Transcript Pelger Huet Anomaly - Cal State LA

Septicemia
Severe Left Shift
Toxic granulation is found in severe inflammatory
states. The toxic granules are azurophilic, usually
found in the promyelocyte, metamyelocyte, band, and
segmented stages. The toxic granulation is thought to
be due to impaired cytoplasmic maturation,in the effort
to rapidly generate large numbers of granulocytes.
Toxic Granulation
L Dohle bodies are single or multiple blue cytoplasmic inclusions. They
represent remnants of rough endoplasmic reticulum from earlier maturational
stages. They are associated with myeloid "left shifts" and are seen in
conjunction with toxic granulation.
DÖHLE Bodies
DÖHLE Bodies
DÖHLE Bodies
Toxic Vacuoles
Intracellular Yeast
Phagocytized yeast
Rickettsia Infection
Pelger Huet Anomaly
Pelger-Huet or Band?
Pelger Huet
Variations in Pelger Huet
Eosinophilia
Monocyte
Eosinophilia
Basophilia
Monocytosis
Lymphocytosis
Infectious Mononucleosis
Atypical Lymphocytes - Peripheral Blood
Copyright © 1999 by W. B. Saunders Company
Atypical Lymphs v. Monocytes
Copyright © 1999 by W. B. Saunders Company
Reactive or Atypical Lymphs
Lymphocytosis
The Alder-Reilly anomaly is associated with the genetic mucopolysaccharidoses. Patients with mucopolysaccharidoses lack the lysozymal
enzymes necessary to break down mucopolysaccharides. Dense azurophilic
granules, resembling toxic granulation in neutrophils, are seen in all leukocytes.
Most characteristic of these disorders are the metachromatic granules
surrounded by a clear zone seen in lymphocytes.
Alder Reilly Syndrome
May Hegglin Anomaly
The Chediak-Higashi syndrome is a rare autosomal recessive condition
associated with abnormally large leukocyte granules resulting from fusion of
lysozymes. This disorder may affect granulocytes, leukocytes, and monocytes.
Chemotaxis and phagocytosis is defective. Platelets lack dense granules and
platelet function is abnormal. Giant melanosomes in occular and skin tissues
result in hypopigmentation.
Chediak-Higashi Syndrome
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IM 3/97: atypical or reactive lymphs
↑ Lymphs: large # of lymphs, some may be reactive
↑ Mono: large # of monocytes
75% Eos: large # of eosinophils
EOS 3/95: large # of eosinophils
Normal
P-H: pelger huet, appear as bands, bilobed (pince nez), hypermature
nuclear chromatin, normal WBC count
pelger huet 7/83: another case of pelger huet, more bilobed
Toxic granulation: toxic granulation, increased bands, possible vacuoles
and Dohle
Toxic left shift: left shift with meta and myelocytes, toxic granulation, etc
Toxic vacuoles: small vacuoles in neutrohils
Döhle: Döhle bodies (may be faded out)
Döhle 12/95: Döhle bodies (may be faded out)
Pneumonia: increased bands
Leuk rxn WBC 60K: left shift (bands), high WBC count