[Haematology] Normal Cells of the Blood and Hematopoietic Organs

Normal Cells of the Blood and Hematopoietic Organs, Proerythroblasts and Basophilic Erythroblasts, Polychromatic and Orthochromatic Erythroblasts (Normoblasts) and Reticulocytes, Myeloblasts and Promyelocytes, Myelocytes and Metamyelocytes, Band Cells and Segmented Neutrophils, Cell Degradation, Special Granulations, and Nuclear Appendages in Neutrophilic Granulocytes and Nuclear Anomalies, Eosinophilic Granulocytes (Eosinophils) and Basophilic Granulocytes (Basophils), Monocytes, Lymphocytes (and Plasma Cells), Megakaryocytes and Thrombocytes, Cell Composition and Principles of Analysis, Medullary Stroma Cells, atlas in medical, tuyenlab, HAEMATOLOGY ATLAS, SUBCLINICAL ATLAS

1. Immature Red Cell Precursors: Proerythroblasts and Basophilic Erythroblasts

The earliest recognizable red cell precursor is the large dark proerythroblast
Fig. 1a. The earliest recognizable red cell precursor is the large dark proerythroblast with loosely arranged nuclear chromatin (1). Below are two orthochromatic erythroblasts (2), on the right a metamyelocyte (3).



Proerythroblast
Fig. 1b. Proerythroblast (1)

Proerythroblast
Fig. 1c. Proerythroblast (1) next to a myeloblast (2); lower region of image shows a promyelocyte (3). Toward the upper left are a metamyelocyte (4) and a segmented neutrophilic granulocyte (5).

2. Mature Red Blood Precursor Cells: Polychromatic and Orthochromatic Erythroblasts (Normoblasts) and Reticulocytes

Two basophilic erythroblasts with  condensed chromatin structure (1) and a polychromatic erythroblast with an almost homogeneous nucleus (2)
Fig. 2a. Two basophilic erythroblasts with  condensed chromatin structure (1) and a polychromatic erythroblast with an almost homogeneous nucleus (2).

The erythropoiesis in the bone marrow is often organized around a macrophage
Fig. 2b. The erythropoiesis in the bone marrow is often organized around a macrophage with a very wide, light cytoplasmic layer (1). Grouped around it are polychromatic erythroblasts of variable size. Erythroblast mitosis (2).

Polychromatic erythroblast
Fig. 2c. Polychromatic erythroblast (1) and orthochromatic erythroblast (normoblast) (2).

The density of the nuclear chromatin is similar in lymphocytes
Fig. 2d. The density of the nuclear chromatin is similar in lymphocytes (1) and erythroblasts (2), but in the erythroblast the cytoplasm is wider and similar in color to a polychromatic erythrocyte (3).

Normal red blood cell findings with slight variance in size of the erythrocytes
Fig. 2e. Normal red blood cell findings with slight variance in size of the erythrocytes. A lymphocyte (1) and a few thrombocytes (2) are seen. The erythrocytes are slightly smaller than the nucleus of the lymphocyte nucleus.

3. Immature White Cell Precursors: Myeloblasts and Promyelocytes


The least mature precursor in granulopoiesis is the myeloblast
Fig. 3a. The least mature precursor in granulopoiesis is the myeloblast, which is released into the blood stream only under pathological conditions. A large myeloblast is shown with a fine reticular nuclear structure and a narrow layer of slightly basophilic cytoplasm without granules.

Myeloblast and neutrophilic granulocytes with segmented  nuclei
Fig. 3b. Myeloblast and neutrophilic granulocytes with segmented
 nuclei (blood smear from a patient with AML).

Myeloblast
Fig. 3c. Myeloblast (1), which shows the start of azurophilic granulation (arrow), and a promyelocyte (2) with copious large azurophilic granules, typically in a perinuclear location.

Large promyelocyte
Fig. 3d. Large promyelocyte (1), myelocyte (2), metamyelocyte (3),
and polychromatic erythroblast (4).


4. Partly Mature White Cell Precursors: Myelocytes and Metamyelocytes

Early myelocyte
Fig. 4a. Early myelocyte. The chromatin structure is denser than that of promyelocytes. The granules do not lie over the nucleus (as can be seen by turning the fine focus adjustment of the microscope to and fro). The blood smear is from a case of sepsis, hence the intensive granulation.

