Abnormal Neutrophil Morphology
What is Abnormal Neutrophil Morphology
Neutrophils accounted for about 53 percent of all white blood cells. Wright stain, the cytoplasm colorless or very shallow reddish, many dispersed small light red or light purple unique particles. Shaped or 2 to 5 lobulated nucleus, the leaves filaments connected. In simple terms, the abnormal neutrophil morphology neutrophils volume cytoplasm, cell eucalyptus or abnormal neutrophil morphology performance.
Symptoms of Abnormal Neutrophil Morphology
What Causes Abnormal Neutrophil Morphology
Neutrophils morphological abnormality etiology
(A) abnormal neutrophil morphology in the pathogenesis of
Human blood cells are originated in pluripotent hematopoietic stem cells. Differentiation of pluripotent hematopoietic stem cells, myeloid progenitor cells myeloblasts promyelocytic cells, in promyelocytic late promyelocytic to the development of mature granulocytes. This process is subject to the regulation of cytokines and hematopoietic microenvironment. Any impact to hematopoietic stem cells, cytokines or hematopoietic microenvironment of environmental factors can lead to abnormal blood cells.
(B) neutrophils morphological abnormality etiology
1 blood diseases
(1) acute leukemia.
(2) myelodysplastic syndrome.
(3) multiple myeloma.
(4) megaloblastic anemia.
(5) aplastic anemia.
3 hereditary diseases
(1) dominant genetic Pelger-Huet disease.
(2) Familial leukocyte vacuoles disease.
(3) Aider-Rdilly exception.
(4) May-Hegglin anomaly.
(5) The huge hereditary neutrophil cell histiocytosis.
(6) The hereditary neutrophil leaf polycythemia.
(7) Chediak-Higashi exception.
Other secondary to bone marrow metastases leukemoid reaction.
Tests and Diagnosis for Abnormal Neutrophil Morphology
Neutrophils morphological abnormality diagnostic idea
Many diseases can be caused by abnormal neutrophil morphology, by detailed history combined with changes in cell morphology contribute to faster diagnosis and differential diagnosis. The ask should pay attention to the following aspects:
(1) Family history: many neutrophil morphology abnormal disease is a genetic disease, so a detailed inquiry of the family history is very important.
(2) fever: blood system disease is often accompanied by fever performance may be due to the disease itself, and also due to co-infection and causes fever, must be careful to look for infection focus. Severe infections can cause abnormal neutrophil morphology, and attention to the identification of the diseases of the blood system.
(3) Past history: megaloblastic anemia often associated with long-term picky eaters or and malabsorption history. Previous changes in blood can also assist in the identification of the diseases of the blood system. Abnormal neutrophil morphology is often accompanied by abnormal function, which can lead to the past history of recurrent infections.
2. Abnormal neutrophil morphology auxiliary examination
(1) Blood tests: blood, peripheral blood smear, nutritional factors, tumor markers, such as blood diseases abnormal blood count is often prompted polyphyletic. Exception can be found in the peripheral blood smear the original naive cells, the original immature cells also contribute to the number of sub-type of the disease. Megaloblastic anemia associated with folic acid, vitamin B12 deficiency, malignant tumor markers often abnormally elevated.
(2) bone marrow examination: it is the primary means of checking the neutrophil morphology observed difference between the blood system diseases or other diseases, and to provide direction for further diagnosis.
The differential diagnosis of abnormal neutrophil morphology
l. giant rod granulocyte
The normal neutrophil diameter of 10 ~ 15μm, very few larger than 17μm, to occur this abnormal cell body can be as large to 30ttm above. Nuclear chromatin detailed lighter coloring, shaped stubby such as eggplant, or was with the shape of cucumbers and also vacuoles in the cytoplasm. Mainly seen huge megaloblastic anemia and hereditary neutrophil cell histiocytosis. The latter for autosomal dominant genetic disease, huge neutrophils size is approximately 2 times the normal cell volume.
2. Multisection the leaf nuclear and giant leaf granulocyte
Normal human neutrophil nuclear average of three leaves, 4 leaves 10%. The heterozygous patients contains 5 leaves neutrophils> 10%, the homozygous for up to 14%.
