Comparison of Leukocyte Conditions
Condition | Characteristics | Causes | Other Information | Comorbidities/Associated Conditions |
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Normal Patients | ||||
Normal adult | ||||
Pre-term neonate | Left shift | |||
Normal neonate | ↑ WBC, % neuts
many segs/bands |
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Normal child (1-3 years) | ↑ % lymphs (~2x neuts)
"Reverse ratio/inverted diff" |
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Normal geriatric adult (>65) | ↓ RBC, WBC, HGB
↑ MCV (slight) |
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Clinical Conditions | ||||
Bacterial infection | Abs neutrophilia
Left shift ↑ Bands -/↑ Metamyelocytes and myelocytes Toxic changes (toxic granulation and vacuolation) |
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Leukemoid Reaction | >50×109/L leukocytosis
neutrophilia left shift Usually only affects neuts |
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Often confused with CML!
Leukemoid reaction usually only affects neuts! CML affects all granulocytes (especially eos and basos), and often causes anemia. |
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Leukoerythroblastic picture | Immature neuts
NRBCs Teardrop cells Often has neutrophilia |
Lesion in bone marrow
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Basophilia | Abs basophilia (>0.15×109/L) | Non-malignant
Malignant
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Eosinophilia | Abs eosinophilia (>0.4×109/L) |
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Pelger-Huët Anomaly | ||||
Alder-Reilly Anomaly | ||||
May-Hegglin Anomaly | ||||
Chediak-Higashi Syndrome |
Granulocyte Alterations & Anomalies
- Acquired
- Hyposegmented nucleus
- Hypersegmented nucleus
- Pyknotic and necrobiotic nuclear forms
- Toxic granulation of cytoplasm
- Degranulation
- Vacuolization
- Döhle bodies
- LE cells
- Auer rods
- Pseudo-Pelger-Huët Anomaly
- Inherited
- Pelger-Huët Anomaly
- Alder-Reilly Anomaly
- May-Hegglin Anomaly
- Chediak-Higashi Syndrome
Reporting Leukocyte Morphology
WBCs | SD/D/N/SI/I | ||
Platelets | SD/D/N/SI/I | ||
Differential | |||
Neutrophils |
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Lymphocytes |
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Monocytes |
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Eosinophils |
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Basophils |
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Metamyelocytes |
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Myelocytes | |||
Promyelocytes |
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Blasts | |||
Smudge Cells | ONLY report if in large numbers AND consistent with CLL (Chronic Lymphocytic Leukemia) | ||
Other Cells |
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Total | |||
NRBC | x per 100 WBCs
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WBC Morphology | |||
Bands | Some/Many AND report Moderate/Marked left shift | ||
Toxic granulation | |||
Toxic vacuolation | |||
Hypersegmented neutrophils | |||
Hyposegmented neutrophils | |||
Dohle bodies | |||
Reactive lymphs | |||
Platelet Morphology | |||
Giant Platelets | |||
Platelet Clumps | |||
Comments | |||
Other Comments | See below. |
Report Under Comments:
- Moderate/Marked Left Shift (immature neutrophils)
- Immature WBCs
- Neutrophilic bands (>5% of neuts)
- Eosinophilic metamyelocytes
- Eosinophilic myelocytes
- Basophilic metamyelocytes
- Basophilic myelocytes
- Prolymphocytes
- Promonocytes
- Pelger-Huet forms
- Abnormal granulation
- Chediak-Higashi
- Alder-Reilly
- Leukemoid reaction
- Auer rods
- Folded cells
- Bite/Blister cells
- Microspherocytes
- Intracellular/Extracellular Organisms
- Bacteria
- Malarial parasites
- Other parasites
- Hemoglobin Crystals
- Hemoglobin C
- Hemoglobin S/C
- Background staining