion field. Note shape variation in erythrocytes of thispatient. The platelets are large and abnormal.

430. Neutrophils with Dohle-like bodies43E. Large abnormal platelets

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

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

43H. Neutrophil with Dahle-likebody (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 deepblue 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 ChronicMyelogenous (Myelocytic) Leukemia

45A. Myeloblast with prominentnucleoli, well-defined chromatinstructure, blue cytoplasm with nogranules

45D, Atypical promyelocyte witha few dark granules

." f.. ... . ~-- .....••. . '"

.-// ~:".,s. ,1IiI.!'.#!~~"'off tI. q:~....#

• of •.,...~45G. Atypical early neutrophil(simulating a monocyte) with indentednucleus, intermediate nuclear chromatinstructure, nonspecific granules and palecytoplasm

458. Megakaryoblast with darkcoarse nuclear chromatin structureand blunt vacuolated blebs(marrow)

45E. Atypical promyelocytewith prominent purplegranules (marrow)

45H. Progranulocyte variant withabundant granular cytoplasm andirregular margin (marrow)(formerly called Ferrata cell)

45C. Myeloblast withAuer rod

/

45F. Atypical promyelocytewith fine and coarse granules

451. Macrocytic polyploidneutrophil

F

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

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)

•

6- .

46A. Myeloid cells in CML (see cellnumbers below)

460. Myeloid cells in CML

46G. Pseudo-Pelger cells in CML

46B. Myeloid cells in CML

46E. Myeloid cells in CML

46H. CML in AML blast crisis withincrease in basophils

...~.

46C. Myeloid cells in CML

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

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)

- D. Myeloblast, promyelocyte, M2: od)

47G. Hypergranular promyelocytes,M3 (marrow)

47B. Myeloblasts-positive Sudan Blackstain, M1 (blood)

47E. Promyelocytes and myelocyte,M2 (marrow)

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

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

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

47F. Positive myeloperoxidase stain,M2 (marrow)

471. Promyelocyte with multiple Auerrods, M3 (marrow)

•••

Plate 48. Cytochemical Stains, Part 1

//

••

-.

Myeloperoxidase Stain: The two upper cells (48A) are myeloperoxidase negative (lymphocytes); the two lowercells (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 thelymphocytic system.

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

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

88

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

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

Plate 48. Cytochemical Stains, Part 2

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

48G. PAS positive lymphocyte-Sezary cell (blood)

48J. Positive reaction-immaturegranulocyte (blood)

48H. Negative PAS reaction-lymphocyte (normal blood)

481. Strongly positive PAS reactlo -segmented neutrophil (blood)

Sudan Black Stain: For the detection of lipids

48K. Negative reaction-lymphocyte(blood)

48L. Strongly positive reaction-Nosegmented (blood)

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

48M. Positive (2+) reaction-neutrophil segmented (blood)

48N. Negative reaction-neutrophilsegmented in CML

480. Strongly positive (4+) reaction-neutrophil 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

49A. M4 (blood)

490. M5: mono blasts (marrow)

49G M5: monoblasts (marrow)

Acute myelomonocytic leukemia: M4; Acute monocytic leukemia M5

49B. M4 (blood)

49E. M5: monoblasts (marrow)

49H. M5: monocytes (blood)

49C. M4 (blood)

49F. M5: positive monocytic esterasestain (marrow)

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, 491same patient

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

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

500. Promonocyte: nuclear folds,foamy cytoplasm

50G. Monocyte: transparent foldednucleus, granules in cytoplasm

50B. Monoblast: prominentnucleoli

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

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

50C. Monocyte: phagocytizedred cell

50F. Monocyte: deeply indentednucleus, fine granular cytoplasm

501. Promonocyte: nucleoli;vacuoles in cytoplasm

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

51A. Macrocytic polychromatophilicerythroblast with three nuclei

51D. Macrocytic orthochromaticerythroblast with five nuclei

4

51G. M6 (See cells below)

51B. Macrocytic basophilic erythroblastwith two nuclei and asynchronism

51E. Nuclear fragmentation in anerythroblast

51H. M6 (See cells below)

-.51C. Macrocytic basophilic erythroblas;with asynchronism

51F. Macrocytic orthochromaticerythroblast with asynchronism

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 erythroblastAsynchronism: nucleus less mature than cytoplasm

