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Neutrophil

Acute Bacterial infection

1. Leukocytosis
2. Shift to left
3. Toxic granules
4. Cytoplasmic vacuoles
5. Doehle bodies: Discrete round or oval density in the periphery of cytoplasm. Stains sky blue with Romanowsky stain
6. Disappearance of Eosinophils

Eosinophil

With quite large, regular, refractile, eosinophilic (pink) cytoplasmic granules, and a bilobed nucleus. Normal :  0-7  %     Absolute count: 0.0-0.7 K/mm3
Increased: >700/mm3	Decreased
Allergic disease Parasitic infections Drugs Aminosalicylic acid Chloropropamide Imipramine Nitrofurantoin Methotrexate Sulfonamides PIE syndrome Collagen vascular disease Malignant neoplasm's Hypereosinophilic syndromes	Steroids Bacterial infection Thymoma

Basophil

Monocyte

Small lymphocyte

Peripheral smear with abnormal cells

Plasma cells: (Rarely seen in normal peripheral smear)

1. Rubella
2. Multiple myeloma
3. Plasma cell leukemia
4. Measles
5. Varicella

Atypical lymphocytes
Abundant finely granular, basophilic cytoplasm containing small fenestration's  

Infectious Mononucleosis:

• Caused by Epstein-Barr Virus
• Total white blood cell count may be increased up to 18,000/microliter
• 95% atypical t-cell lymphocytes
• With abundant finely granular, basophilic cytoplasm containing small fenestration's

Acute Myelogenous Leukemia (AML):

• Cancerous transformation of multipotent myeloid stem cells associated with many different cytogenetic abnormalities and gene findings, with increased myeloblasts in peripheral smear and marrow
• Peripheral smear: Immature white cells called blasts that are larger than those in ALL and have a lower nuclear /cytoplasmic ratio
• Cytoplasm may stain for enzymatic markers such as peroxidase or esterase and may contain auer rods (abnormal primary granules)
• High blast production may cause pancytopenia by feedback suppression leading to decreased white blood cells, red blood cells, and platelets.

 Acute Lymphocytic Leukemia:

• 80% of B cell origin; 20% of T cell origin
• The nuclei of leukemic blasts in Wright-Giemsa stained preparations have somewhat course and clumped chromatin and 1-2 nucleoli
• Unlike AML blasts, the cytoplasm of these blasts do not contain azurophilic granules (auer rods) or cytochemical peroxidase
• Cytoplasm of these blasts often have large aggregates of PAS material

Chronic Myelogenous Leukemia (CML):

• Disorder of pluripotent stem cells with a specific cytogenetic abnormality, t(9;21), and genetic finding of BCR/ABL fusion gene,that results in abnormal differentiation along granulocytic pathways
• Increased leukocyte count; usually >100,000 / mm3
• Primarily neutrophils and metamyelocytes but may have prominent basophils and Eosinophils, also.
• Small number of myeloblasts may also be present in peripheral smear Ø 50% have thrombocytosis also early in disease
• Different from leukomoid reaction b/c almost total lack of alkaline phosphatase in granulocytes Eventually all patients transform to an aggressive acute leukemia

Chronic Lymphocytic Leukemia (CLL):

• Neoplasm of CD5 positive B cells (a rare normal B cell phenotype). CLL cells do not mature normally and fail to undergo apoptosis
• Absolute Lymphocytosis with small mature looking lymphocytes
• May develop autoantibodies to red blood cells and platelets causing hemolytic anemia and thrombocytopenia
• Leukocyte count may be slightly or markedly increased

Hairy cell Leukemia

Plama cell leukemia:

Multiple myeloma

Leukemoid reaction

Resembling but not Leukemia
Either increase in magnitude of Leukocytosis or Blast cells
Encountered in

1. Infections
   • Disseminated TB
   • Pertusis
   • Hepatitis
2. Malignancies
   • Hodgkin's
   • Gastric, Breast, Lung cancers
3. Intoxication's