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Chromatin: Indented shaped nucleus resembling a kidney bean structure, patches of coarse chro-matin in spots

Cytoplasm: Pale blue to pinkish tan with moderate specific granules

Differentiating characteristics: Nuclear indentation and condensed chromatin with no nuclei (Fig. 9.4).

CD markers are the same as for the myelocyte

Band

Chromatin: Band shaped like a cigar band, C or S shaped, unable to see filament, coarsely clumped almost like leopard spot coarseness

Cytoplasm: Brown-pink, with many fine secondary granules

Differentiating characteristics: No filament, may resemble a metamyelocyte but indentation is more severe and chromatin is more clumped (Fig. 9.5).

CD45, CD13, CD15, CD11b/11c

Segmented Neutrophil

Chromatin: Two to five lobes of nucleus connected by thin thread-like filaments, cannot observe chromatin pattern in filaments

Cytoplasm: Pale lilac with blue shading and many fine secondary dust-like granules

Distinguishing characteristics: If chromatin can be observed in filament, then the identification is a band; if no constriction is observed in nucleus, then the cell is a band (Fig. 9.6).

Figure 9.5 Band. No nuclear lobes, no filament, and clumped chromatin.

Eosinophils and Basophils

Eosinophil

Eosinophils can appear at the myelocytic stages and move through the maturation sequence. Size: 10 to 16 pm N:C: Barely 1:1

Chromatin: Eccentric nucleus, usually bilobed Cytoplasm: Large, distinctive red-orange SPECIFIC granules with orange-pink cytoplasm, granules are highly metabolic and contain hista-mine and other substances Distinguishing characteristics: Granules are uniformly round, large, and individualized; if stain is less than adequate, observe granules carefully for their crystalloid nature (Fig. 9.7).

Figure 9.6 Segmented neutrophils. Note two to five lobes in the nucleus with well-distinguished filament, pale dustlike granules.

Figure 9.4 Metamyelocyte. Indented nucleus with condensed chromatin, small granules, and no nuclei.

Figure 9.6 Segmented neutrophils. Note two to five lobes in the nucleus with well-distinguished filament, pale dustlike granules.

Figure 9.7 Eosinophil. Bilobed nucleus with large uniformly round orange-red granules.

Basophil

Basophils can appear at the myelocytic stage and move through the maturation sequence. Size: 10 to 14 pm N:C: Difficult to determine Chromatin: Coarse, clumped bilobed Cytoplasm: Many large SPECIFIC purple-black granules seem to obscure the large cloverleaf form nucleus, may decolorize during staining leaving pale areas within cell; granules much larger than neutrophilic granules Distinguishing characteristics: Size and color of granules will obscure the nucleus (Fig. 9.8).

The Agranular Cell Series

The Monocytic Series

Monoblast

See description for myeloblast.

Promonocyte

Size: 12 to 20 pm

Chromatin: Round, flattened nucleus, nucleoli may be present, folding, and creasing, and crimping may be observed

Cytoplasm: Gray-blue, some blobbing may appear, rare granules

Distinguishing characteristics: None noted

Monocyte

Size: 12 to 20 pm

Chromatin: Nuclei take different shapes from brainy convolutions to lobulated and S shaped, chromatin is loose-weaved, lacey, open, and thin

Cytoplasm: Abundant gray-blue with moderate granules, may show area of protrusion or bleb-bing

Distinguishing characteristic: Nuclear chromatin lacks density, it is open weaved, soft and velvet-like (Fig. 9.9).

CD33, CD13, CD14

The Lymphocytic Series

Outlining CD markers for the lymphocyte cell population is a complex task and beyond the scope of this chapter. Lymphocytes develop subpopulations along the path to maturity, each with a unique CD subset. For this reason, only a modified CD list will be included (Table 9.1).

Lymphoblast

Size: 10 to 20 pm

Figure 9.9 Monocyte. Nuclear chromatin is loose-weaved and open, abundant gray-blue cytoplasm.

Figure 9.8 Basophil. Indistinguishable nucleus with large, purple-black granules.

Figure 9.9 Monocyte. Nuclear chromatin is loose-weaved and open, abundant gray-blue cytoplasm.

134 Part III • White Cell Disorders

Table 9.1

A Modified List of Antigen Markers of Lymphocytes*

LSC-HLA-DR CD34, CD45 tDt

Pre-B (most mature)

CD19, CD24, CD45, CD10 tDt

Cytop B cell (mature)

CD19, CD20, CD22, CD45 IgM, IgD

S Ig

T cell (most mature)

*List does not represent all possible CD cell designations.

Chromatin: One or two nucleoli with smudgy chromatin

Cytoplasm: Little, deep blue staining at edge

Distinguishing characteristics: Nucleoli is surrounded by dark rim of chromatin

Prolymphocyte

Chromatin: Nucleoli present, slightly coarsened chromatin

Cytoplasm: Gray-blue, mostly blue at edges

Distinguishing characteristics: None noted

Small Lymphocyte

Chromatin: Oval nucleus with coarse lumpy chromatin with specific areas of clumping, a compact cell

Cytoplasm: Usually just a thin border, with few azurophilic, red granules

Distinguishing characteristics: Clumping of chromatin around the nuclear membrane may help to distinguish this from a nucleated cell (Fig. 9.10).

Large Lymphocyte

Figure 9.10 Small lymphocyte. Oval nucleus with coarse, lumpy chromatin.

Chromatin: Looser chromatin pattern, more transparent

Cytoplasm: Larger amount of cytoplasm, lighter in color

Distinguishing characteristic: Cytoplasm is more abundant with tendency for azurophilic granules (Fig. 9.11).

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