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

52A. Macrocytic proerythroblast: nucleoli and small vacuolesin cytoplasm

52B. Macrocytic proerythroblast: nucleoli and prominentcytoplasmic vacuolization

J .f,'\

52C. Macrocytic basophilic erythroblast: two large nuclei 520. Macrocytic polychromatophilic erythroblast: four nucleiof different sizes; asynchronism

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

52F. Large basophilic erythroblast: three nuclei

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

53A. Large basophilic erythroblast

53D. Large polychromatophilic erythroblast:three nuclei

53G. Prussian blue iron stain: ringedsideroblasts

53B. Basophilic erythroblast: two nuclei

53E. Macrocytic proerythroblast: four nuclei

53H. Periodic Acid Schiff stain: positivepolychromatophilic erythroblast

53C. Proerythroblast: two nuclei

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

531. Periodic Acid Schiff stain: positivelobulated polychromatophilic erythroblast

Plate 54. Micromegakaryoblasts in Blood and Marrow Smearsof 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 earlyplatelet formation) are noted.

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

55A. Micromegakaryoblasts (blood)

55D. Micromegakaryoblast; largeplatelet (blood)

55G. Megakaryoblast with blebs(marrow)

55B. Megakaryoblasts (marrow)

55E. Megakaryoblast with blebs andlong platelet (marrow)

55H. Megakaryoblast with platelets(marrow)

•55G. Megakaryoblast withcytoplasmic blebs; mitotic figure(marrow)

55F. Megakaryoblast with blebs(marrow)

551. Megakaryoblast with blebs (topleft); micromegakaryoblast (marrow)

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

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

56D. Prussian blue iron stain: ringedsideroblasts, macrophage withhemosideMn,RARS,BM

o56G. Pseudo-Pelger neutrophils(right); N. metamyelocytes (left),MDSBM

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

56E. RARS, BM: erythroblastichyperplasia: orthochromatic,polychromatic erythroblasts; andtwo nuclei in 2 cells

56H. RAEB: Three myeloblasts,2 basophils, BM

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

56F. Proerythroblasts with vacuoles,basophilic, and polychromaticerythroblasts, RARS BM

561. CMML: Two atypicalvacuolated monocytes, BS

Myelodysplasia categories: RA: Refractory anemia; RARS: Refractory anemia with ringed sideroblasts; RAEB: Refractory anemia witexcess blasts; CMML: Chronic myelomonocytic leukemia

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

57A. Myelofibrosis: teardrop andoval erythrocytes

j

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

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

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

57J. ET:thrombocytosis, sixlobed N. segmented

57C. Myelofibrosis: teardrop,oval and odd shapes

~.57G. Myelofibrosis: myeloblast(top); megakaryoblast; largeplatelets: one giant platelet

57K. ET:thrombocytosis

57D. Myelofibrosis: anisocytosspoikilocytosis; large platelets

57H. Myelofibrosis: giantplatelet, large platelets

57L. Essential thrornbocytos.s

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

58A. lymphoblast with nucleolus, All

58D, Prolymphocyte: intermediatechromatin structure, rippledcytoplasm, All

58G, Prolymphocyte withdeep nuclear cleft, All

588, lymphoblast with prominentnucleoli, All

58e, Prolymphocyte withindistinct nucleolus, All

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

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

58H, Atypicallymphocyte with nuclearlobulation, ell

581. lymphocyte with 58J, Smudge (frequent in ell)nuclear fragment, 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)

59E. ALL, BM. SmallIymphoblasts: no or indistinctnucleoli, little cytoplasm (L1)

591. PAS positive stain, BM.Smaillymphoblasts (L1)

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

59F. ALL, BM. LargerIymphoblasts with nucleoli (L2)

59J. ALL, CSF.LargerIymphoblasts with nucleoli (L2)

59C. ALL, BM. LargeIymphoblasts (~ lineage) withvacuoles and nucleoli (L3)

59G. ALL, BM. LargeIymphoblasts (~ lineage) withvacuoles and nucleoli (L3)

59K. ALL, BM. LargeIymphoblasts (~ lineage) withvacuoles and nucleoli (L3)