Slightly activated myelocyte
Fig. 4b. Slightly activated myelocyte (the cytoplasm is still relatively basophilic).

Typical myelocyte
Fig. 4c.Typical myelocyte (1) close to a segmented neutrophil (2).

This metamyelocyte is distinguished from a myelocyte by incipient lobe formation
Fig. 4d. This metamyelocyte is distinguished from a myelocyte by incipient lobe formation.

5. Mature Neutrophils: Band Cells and Segmented Neutrophils

Transitional form between a metamyelocyte and a band cell.
Fig. 5a. Transitional form between a metamyelocyte and a band cell.

Copious granulation in a band cell
Fig. 5b.  Copious granulation in a band cell (1) (toxic granulation) next
 to band cells (2) with Döhle bodies (arrows).

Two band cells.
Fig. 5c. Two band cells.

Band cells can also occur as aggregates.
Fig. 5d. Band cells can also occur as aggregates.

Segmented neutrophilic granulocytes.
Fig. 5e. Segmented neutrophilic granulocytes.

Segmented neutrophilic granulocyte after the peroxidase reaction
Fig. 5f. Segmented neutrophilic granulocyte after the peroxidase reaction.

Segmented neutrophilic granulocyte after alkaline  leukocyte phosphatase (ALP) staining.
Fig. 5g. Segmented neutrophilic granulocyte after alkaline
leukocyte phosphatase (ALP) staining.

6. Cell Degradation, Special Granulations, and Nuclear Appendages in Neutrophilic Granulocytes and Nuclear Anomalies


Reactive state with toxic granulation of the neutrophilic granulocytes,  more visibly expressed in the cell
Fig. 6a. Reactive state with toxic granulation of the neutrophilic granulocytes,
more visibly expressed in the cell on the left (1) than the cell on the right (2)

Sepsis with toxic granulation, cytoplasmic vacuoles,  and Döhle bodies (arrows) in band cells (1) and a monocyte (2).
Fig. 6b. Sepsis with toxic granulation, cytoplasmic vacuoles,
and Döhle bodies (arrows) in band cells (1) and a monocyte (2).

Pseudo-Pelger cell looking like sunglasses (toxic or myelodysplastic cause).
Fig. 6c. Pseudo-Pelger cell looking like sunglasses (toxic or myelodysplastic cause).

Döhle-like basophilic inclusion (ar- row) without toxic granulation.  Together with giant thrombocytes this suggests May–Hegglin anomaly.
Fig. 6d. Döhle-like basophilic inclusion (ar- row) without toxic granulation.
Together with giant thrombocytes this suggests May–Hegglin anomaly.

Hypersegmented neutrophilic granulocyte (six or more segments).
Fig. 6e. Hypersegmented neutrophilic granulocyte (six or more segments). There is an accumulation of these cells in megaloblastic anemia.

Drumstick (arrow 1) as an appendage with a thin filament bridge to the nucleus
Fig. 6f. Drumstick (arrow 1) as an appendage with a thin filament bridge to the nucleus
(associated with the X-chromosome), adjoined by a thrombocyte (arrow 2).

Very large granulocyte from a blood sample taken after chemotherapy.
Fig. 6g. Very large granulocyte from a blood sample taken after chemotherapy.

Segmented neutrophilic granulocyte during degradation, often seen as an artifact after prolonged sample storage (more than eight hours).
Fig. 6h. Segmented neutrophilic granulocyte during degradation, often seen as an artifact after prolonged sample storage (more than eight hours).

7. Eosinophilic Granulocytes (Eosinophils) and Basophilic Granulocytes (Basophils)

Eosinophilic granulocytes with corpuscular, orange-stained granules.
Fig. 7a. Eosinophilic granulocytes with corpuscular, orange-stained granules.

Eosinophilic granulocytes with corpuscular, orange-stained granules.
Fig. 7b. Eosinophilic granulocytes with corpuscular, orange-stained granules.

Eosinophilic granulocytes with corpuscular, orange-stained granules.
Fig. 7c. Eosinophilic granulocytes with corpuscular, orange-stained granules.

In contrast, the granules of neutrophilic granulocytes  are not round but more bud-shaped.
Fig. 7d. In contrast, the granules of neutrophilic granulocytes
are not round but more bud-shaped.

