Comparison of Leukocyte Conditions

Condition	Characteristics	Causes	Other Information	Comorbidities/Associated Conditions
Normal Patients
Normal adult
Pre-term neonate	Left shift
Normal neonate	↑ WBC, % neuts many segs/bands
Normal child (1-3 years)	↑ % lymphs (~2x neuts) "Reverse ratio/inverted diff"
Normal geriatric adult (>65)	↓ RBC, WBC, HGB ↑ MCV (slight)
Clinical Conditions
Bacterial infection	Abs neutrophilia Left shift ↑ Bands -/↑ Metamyelocytes and myelocytes Toxic changes (toxic granulation and vacuolation)
Leukemoid Reaction	>50×109/L leukocytosis neutrophilia left shift Usually only affects neuts	Severe or chronic infection Metabolic disease Inflammation Malignancy (immune response to)	Often confused with CML! Leukemoid reaction usually only affects neuts! CML affects all granulocytes (especially eos and basos), and often causes anemia.
Leukoerythroblastic picture	Immature neuts NRBCs Teardrop cells Often has neutrophilia	Lesion in bone marrow Metastatic tumour Fibrosis, especially primary myelofibrosis Lymphoma Leukemia Hyperplasias
Basophilia	Abs basophilia (>0.15×109/L)	Non-malignant Insect stings Food or drug hypersensitivity Chronic infections Hypothyroidism Chronic inflammation Radiation therapy Malignant Chronic myelogenous leukemia
Eosinophilia	Abs eosinophilia (>0.4×109/L)	Allergies Parasitic infection Autoimmune disorders Fungal infections Acute lymphoblastic leukemia
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	All mature AND band neutrophils
Lymphocytes	All mature lymphocytes, including reactive/atypicals
Monocytes	All mature monocytes
Eosinophils	All eosinophil lineage, including immature
Basophils	All basophil lineage, including immature
Metamyelocytes	Neutrophil lineage only
Myelocytes
Promyelocytes	All cell lines
Blasts
Smudge Cells	ONLY report if in large numbers AND consistent with CLL (Chronic Lymphocytic Leukemia)
Other Cells	Hairy cells Plasma cells
Total
NRBC	x per 100 WBCs Report if >0 If ≥ 10, correct WBC count for NRBCs
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