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

590. T cell ALL, BS. Lymphoc -cells with prominent azuregranules

59H. All, BM. Acid phosphateepositive stain

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

•Plate 60. Chronic lymphocytic leukemia (Cll): Blood Smear (BS)

and Bone Marrow (BM); Pro lymphocytic Leukemia (Pll)

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

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

=::3. ClL: lymphocytes, Iymphoblasts=.BM

60B. ClL: many lymphocytes, smudgecell, no platelets, BS

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

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

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

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

601 Pll: big prolymphocyte withnucleolus, 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 anddelicate threadlike filaments. Hairy cells tend to push neighboring cells away or aside, leaving clear spaces around the hairycell. 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

620. Hairy cells, 6 lobedN. segmented, BS

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

62G. Hairy cells-one cell withcytoplasmic extension, BM

62H. Hairy cells, BM

,•

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

62F. Hairy cell, BM

621. Hairy celis, BM

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

63A. Proplasmacyte: three earlynuclei and reticular cytoplasm

63B. Plasma cell: nebulouscytoplasmic margin, multipleglobules, pink-staining secretorymaterial

630. Flame type of plasma cell

63F. Plasma cell myeloma, BM

63H. Plasma cell myeloma, BM: note nucleoli in 3 cells

63C. Plasma cell: red-stainingglobules (Russell bodies)

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

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

~631. (a) Rouleaux of erythrocytes, blood(myeloma); vs (b) Agglutination

Plate 64. Selected Cells from Blood Smears of Sazary Syndrome

64A. Vacuolated atypicalimmature lymphocyte:indented nucleus, swirledchromatin pattern, nucleoli:Sezary cell

648. Vacuolated atypicalearly lymphocyte: distinctchromatin pattern: Sezary cell

64E. Sezary cell 64F. Sezary cell

641. Sezary cell with nuclear convolutions andnuclear fragment

64C. Atypical lymphocyte ofintermediate size: brainlike(cerebriform) convolutionsand granules: Sezary cell

64D. Atypical lymphocyte withnuclear folds: Sezary cell

64G. Sezary cell 64H. Sezary cell

64J. PAS positive Sezary cell

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

65A. Primitive plasma-like cell

650. Large reactive lymphocyte:unevenly stained bluish cytoplasm

i

~-

65G. Large lymphocyte; azure granules,scalloped borders (indented by red cells)

65J. Reactive lymphocytes

-b

658. Early plasma-like cell:indented nucleus

65E. Large lymphocyte:vacuolated periphery

65H. Large lymphocyte:prominent azurophilic granules

65K. Reactive lymphocytes,normal small lymphocyte

65C. Early plasma-like cell-.

65F. Atypical monocyte; fine andcoarse granules, pseudopods

651. Atypical monocyte

65L. Reactive lymphocytes

- ------------------ --. ..-.--------------------

Plate 66. Reactive Lymphocytes-from Blood Smears

In this color plate leukocytes other than lymphocytes have been left out. Selected lymphocytes reacting to antigenic stimuliand showing heterogeneous forms have been portrayed in increased numbers in order to reveal the marked variation insize 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.

Early ring

Late ring

Early trophozoite

Late trophozoite

Immature schizont

Mature schizont

Macrogametocyte

Microgametocyte

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

Plasmodiumfalciparum

,

•

Plasmodiumvivax

Plasmodiummalariae

/

Plasmodiumovale

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

,"

68A. Plasmodium talciparumrings (Wright-Giemsa stain)

.,.

68E. P. vivax rings

681. P. malariae ring

68B. P. talciparumgametocytes

68E P. vivax ring, immatureschizont

68J. P. malariae trophozoite

68N. Platelet on RBC (left) vsRing in RBC (right)

68C. P. talciparum gametocyte

68G. P. vivax mature schizont

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

680, P. vivax trophozoites

,.. ...

680. P. talciparum thick drop-many rings (Giemsa stain)

...,.

68H, P. vivaxthick drop-trophozoites, schizonts (Giemsastain)

68L. P. malariae mature schizont

-.

68P. P. vivax trophoz "as

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

68, Part 2 A. Babesia microti, intracellular andextracellular parasites

&--68, Part 2 C.

