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Peripheral Blood

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Slide 1: Two monocytes (left column), two polymorphs (top middle slide, left cell and bottom middle), two lymphocytes (top right and top middle, right cell), eosinophil (bottom right). Note the darker purple to red brown color of the eosinophilic cytoplasm as compared to that of the neutrophils. The granular texture of the esoinophil cytoplasm should be apparent.  

Slide 2: Lymphocyte and polymorph (neutrophil) - note the "sex chromatin" (Barr body) of the neutrophil. Photographed with a light blue filter (thus grey erythrocytes).  

Slide 3: Lymphocyte and a monocyte (one on the end with a bizzare-shaped nucleus), Lymphocytes vary in size such that the smallest appear to have just a rim of perinuclear cytoplasm to the largest which are almost the size of monocytes. Compare the monocyte with the large lymphocyte next to it. Note that the nucleus of the monocyte, in addition to its irregular shape, is also with less condensed chromatin and that the 2 medium-sized lymphocytes in this slide have some azurophilic granules. Giemsa stain.  

Slide 4: Monocyte and neutrophil - compare their nuclei. Wright's stain.  

Slide 5: Three monocytes, a neutrophil, a lymphocyte and an eosinophil.  

Slide 6: Eosinophil. The granularity of the esoinophil cytoplasm is apparent as is its typical bilobed nucleus. Wright's stain.  

Slide 7: Compare the eosinophil with the neutrophil at the other end of the slide. In the middle panel is a band neutrophil (also called a juvenile or immature form). Can you find the 4 platelets (2 large, 2 smaller)? Giemsa stain.  

Slide 8: 2 Eosinophils and 3 neutrophils (also a broken nucleus and part of a cell at the edge which you should ignore). Compare their granularity. Note that the eosinophil cytoplasm has azurophilic granules as well as the predominating more red brown colored specific granules. The solitary eosinophil (is actually almost but not quite mature) was photographed with a light blue filter.  

Slide 9: Human peripheral blood smear. Wrights, well spread area (rbc not piled up) and not so well spread area. Eosinophil and 2 PMNs at bottom, basophil and PMN at top. Platelets in both fields.  

Slide 10: Basophil - more typical Wright's stain appearance.  

Slide 11: Probably a monocyte, although nucleus mimics a juvenile neutrophil - but the nuclear chromatin is not condensed enough.  

Slide 12: What is the cell diagonally across from the neutrophil? (Ans: most likely a lymphocyte). For comparison the other 2 cells in the field are a typical lymphocyte and monocyte.  

Slide 13: Human PMN's in an arteriole. EM orig. mag 5,000x  

Slide 14: Monocyte EM. Nucleus is more typical than the cytoplasm, which is not sectioned through any azurophilic granules.  

Slide 15: Lymphocyte EM with several azurophilic granules.  

Slide 16: Eosinophil EM. In C.T. not intravascular.  

Slide 17: Red blood cells - sickle cell anemia. Note the sickled cells.  

Slide 18: In section low power; megakaryocytes and fat cells are visible (they are the two largest elements in the field). H&E  

Slide 19: In section different preparation. Megakaryocytes are the big bright cells with polyploid nuclei. Note the bone trabeculum.  

Slide 20: Smear - medium power - heteromorphic field, note cells of different series; cells with small dense nuclei are of erythroid line; the larger cells, some of which have granules in their cytoplasm, represent different stages of granulocyte maturation. To be elaborated upon in subsequent slide - all are from marrow smears. Note that white cell precursors greatly outnumber red cell precursors even though the situation is just the opposite in the peripheral circulation. This is because for the most part the white cells (especially neutrophils) last only a few days while red cells, on average, live 120 days.  

Slide 21: Smear - high power - concentrate on the two largest cells in the field which are "blasts". They have pale blue cytoplasm, no cytoplasmic granules and large euchromatic nuclei with prominent nucleoli. They are of uncertain lineage (especially to the non-expert). Be prepared to be unable to positively identify every cell that you see in marrow smears.  

Slide 22: Promyelocyte and neutrophilic myelocyte: the more advanced myelocyte with slightly indented nucleus and with more condensed chromatin usually has fewer azurophilic granules.  

Slide 23: REFER TO THE SUPPLEMENTAL DIAGRAM

  • 1 = a promyelocyte which has a more basophilic cytoplasm than the one in slide 7-22. Its nucleus is very euchromatic and the cytoplasmic azurophilic granules are quite evident.
  • 2 and 3 = neutrophilic myelocytes (2 - early one). Note their more heterochromatic nuclei, lack of cytoplasmic basophilia and few azurophilic granules.
  • 4 and 5 = neutrophilic metamyeolcytes.
  • 6 = an almost mature PMN (neutrophil),
  • 7 and 8 = normoblasts of the red cell maturation series.
 