Basophilic granulocyte.
Fig. 7e.  Basophilic granulocyte. The granules are corpuscular like those of the eosinophilic granulocyte but stain deep blue to violet.

Very prominent large granules in a basophilic granulocyte in  chronic myeloproliferative disease.
Fig. 7f.  Very prominent large granules in a basophilic granulocyte in
chronic myeloproliferative disease.

8. Monocytes

Range of appearances of typical monocytes with lobed, nucleus, gray–blue stained cytoplasm and fine granulation.
Fig. 8a. a–c Range of appearances of typical monocytes with lobed, nucleus, gray–blue stained cytoplasm and fine granulation.

Range of appearances of typical monocytes with lobed, nucleus, gray–blue stained cytoplasm and fine granulation.
Fig. 8b. a–c Range of appearances of typical monocytes with lobed, nucleus, gray–blue stained cytoplasm and fine granulation.

Range of appearances of typical monocytes with lobed, nucleus, gray–blue stained cytoplasm and fine granulation.
Fig. 8a. a–c Range of appearances of typical monocytes with lobed, nucleus, gray–blue stained cytoplasm and fine granulation.

Phagocytic monocyte with plasma vacuoles.
Fig. 8d. Phagocytic monocyte with plasma vacuoles.

Monocyte (1) to the right of a lymphocyte with azurophilic granules (2)
Fig. 8e.  Monocyte (1) to the right of a lymphocyte with azurophilic granules (2)

Monocyte (1) with nucleus resembling that of a band neutrophil,  but its cytoplasm stains typically gray–blue. Lymphocyte (2).
Fig. 8f. Monocyte (1) with nucleus resembling that of a band neutrophil,
but its cytoplasm stains typically gray–blue. Lymphocyte (2).

A monocyte that has phagocytosed two erythrocytes and harbors them in its wide cytoplasm (arrows) (sample taken after bone marrow transplantation).
Fig. 8g. A monocyte that has phagocytosed two erythrocytes and harbors them in its wide cytoplasm (arrows) (sample taken after bone marrow transplantation).

Esterase staining, a typical marker enzyme for cells of the monocyte lineage.
Fig. 8h. Esterase staining, a typical marker enzyme for cells of the monocyte lineage.

9. Lymphocytes (and Plasma Cells)

Range of appearance of normal lymphocytes (some of them adjacent to segmented neutrophilic granulocytes).
Fig. 9a. a–c Range of appearance of normal lymphocytes (some of them adjacent to segmented neutrophilic granulocytes).

Range of appearance of normal lymphocytes (some of them adjacent to segmented neutrophilic granulocytes).
Fig. 9b. a–c Range of appearance of normal lymphocytes (some of them adjacent to segmented neutrophilic granulocytes).

Range of appearance of normal lymphocytes (some of them adjacent to segmented neutrophilic granulocytes).
Fig. 9c. a–c Range of appearance of normal lymphocytes (some of them adjacent to segmented neutrophilic granulocytes).

In neonates, some lymphocytes from a neonate show irregularly  shaped nuclei with notches or hints of segmentation.
Fig. 9d. In neonates, some lymphocytes from a neonate show irregularly
shaped nuclei with notches or hints of segmentation.

A few larger lymphocytes with granules may occur in a normal person.
Fig. 9e. A few larger lymphocytes with granules may occur in a normal person.

Occasionally, and without any recognizable trigger, the cytoplasm may widen.
Fig. 9f. Occasionally, and without any recognizable trigger, the cytoplasm may widen.

A smear taken after infection may contain a few plasma cells, the final,  morphologically fully developed cells in the B-lymphocyte series
Fig. 9g. A smear taken after infection may contain a few plasma cells, the final,
morphologically fully developed cells in the B-lymphocyte series

10. Megakaryocytes and Thrombocytes

Megakaryocytes in a bone marrow smear.
Fig. 10a. Megakaryocytes in a bone marrow smear. The wide cytoplasm displays fine,
cloudy granulation as a sign of incipient thrombocyte budding.

Normal density of thrombocytes among the erythrocytes,  with little variation in thrombocyte size
Fig. 10b. Normal density of thrombocytes among the erythrocytes,
with little variation in thrombocyte size.