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

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

68, Part 2 D. Plasmodium falciparum rings

68 Part 2 F. Plasmodium talciparum rings

Plate 69. Infections in Hematology: Blood Smears

69A. Ehriichia phagocytophiia inneutrophil (Wright stain)

69G. Ehriichia caffenesis in monocyte

'-

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

69B. Ehriichia phagocytophiia in neutrophil

~690. Ehriichia phagocytophiia in neutrophil

69F. Meningococci in a monocyte(Wright stain)

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

70A. Macrophage with phagocytized Histoplasma capsulatum(marrow)

70C. Histoplasma capsulatum in neutrophils at featherend of blood smear

70E. Histoplasma capsulatum inmacrophage-bone marrow

70G. Histoplasma capsulatum indisintegrating cell-blood

70B. Macrophage with Leishmania donovani (marrow)

700. Macrophage with amastigotes ofLeishmania species

70F. Macrophage with amastigotes ofLeishmania species

70H. Microfilaria in thick drop of blood

-.

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

r

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

PLate 72. Lipid Histiocytes: Bone Marrow Smears

72A. Gaucher cell

72C. Gaucher cell

72E. Two Gaucher cells

4

:i·:.

72B. Nieman-Pick cell

72D. Nieman-Pick cell

72F. Three Nieman-Pick cells

Plate 73. Platelets on Blood Smears

~.iJ$: :"

~~r:

73A. Platelets-idiopathicthrombocytopenic purpura (ITP)

:f~;~:'"

73B. Platelets-May-Hegglin anomaly 73C. Platelets-myelofibrosis

a .•..1

73E. Platelets-May-Hegglin anomaly

.~

73H. Giant platelet syndrome

731. Platelet satellitosis (EDTAblood smear)

Plate 74. Origin and Development of Blood Cells

Myeloblast

Basophilic myelocyte Eosinophilic myelocyteNeutrophilic myelocyte

Basophilic metamyelocyte Eosinophilic metamyelocyteNeutrophilic metamyelocyte

Basophilic band Neutrophilic band Eosinophilic band

3£5 . nillc segmented Neutrophilic segmented Eosinophilic segmented

"'"

/

Monoblast

Promonocyte

Monocyte

--------proerytl1roblast

MegaKaryoblast

\3asopl1iliCerytl1roblast

promegaKarvOcyte

POlyc\lromatoPl1iliC ervtl1roblast

MegaKaryocyte wit\1Out platelets

ort\1Ocl1romatic ervtl1roblast

POlyCl1rOmatoPl1iliCerytl1rocyte

~ .,.'li.~ '\'''#*1••

t *••Platelets

Plasmablast

proplasmacyte

Plasma Cell(plasmaC'j\:c \ ",

~~v~~ ----------~~~~-------------------------

Ervtl1rocyte

Index

Cabot ring 16, F8 (17), P33, P39 (Parts 1-2)CALLA (Common acute lymphoblastic antigen) 9CD (Cluster designation) Markers 9, F4 (10)Chediak-Higashi anomaly 27, P42Chronic lymphocytic leukemia (CLL) 33, P58, P60Chronic myelogenous leukemia (CML) 27, P45-P46Classification of ALL 35, P58-P59Classification of AML 30, P45, P47-P55Classification ofMD5 31, P56, T6 (31)Clostridium perfringens P26Cooley's anemia 22, P29Crescent body (semilunar body) P23

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, P26Acid phosphatase stain P59Acute erythroleukemia P52, P53Acute lymphoblastic leukemia (ALL) 35, P58-P59Acute megakaryocytic leukemia P54, P55Acute myelogenous leukemia 30,31, P45, P47-P49Acute myelomonocytic leukemia (AML) P30, P49Alder-Reilly Anomaly 27, P44Anemia

aplastic 20heart valve dysfunction P25 (Part 2)hemolytic due to burns, venoms 25, P31hemolytic uremic syndrome 25iron deficiency 18,P24, P36-P37megaloblastic 19, P36-P39 (Parts 1-2)microangiopathic hemolytic anemias 25,

P25 (Parts 1-2)sickle cell 22, P23, P27-P28sideroblastic 19, P34Thalassemia major 22, P29Thalassemia minor 21,22, P30Thrombotic thrombocytopenic purpura 25,

P25 (Part 1)Anisocytosis 15Aplastic anemia 20Auerrod(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, P74metamyelocyte 5, FI (2), PI, P74myelocyte 5, FI (2), PI, P74segmented 5, FI (2), PI, P74

