Variations in White Cell Morphology -- Granulocytes

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Authors: Marjorie A. Spahn, MT (ASCP); Barbara Minderman, MT (ASCP)
Reviewers: Rory Huschka, M.Ed., MT(ASCP); Dr. Linda Miller, PhD I, MBCM(ASCP)SI

This course covers all aspects of white blood cell morphology, including identifying changes in morphology in granulocytes. Addresses Barr bodies, Dohle bodies, Auer rods, vacuoles, hypersegmented granulocytes, and hyposegmented granulocytes. Excellent as a refresher or for clinical laboratory science students.

Continuing Education Credits


  • Explain the importance of identifying changes in granulocyte morphology.
  • Define, describe, and explain the relationship of Barr bodies to abnormal morphology.
  • Discuss nuclear hypersegmentation and hyposegmentation, with respect to: definition, appearance, composition, and significance.
  • Discuss nuclear hypersegmentation and hyposegmentation, with respect to: hypersegmented granulocytes and hyposegmented granulocytes.
  • Identify each of the following cytoplasmic variations: Dohle bodies, Auer rods, vacuoles, and abnormal granulation.
  • Identify and describe the morphological changes associated with Pelger-Huet anomaly, Chediak-Higashi anomaly, Alder-Reilly anomaly, and May-Hegglin anomaly.

Course Outline

  • Introduction
      • Variations in Morphology
      • Importance of Recognition
      • Match the following:
  • Nuclear Variations
      • Hypersegmentation
      • Conditions Associated with Hypersegmented Neutrophils
      • Hypersegmented Neutrophil versus Normal Segmented Neutrophil
      • Which of the following statements is true for hypersegmented neutrophils? (Choose ALL of the correct answers)
      • Hyposegmentation
      • Conditions Associated with Hyposegmented Neutrophils
      • Pelger-Huet Anomaly
      • Normal Band Forms vs. Pelger-Huet Bands
      • Bilobed Neutrophil
      • Pelger-Huet Cells
      • Single-Lobed Pelger-Huet Cells
      • Which of the following are seen in Pelger-Huet anomaly?
      • Barr Body
      • Which of the following best describes a Barr body?
      • Summary
  • Cytoplasmic Variations
      • Döhle Bodies
      • Döhle Bodies, continued
      • Toxic Granulation
      • Toxic Granulation and Vacuolation
      • Cytoplasmic Vacuolation
      • Neutrophil with Normal Granulation
      • Toxic granulation is seen most frequently in:
      • Auer Rods
      • Auer Rods, continued
      • Which of the following inclusions may be seen in the cytoplasm of myeloblasts and promyelocytes?
      • Auer rods are significant when they are seen in the cytoplasm of blast cells because they are diagnostic for:
      • Chédiak-Higashi Syndrome
      • Albinism and Chédiak-Higashi Syndrome
      • Chédiak-Higashi Syndrome (Anomaly) vs. Toxic Granulation
      • Chediak-Higashi Anomaly Inclusions
      • Chediak-Higashi anomaly is characterized by which of the following?
      • May-Hegglin Anomaly
      • Alder-Reilly Anomaly
      • Alder-Reilly Anomaly, continued
      • Alder-Reilly anomaly inclusions may be found in which of the following white blood cell types?
      • Which of the following inclusions has a similar appearance on a Wright's stained smear to a Döhle body?
      • The inclusions that are frequently seen on the same peripheral blood smear with toxic granulation include: (Choose ALL that apply)
      • What type of inclusions are present in the cell that is indicated by the arrow?
      • The cell in this image is typical of other neutrophils on this peripheral blood smear from a patient with sepsis. Which morphologic term describes the...
      • Summary
  • References
      • References

Additional Information

Level of instruction: Intermediate
Intended Audience: clinical laboratory science students, medical technologists, and medical laboratory technicians seeking review or continuing education. It is also appropriate for medical students, pathology residents, and pathologists.
Course Description: This course covers morphologic variations observed in granulocytes, including nuclear and cytoplasmic variations.
Authors: by Marjorie A. Spahn, MT (ASCP) and Barbara Minderman, MT (ASCP).
Reviewer: Rory Huschka, M.Ed., MT(ASCP), has over 25 years of combined experience as a medical technologist, technical supervisor, professor, and manager. He is a former Director of Medical Laboratory Science and Medical Laboratory Technician Programs. He is currently a Program Director at MediaLab, Inc. Rory holds a BS degree in Medical Technology from North Dakota State University and a Masters in Educational Leadership. 
Reviewer: Dr. Linda Miller, PhD I, MBCM(ASCP)SI, is an Assistant Editor for the Immunohematology section of Lab Medicine. She received her BS degree in Biology from Syracuse University and her PhD in Immunology from SUNY Upstate Medical University. She holds certifications as a Technologist in Immunology, Specialist in Immunology, and Technologist in Molecular Biology from the ASCP. Dr. Miller is a professor of Clinical Laboratory Science at Upstate Medical University and the Director of the Medical Biotechnology program in the same department. There, she teaches courses in Immunology, Human Genetics, Molecular Methods, and Medical Biotechnology. She has served as a member of the ASCP Immunology Exam Committee and the ASCP Lab Q Editorial Board as Associate Editor of Clinical Immunology. Dr. Miller has written numerous continuing education exercises and book chapters in clinical immunology and is co-author of the 4th edition of the textbook, Clinical Immunology and Serology: A Laboratory Perspective (FA Davis). 

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This course is part of:
Auer rod
Barr body
Hyposegmented neutrophil
Alder Reilly 2
Alder normal neutrophils arrow