Slide 24: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = promyelocyte in division.
  • 2 = late promyclocyte early neutrophilic myelocyte
  • 3 = neutrophilic metamyelocytes
  • 4 = almost normoblast (red cell series - stay tuned)
 

Slide 25: PLEASE REFER TO SUPPLEMENTAL DIAGRAMS

  • 1,2 = promyelocytes with prominent azurophilic granules in the cytoplasm plus large euchromatic nuclei with prominent nucleoli.
  • 3 = neutrophilic metamyelocyte
  • 4 = band neutrophil
  • 5 = essentially mature neutrophils
 

Slide 26: Human marrow. Wrights Neutrophil development series: late promyelocyte to mature PMN's.  

Slide 27: Human marrow. Promyelocyte and (lymphocyte?) at left. Eosinophilic myelocyte and mature neutrophil at right.  

Slide 28: Sometimes eosinophil precursors retain some cytoplasmic basophilia. This tends to deepen the appearance of the cytoplasmic staining and sometimes gives it a "muddy" look. Both early eosinophilic myeolocytes here illustrate this point and sometimes the "blue background" is even more pronounced.

  • 1 = early eosinophilic myelocytes with many eosinophilic (specific granules)
  • 2 = neutrophilic myeolocytes - early - still with many azurophilic (nonspecific) granules
  • 3,4 = neutrophilic metamyelocytes
  • 5 = late neutrophilic band
  • 6 = mature neutrophil
  • 7 = early basophilic erythroblast
 

Slide 29: Eosinophilic and neutrophilic metamyelocytes and bands.  

Slide 30: Human marrow. Neutrophilic and eosinophilic mylelocytes. Neutophilic band and part of a basophilic erythroblast.  

Slide 31: REFER TO The SUPPLEMENTAL DIAGRAMS

  • 1,2 = eosinophilic metamyelocytes (almost mature)
  • 3 = neutrophilic metamyelocyte
  • 4,5,6 = mature neutrophils (or almost mature)
 

Slide 32: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = mature eosinophil
  • 2 = not sure (neutrophilic metamyelocyte)
  • 3 = platelets
 

Slide 33: Developing cells of the basophil series are extremely rare and difficult to find - thus we do not ask you to do so on your microscope slide. If found, they can be identified by their navy blue specific granules.

  • 1 = basophilic myelocyte
  • 2 = eosinophilic myelocytes
  • 3 = neutrophilic metamyelocyte
  • 4 = neutrophilic band
  • 5 = polychromatophilic erythroblasts
  • 6 = mature neutrophil
 

Slide 34: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = blast cell
  • 2 = late basophilic or early polychromatophilic erythroblast
  • 3 = almost normoblast
  • 4 = neutrophils
 

Slide 35: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = blast cell
  • 2, 3 = late basophilic (somewhat broken) more likely early polychromatophilic erythroblasts
  • 4 = almost normoblast (late polychromatophilic erythroblast)
  • 5 = cell in division (granulocyte series)
  • 6, 7 = neutrophilic metamyelocytes (7 slightly earlier than 6).
  • 8 = mature PMN
 

Slide 36: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = blast cell
  • 2 = basophilic erythroblast
  • 3 = late polychromatophilic erythroblasts
  • 4 = band neutrophils
  • 5 = neutrophils
  • 6 = probably a lymphocyte
 

Slide 37: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = basophilic erythroblasts (just post-mitotic)
  • 2 = neutrophils
  • 3 = eosinophil
  • 4 = early neutrophilic myelocyte (or late promyelocyte)
  • 5 = neutrophilic metamyelocyte
  • 6 = ? some azurophilic granules, probably a neutrophilic myelocyte
 

Slide 38: Late polychromatophilic or early orthochromatic erythroblast (normoblast) and mature erythrocytes.  

Slide 39: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = plasma cell
  • 2 = neutrophil
  • 3 = normoblasts
  • 4 = lymphocyte
  • 5 = late neutrophilic myeolocyte/early metamyeloctye
  • 6 = ?
 

Slide 40: REFER TO THE SUPPLEMENTAL DIAGRAMS

  • 1 = plasma cell
  • 2 = promyelocyte
  • 3 = lymphocyte
 

Slide 41: Monocyte and lymphocyte. Human peripheral blood smear.  

Slide 42: Human marrow. Promyelocyte, eosinophil, band neutrophils, lymphocytes and nucleus from a sheared cell.  

Slide 43: Human marrow. Megakaryocyte with erythroblasts and other marrow precursors.  

Slide 44: Megakaryocyte


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