Basophilic erythroblast 1,7, F1 (2), F7 (17), PH, P36, P74,T2 (1)

Basophilic stippling 16, F7 (17), P32Bite cell 15, P26Blister cell P23Blood cells, normal values TI (1)Bone cells l3, P20-P21Bone marrow cells, normal values T2 (1)Burned patients, erythrocytes in 25, P31Burr cell 15, P23, P26

118

Degenerated neutrophil 26, P40D6We body 26, P40, P43Drepanocyte (sickle cell) 16

Echinocyte 15, P23, P26Ehrlichiosis 36, P69Electrophoresis Hb 22, 23Elliptocyte 24, P23, P29Elliptocytosis 24, P23, P29Endothelial cell 14, P22Eosinophil 1,4, FI (2), PI-P4, PI8, P74, Tl (1), T2 (1)

band 4, FI (2), PI-P2, P74metamyelocyte 4, FI (2), PI-P3, PI8, P74myelocyte 4, FI (2), PI-P2, PI8, P74segmented 4, Fl (2), PI, P4, P74

Erythrocyteacanthocyte (spur, thorn) 15, P23basophilic erythroblast 7, FI (2), PH, P36, P74,

T2 (1)basophilic stippling 16,F7 (17), P32bite 15,P26blister (marginal achromia) P23burn patient 25, P31burr 15, P23, P26Cabot ring in 16, F8 (17), P33, P39 (Part 1)crenated P23crescent (semilunar body) P23crystals (Hb 55, 5C, CC) 23, P23, P27echinocyte 15, P23, P26elliptocyte 24, P23, P29filamented P23folded P23fragment (schistocyte) 16, 25, P23, P25 (Parts 1-2)

helmet 15, P23, P25-(Parts 1-2)Heinz body 16, F7 (17), P35Howell-Jollybody 16,F7 (17),P33,P39 (Parts 1-2)hypochromic 16, P24, P37inclusions in 7, F7 (17), P32-P35keratocyte 15leptocyte 16, P24macrocyte 15, P24, P36-P37, P39 (Parts 1-2)malaria in 36, P67-P68membranous ghost P23microcyte 15, 18, P24, P36-P37, P39 (Parts 1-2)normal 7, 15, P23-P24orthochromatic erythroblast 7, FI (2), PH, P36, P74,

T2 (1)oval (ovalocyte, elliptocyte) 24, P23, P29pear 20, P23pinched (pinchered) P23poikilospherocyte P23polychromasia 18polychromatophilic erythroblast 7, FI (2), PH, P36,

P74, Tl (1)polychromatophilic erythrocyte 7, 18, FI (2), Pll,

P32,P36,P74proerythroblast 6, FI (2), Pll, P36, P74, T2 (1)ringed sideroblast 18, P34rouleaux 16,34, P63schistocyte (fragment) 16,25, P23, P25 (Part 1)semilunar body (crescent) P23sickle cell (drepanocyte) 16,22, P23, P27, P28sideroblast 18, P34siderocyte 18, P34, F7 (17)siderotic granules in 18, F7 (17), P34spherocyte 16, P23, P26, P29stippled 16, F7 (17), P32stomatocyte 16, F9 (24), P23target 16,P23, P27, P29-P30teardrop 16, P23, P24, P39 (Parts 1-2), P56-P57triangular 16, P23, P25 (Part 1)venoms.nn 25, P26

Erythropoiesis 2,6, F1 (2), Pll, P36Esterase stains

monocytic 31myelocytic 30

FABclassification of ALL 35, P58-P59, T8 (35)FABclassification of AML 30, P45, P47-P55, T5 (30)FABclassification ofMDS 31, P56, T6 (31)Fat cell (lipocyte) 13, PI9Ferrata cell P45Fibroblast 15Folic acid deficiency 19, P24, P36-P39 (Parts 1-2)Fragmented cell (schistocyte) 16,24,25, P23

