Part TWO – Deferential White Blood Cells count (Diff. WBCs Count) and microscopic examination of Well Stained Blood Film
II) WBCs examination and abnormalities:
This is part two of the deferential WBCs count and microscopic examinaiton of well stained blood film. In the part one (click here) we talk about the procedure and the abonrmalities of RBCs and now we will talk about the abnormalities of WBCs
We have spoken about the techniques of how to stain a blood film (click here)
A) Normal WBCS:
In contrast to erythrocytes, leukocytes contain a nucleus that may vary in size and shape. As already mentioned, there are five main types of leukocyte — neutrophils, eosinophils, basophils (granulocytes), lymphocytes and monocytes (Agranulocytes).
Polymorphonuclear cells (neutrophils, eosinophils and basophils) have:
— a nucleus with several lobes;
— granules in the cytoplasm (hence their usual name, granulocytes).
Polymorphonuclear neutrophils (Segmented Neutrophilic Granulocyte, PMNs, polys):
There are 2 types of neutrophils
1) Segmented Neutrophils (segs)
Shape: rounded, well defined.
Nucleus: several (2–5) lobes connected by delicate filaments – deep stained; deeply; it is irregular and often assumes shapes comparable to such letters as E, Z, and S. , linked by strands of chromatin. The chromatin appears as a uniform deep purple mass (i.e. dark mauve).
Cytoplasm color: abundant, pinkish, containing numerous very small, mauve granules. The granules appear brown-violet after staining.
2) Band Neutrophils:
The band neutrophils has either a strand of nuclear material thicker than a filament connecting the lobes, or a U-shaped nucleus of uniform thickness
Polymorphonuclear eosinophils (eosinophilic granulocyte)
Size: 12–15 mm
Nucleus: usually two lobes – dark mauve.
Cytoplasm: very little visible (pale stained), containing numerous large, round, densely packed, orange-red granules or purple. Sometimes the cell appears damaged, with scattered granules.
Polymorphonuclear basophils (Basophilic Granulocyte)
These are the rarest type of granulocyte.
Nucleus: difficult to see because it is covered by the granules.
Cytoplasm: very little visible, containing numerous very large, round, deep purple granules, less densely packed than those of the eosinophils. Small colourless vacuoles are sometimes present because many granules are dissolved.
Lymphocytes and monocytes (mononuclear cells – Agranuolocytes)
Lymphocytes and monocytes have a compact nucleus.
Size: 7–10mm about the size of an erythrocyte or slightly larger.
Nucleus: large (occupying most of the cell), with densely packed dark purple or dark purple chromatin (Wright’s stain) sometimes indented at one side.
Cytoplasm: Thin rim of pale blue cytoplasm surrounds the nucleus with no granules.
Size: 12–16 mm.
Shape: round or irregular due to pressure of neighboring cells.
Nucleus: oval or round, may lie to one side of the cell (less densely stained).
Cytoplasm: more abundant, pale blue or purple, containing several dark red granules larger than the neutrophilic granules.
Size: 15–25mm (largest of the leukocytes).
Nucleus: variable, often kidney-shaped, bean shaped or horseshoe shaped with pale mauve chromatin arranged in strands >>>> it is not deeply stained.
The cytoplasm is blue-gray and has a ground-glass appearance and often contains fine red to purple granules that are less distinct and smaller than the granules of neutrophils. Occasionally, blue granules may be seen. When the monocyte transforms into a macrophage, it becomes larger (20–40 μm); the nucleus may become oval and the chromatin more reticular or dispersed, so that nucleoli may be visible. A perinuclear clear zone (Golgi) may be evident. The fine red or azurophil granules are variable in number or may have disappeared. The more abundant cytoplasm tends to be irregular at the cell margins and to contain vacuoles. These are phagocytic vacuoles, which may contain ingested red cells, debris, pigment, or bacteria. Evidence of phagocytosis in monocytes or the presence of macrophages in directly made blood films is pathologic and often indicates the presence of active infection.
In patients suffering from malaria the cytoplasm often contains brownish-black masses. These masses are malaria pigment.
Abnormal WBCs ===> Page 2
الاشكال الغير طبيعية لكرات الدم البيضاء ===> page 2