Ring rod nuclear granulocytes
Which is characterized by cell body than the same period in the neutral rod nuclear granulocytes. Depression in the ring or lock-shaped nucleus, clear cytoplasm containing particles in the middle. The most common clinical megaloblastic anemia, the other also seen in MDS, acute myeloid leukemia, chronic myelogenous leukemia, severe alcoholism, myelofibrosis and other.
4. Nuclear chromatin
Morphological characteristics of mature neutrophil nuclei chromatin presents loose close coarse granular, small block, was uniformly light purple, typical chromosomes like chrysanthemum-like, clear blank gap between the petals. Seen in MDS and AML bone marrow and blood on the clinical diagnosis of dysplasia performance.
5 neutrophils leaf can not (Petger-Huet anomaly)
Non-sex-linked dominant genetic disease, the main features from the cytoplasm has matured but the nucleus is still leaf cell size and the same normal ring-shaped nucleus, dumbbell-shaped, rough walnut-shaped eyes like chromatin. Into stripes, gathered each other was clearer boundaries of the small heap like a blank gap in the middle, less nuclear cytoplasm ratio, nuclear and more in the cells on one side, such as the multi-leaf, Futaba, the middle of a filamentous staining Zhixianglian. Homozygous in all neutrophil nuclei are round or oval, eosinophils, basophils and megakaryocytes also showed eucalyptus chromatin condensation and nuclear rounded. The heterozygous most Futaba nuclear, 10% clover nuclear. Pelger-Huet common clinical disorders myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). In addition, severe infection, agranulocytosis disease, multiple myeloma, may also occur secondary to bone marrow metastases leukemoid reaction Pelger-Huet anomaly, called false Pelger-Huet anomaly.
6. Poisoning particle formation
Neutral late promyelocytic often accompanied can appear a scruffy dark purple toxic granules, and vacuoles in the cytoplasm of the rod-shaped leaf nuclear granulocytes and monocytes. Especially common in miliary tuberculosis with leukemoid reaction.
7. Neutrophils drumstick body
The drumsticks body is one end of the mature neutrophils nuclei or other parts of a diameter of 2 ~ 4μm, outwardly directed protrusions. The head end is elliptical or circular, with the nuclei of the connecting portion smaller, the shape of the drumstick. A normal female often about 5% (2% to 20%), men in the 1% to 1O%. In radiation sickness, leukemia, endocrine diseases and malignant tumors can be increased.
Also known as mucopolysaccharidosis disease of abnormal white blood cells, an autosomal recessive genetic. Which is characterized by neutrophils contain large particles than normal azurophilic granules and basophilic particle volume, also known as the Alder-Reilly bodies. Wright stain was purple, commonly found in the bone marrow, peripheral blood check is not easy to see. The formation of the particles because cells lacking mucopolysaccharide degradation of the catalytic enzyme, resulting in degradation of mucopolysaccharides incomplete accumulate in cells.
Autosomal dominant disease. Abnormal myeloid locus coeruleus, the larger (diameter of 2 to 5 μm), available at neutrophils, eosinophils, eosinophilic cytoplasm appears alkali granulocytes and monocytes, is due to RNA agglutination. With varying degrees of thrombocytopenia and containing particles of a few giant platelets.
l0. familial leukocyte vacuolization
Wherein can contain more large vacuoles, containing smaller, less vacuoles in cytoplasm of lymphocytes and plasma cells in the cytoplasm of neutrophils and monocytes. The histochemical fluorescence microscope analysis can be found in the vacuoles containing lipid compounds. This vacuoles and serious infection, toxic hepatitis, patients with diabetic ketoacidosis fat staining vacuoles phase identification.
The abnormal membrane structural defects blood cells, also known as cut - East Syndrome. Granulocyte both the deformation capacity and any directional movement dysfunction have abnormal morphology. Neutrophil cytoplasmic ranging round r oval gray purple peroxidase-positive granules, 1 ~ 3μm, a small number of deep purple, surrounded by the zona pellucida. Such particles may be the Golgi - endoplasmic reticulum - lysosomal expansion part is formed. The coarse red inclusion bodies in the cytoplasm of lymphocytes and monocytes. The clinical manifestations main part of albinism, mild bleeding and recurrent infections.