The Morphology of Human Blood Cells

Gaucher cell P72G-6-PD Deficiency 15, P26Granule(s)

primary 1,3secondary 1,3siderotic (iron-containing) 18, P34

Hairy cell leukemia 33, P60-P62Heinz body 16, F7 (17), P35Helmet cell 15, P23, P25 (Parts 1-2)Hematopoiesis 1, FI (2)Hematopoietic stem cell 1, FI (2), F4 (10)Hemoglobin A 22, 23Hemoglobin Az 23Hemoglobin AC 23Hemoglobin AE 23Hemoglobin AS 22, P28Hemoglobin ~o thalassemia 22, P29Hemoglobin ~+ thalassemia 22, P30Hemoglobin Bart's 21, T4 (21)Hemoglobin concentration 16Hemoglobin CC 23, P27Hemoglobin E 23Hemoglobin E-I3-thalassemia 23, P30Hemoglobin electrophoresis 22, 23Hemoglobin H 21Hemoglobin 0 23Hemoglobin SC 23, P23, P27Hemoglobin SS 23, P23, P27-P28Hemoglobin ZUrich P26Hereditary elliptocytosis 24, P23, P29Hereditary pyropoikilocytosis 24, P31Hereditary spherocytosis 24, P23, P29Hereditary stomatocytosis 24, F9 (24), P23Histioplasma capsulatum 37, FH (37), P70Histoplasmosis 37, P70HLA-DR 10Hodgkin's disease 32Howell-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, P33Infectious mononucleosis 36, P65-P66Iron deficiency anemia 18, P24, P36-P37Iron Stain P34, P53-P56Iron studies 19

Keratocyte 15

The Morphology of Human Blood Cells

L.E. cell P40Leishmaniasis 37, P70Leptocyte 16Leukemia

basophilic 5erythroleukemia (erythroblastic) P51- P53, T5 (30)hairy cell 33, P60-P62lymphoblastic, acute 35, P58, P59, T7-T8 (35)lymphocytic, chronic 33, P58, P60megakaryoblastic, acute 30, P54-P55monocytic, acute 30, P49-P50myelocytic, chronic 27, P45-P46myelogenous, acute 30, P45, P47-P55, T5 (30)myelogenous, chronic 27, P45-P46myelomonocytic, acute 30, P49myelomonocytic with eosinophilia 30plasma cell 34promyelocytic 30, P47, T5 (30)prolymphocytic 11,P59-P60

Leukocyte alkaline phosphatase (LAP) stain 28, P46,P48 (Part 2)

Lipocyte (fat cell) 13, Pl9Lymphoblast 9,35, PIO, P58-P59Lymphocyte Tl-T2 (1)

B cell 9, FI (2), F4 (10)cell markers 9, F4 (10)reactive 36, P65-P66T 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, P56Malaria 36, P67-P68 (Parts 1-2)Mast cell 12, Pl8May Hegglin anomaly 26, P43Mean corpuscular hemoglobin (MCH) 19,22Mean corpuscular values 19,20Mean corpuscular hemoglobin concentration (MCHC)

19,22Mean corpuscular volume (MCV) 19,20,22Megakaryoblast 8, FI (2), Pl4-PI5, P74Megakaryocyte 8, FI (2), PI4-PI5, P74Megaloblastic anemia 19, P36-P39 (Parts 1-2)Metamyelocyte

basophilic 1,5, FI (2), PI-P3, P74eosinophilic 1,4, FI (2), PI-P3, P74neutrophilic 1,FI (2), F2 (3),3, F3 (4), PI-P3, P74,

T2 (1)Microangiopathic hemolytic anemia (MAHA) 25,

P25 (Parts 1-2)

120

Microcyte 8, 15, 18, P24, P36-P37Micromegakaryoblasts 8, P54-P55Monoblast 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, P74Myelocyte

basophilic 1,5, FI (2), PI-P3, P74eosinophilic 1,4, FI (2), PI-P3, P74neutrophilic 1,3, FI (2), PI-P3, P74

Myelodysplastic syndrome 31, P56Myelofibrosis 29, P57, P73Myelogenous leukemia P45-P48

acute 30, P45-P55, T5 (30)chronic 27, P45-P46, P48

Myeloid: Erythroid ratio 1, T2 (1)Myeloma 34, FIO (34), P63Myeloperoxidase stain (MPO) 30, P48 (Part 1)Myelopoiesis 1,FI (2)

