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WHITE BLOOD CELL ANOMALIES
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NUCLEAR CHANGES
Basket Cells/ Smudge Cells Biconcave Disc
Hypersegmentation
Pelger-Huet Anomaly
Twinning Deformity
Pyknotic Cells

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HYPERSEGMENTATION
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APPEARANCE : Neutrophils with many nuclear lobes
with many reddish granules of flat cell
characterized by 5 or more lobes

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CLINICAL SIGNIFICANCE : associated with megaloblastic anemia due to vitamin b12 or
folic acid deficiencies, uremia, Gastric cancer, Bleeding peptic ulcers, renal insuffiency
and myelopthisic anemia

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2 types :
• TRUE PELGER HUET : congenital abnormality (autosomal dominant )
• PSEUDO-PELGER HUET : acquired abnormality
CLINICAL SIGNIFICANCE : Iron deficiency anemia, Hereditary elliptocytosis and
ovalocytosis, myeloid metaplasia, infectious mononucleosis, following myelotoxic
therapy and in Fanconi’s anemia

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PYKNOTIC CELLS
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APPEARANCE: Absence of chromatin bridge between the nuclear lobes
Often mistaken for band and metamyclocyte
Seen in infection and aging cell

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May be due to increased proteins in RBCs
CLINICAL SIGNIFICANCE : transfusion reactions, MAHA,IHA, and may also be seen in
banked blood stored for a long time
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ALDER-REILLY GRANULATION
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APPEARANCE : Due to abnormal polysaccharide metabolismwhich preventsthe
formation of secondary granules
Coarse, dark, azurophilic granules in the cytoplasm of PMNs covering the nucleus
Autosomal recessive inheritance
Morphologically abnormal, but functionally normal
Mistaken for toxic granulation
CLINICAL SIGNIFICANCE : Seen in Hurler’s and Hunter’s syndrome, genetic
mucopolysaccharidoses

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CHEDIAK-HIGASHI ANOMALY
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APPEARANCE : Neutrophils show large inclusions that vary in size and color
- Show chemotactic defects and defective lysosomal emptying into phagocytic
vacuoles
Abnormal fusion of primary and secondary neutrophilic granules
Peroxidase positive granules
Morphologically and functionally abnormal : unable to degranulate and kill invading
bacteria
CLINICAL SIGNIFICANCE : Seen in albinism ( photophobia and hypopigmentation)

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TOXIC GRANULATION
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APPEARANCE : Large,dark staining granules that are abnormally activated and
enzyme-containing
Represent autophagosomes
Myeloperoxidase test positive
CLINICAL SIGNIFICANCE : Seen in Chemical poisoning, toxic stages, severe infection

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MALIGNANCY-ASSOCIATED CHANGES
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APPEARANCE : Thin, Thread-like pointed, small inclusions surrounded by halos within
the cytoplasm of monocytes

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TART CELL
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APPEARANCE : monocytes that have engulfed nuclear material
Phagocytosed frequently eosinophilic nucleus with and almost intact nuclear pattern,
is frequently vacuolated, and has a conspicuous, condensed chromatin, especially
around its circumference
CLINICAL SIGNIFICANCE : positive test is usually diagnostic of disseminated lupus
erythematosus
Also positive in patients with periarteritis nodosa, dermatomyositis, scleroderma,
drug hypersensitivity, RA, Hepatitis and hydralazine syndrome

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DESIGN FORMATION
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APPEARANCE : Reflects technical error, bad smear preparation
Presence of fat or oil in the slide
Too much pressure when smearing



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