Peripheral blood smears with aggregations of thrombocytes.
Fig. 10c. c and d Peripheral blood smears with aggregations of thrombocytes. When such aggregates are seen against a background of apparent thrombocytopenia, the phenomenon is called “pseudo- thrombocytopenia” and is usually an effect of the anticoagulant EDTA

Peripheral blood smears with aggregations of thrombocytes.
Fig. 10d. c and d Peripheral blood smears with aggregations of thrombocytes. When such aggregates are seen against a background of apparent thrombocytopenia, the phenomenon is called “pseudo- thrombocytopenia” and is usually an effect of the anticoagulant EDTA

11. Bone Marrow: Cell Composition and Principles of Analysis

Bone marrow cytology of normal cell density in a young adult
Fig. 11a. Bone marrow cytology of normal cell density in a young adult
(smear from a bone marrow spicule shown at the lower right;

More adipocytes with large vacuoles are present in this bone marrow preparation with normal hematopoietic cell densities; usually found in older patients.
Fig. 11b. More adipocytes with large vacuoles are present in this bone marrow preparation with normal hematopoietic cell densities; usually found in older patients.

Normal bone marrow cytology.
Fig. 11c. Normal bone marrow cytology. Even this overview shows clearly that erythropoiesis (dense, black, round nuclei) accounts for only about one-third of all the cells.

Normal bone marrow
Fig. 11d. Normal bone marrow: megakaryocyte (1), erythroblasts (2), and myelocyte (3).

Iron staining in the bone marrow cytology: iron-storing macrophage.
Fig. 11e. Iron staining in the bone marrow cytology: iron-storing macrophage.

Normal bone marrow with slight preponderance of granulocytopoiesis
Fig. 11f. Normal bone marrow with slight preponderance of granulocytopoiesis, e.g., promyelocyte (1), myelocyte (2), metamyelocyte (3), and band granulocyte (4).

 Normal bone marrow with slight preponderance of erythropoiesis
Fig. 11g. Normal bone marrow with slight preponderance of erythropoiesis, e.g., basophilic erythroblast (1), polychromatic erythroblasts (2), and orthochromatic erythroblast (3). Compare (differential diagnosis) with the plasma cell (4) with its eccentric nucleus.

12. Bone Marrow: Medullary Stroma Cells

Spindle-shaped fibroblasts form the structural framework of the bone marrow
Fig. 12a. Spindle-shaped fibroblasts form the structural framework of the bone marrow (shown here: aplastic hematopoiesis after therapy for multiple myeloma).

 A macrophage has phagocytosed residual nuclear material
Fig. 12b. A macrophage has phagocytosed residual nuclear material
 (here after chemotherapy for acute leukemia).

Bone marrow osteo- blasts are rarely found in the cytological assessment.
Fig. 12c. Bone marrow osteo- blasts are rarely found in the cytological assessment. The features that distinguish osteoblasts from plasma cells are their more loosely structured nuclei and the cloudy, “busy” basophilic cytoplasm.

Osteoclasts are multinucleated giant cells with wide, spreading cytoplasm.
Fig. 12d. Osteoclasts are multinucleated giant cells with wide, spreading cytoplasm.

This is only a part of the book : Color Atlas of Hematology: Practical Microscopic and Clinical Diagnosis (Clinical Sciences) 2nd of authors: Harald Theml, M.D; Heinz Diem, M.D and Torsten Haferlach, M.D. If you want to view the full content of the book and support author. Please buy it here: https://goo.gl/sxasqM

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Atlas for Medical: [Haematology] Normal Cells of the Blood and Hematopoietic Organs
[Haematology] Normal Cells of the Blood and Hematopoietic Organs
Normal Cells of the Blood and Hematopoietic Organs, Proerythroblasts and Basophilic Erythroblasts, Polychromatic and Orthochromatic Erythroblasts (Normoblasts) and Reticulocytes, Myeloblasts and Promyelocytes, Myelocytes and Metamyelocytes, Band Cells and Segmented Neutrophils, Cell Degradation, Special Granulations, and Nuclear Appendages in Neutrophilic Granulocytes and Nuclear Anomalies, Eosinophilic Granulocytes (Eosinophils) and Basophilic Granulocytes (Basophils), Monocytes, Lymphocytes (and Plasma Cells), Megakaryocytes and Thrombocytes, Cell Composition and Principles of Analysis, Medullary Stroma Cells, atlas in medical, tuyenlab, HAEMATOLOGY ATLAS, SUBCLINICAL ATLAS
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