Neiman-Pick disease P72Neutrophilic

band 1-3, FI (2), F2 (3), PI-P4, P74, Tl-T2 (1)degenerated 26, P40hypersegmented 26, P39-P40hyposegmented (Pelger-Huet) 26, P41metamyelocyte 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 32Normal values

bone marrow 1,T2 (1)peripheral blood 1,Tl (1)MCH 19MCHC 19,22MCV 19,20,22RDW 19,20,22

Orthochromatic erythroblast 7, FI (2), P11, P36, P74, T2Osteoblast 13, F5 (14), P20-P21Osteoclast 14, F6 (14), P20-P21

Pappenheimer body (siderocyte) 18, F7 (17), P34Parvovirus B19 37, P71Pelger-Huet anomaly 26, P41Periodic Acid Schiff (PAS) stain P48 (Part 2), P53,

P59,P64

Peroxidase stain 30, P48 (Part 1)Plasmablast 12,PlO, P63, P74Plasma cell (Plasmacyte) 11,P10, P74Plasma cell leukemia 12Plasmodium

falciparum 36, P67-P68 (Parts 1-2)malariae 36, P67-P68 (Part 1)ovale 36, P67vivax 36, P67-P68 (Part 1)

Platelet (thrombocyte) 8, Fl (2), P4, PI4-PI5, P73, P74Pluripotent stem cell F4 (10)Poikilocytosis 15Polychromasia 18Polychromatophilic erythroblast 7, Fl (2), Pll, P36, P74Polychromatophilic erythrocyte 7, 18, Fl (2), PI I, P32,

P36,P74Polycythemia vera 27,28Precursor 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, P74Promegakaryocyte 8, FI (2), PI4-PI5, P74Promonocyte 5, FI (2), PIO, P49-P50, P74, T2 (2), T5 (30)Promyelocyte (progranulocyte) 3, FI (2), PI-P3, P46-P47,

P74Proplasmacyte 12, PlO, P74Prothymocyte F4 (10)Prussian blue iron stain on

erythrocytes P34, P53, P56macrophage P56

Pseudo-Pelger Huet cell 31, P56Pyropoikilocytosis, hereditary 24, P3I

Red cell distribution width (RDW) 19,20, T3 (19)Reactive lymphocyte 36, P65-66Reticulocyte 18, F7 (17), P32Ringed sideroblast 18, 19, P34Rouleaux 12,34, P63Russell body (plasma cell) 11, P63

Satellitosis (platelets around neutrophil) 9, P73Schistocyte 16,25, P23, P25 (Parts 1-2)Semilunar (crescent) body P23Sezary syndrome 34, P48, P64Sickle cell 22, P23, P27, P28Sickle cell anemia (Hb SS) 22, P23, P27-P28Sickle cell-hemoglobin SC disease (Hb SC) 23, P23, P27

The Morphology of Human Blood Cells

Sickle cell trait (Hb AS) 22, P28Sideroblast-ringed 18,19, P34Sideroblastic anemia 19, P34Siderocyte 18, F7 (17), P34Smudge cell 33, P60Spherocyte 16,24, P23, P26, P29Spherocytosis, hereditary 24, Pi9Spider bite on RBC 25, P26Spur cell P26Stem cell l , FI (2), F4 (10)Stem cell compartment 1Stippled red blood cell 16, F7 (17), P32Stomatocyte 16,24, F9 (24), P23Stomatocytosis, hereditary 16,24, F9 (24), P23Sudan black B stain 30, P47, P48 (Part 2)

Target cell 16,21,22, P23, P27Tartrate-resistant acid phosphatase (TRAP) 33, 34, P62T cell 9, Fl (2), F4 00)T-cell receptor (TCR) 9,10Terminal deoxynucleotidyl transferose (TdT) 9,30, F4 (10)Teardrop cell 16, P23-P24, P37, P39 (Parts 1-2)Thalassemia

alpha 21beta 21,23major 21,22, P29, P30minor 21,22, P30

Thermal injury to RBC 25, P31Thrombocyte (platelet) satellitosis P73Thrombocythemia, essential 29, P57Thrombotic thrombocytopenic purpura (TTP) 25,

P25 (Part 1)Thymocyte F4 (10)Thymus FI (2), F4 (10)Tissue basophil PI8Tissue eosinophil PI8Toxic granules 26, P40

Venoms on erythrocytes 25, P26Vitamin B12, Folic Acid deficiency 19, P36-P39 (Parts 1-2)

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