Hema Mod 6 Quiz Bowl for G3 (average)

Identify the WBC.

Answer explanation

Neutrophilic metamyelocytes have condensed chromatin and a slightly indented nucleus (the indentation is less than half the diameter of the nucleus). The cytoplasm contains abundant specific granules and rare primary (azurophilic) granules.  Metamyelocytes are not normally present in the peripheral blood, but can be seen in infectious or inflammatory states, and in other reactive and neoplastic conditions. 

https://imagebank.hematology.org/image/60398/metamyelocyte?type=upload

Identify the cell pointed by the arrow.

Answer explanation

Plasma Cell/Plasmacyte

End stage of B lymphocytes

• Characteristics:

a. 10-20 um

b. Dominant in lymph nodes

c. Not normally seen in circulation

d. Stimulated by antigens; capable of producing antibodies

• Stages: Plasma blast, proplasmacyte, plasma cell

NUCLEUS

• Eccentric

• Very coarse, clumped chromatin

pattern (cartwheel pattern)

CYTOPLASM

• Royal blue, abundant

• Prominent perinuclear (golgi)

zone/hof

Identify the WBCs.

Answer explanation

BLAST (Monoblast)

12-18 um; N:C ratio 4:1

Morphologically indistinguishable

from myeloblast (differentiated by  cytochemical stains)

NUCLEUS

Round/oval with fine chromatin; 1-2  nucleoli

CYTOPLASM

Dark blue; no cytoplasmic granules

Identify the cell pointed by the arrow.

Answer explanation

Metamyelocyte/Juvenile Cell

aka Juvenile cell

Nucleus: indented/kidney/bean shaped with coarse, clumped chromatin; nuclear indent is less than half the width of a hypothetical round nucleus

Shape of nucleus is the chief identification criterion!

Cytoplasm: pink filled with specific/secondary granules; nonspecific granules are present but usually do not stain; synthesis of tertiary granules begins

What is the most predominant constituent granule of this WBCs?

Answer explanation

Major basic protein (MBP) is an eosinophil granule protein. Eosinophil granules contain a crystalloid core comprised of MBP and a matrix consisting of other toxic and pro-inflammatory mediators. MBP is the predominant constituent in eosinophil granules.

Identify the structure pointed by the red arrows.

Answer explanation

Nucleoli

Lymphoblast with nucleoli

Identify the WBC.

Answer explanation

Plasma cell

End stage of B lymphocytes

10 - 20 um

Nucleus: eccentric with very coarse, clumped chromatin pattern (cartwheel pattern/ tortoise shell/ clock face appearance)

Cytoplasm: royal blue, abundant with prominent perinuclear (golgi) zone/hof

Dominant in lymph nodes; not normally seen in circulation

Stimulated by antigens; capable of producing antibodies

Most common malignant disease of plasma cells: Multiple Myeloma

Identify the WBC.

Answer explanation

Reactive Lymphocyte

Nucleus: round, oval or indented; condensed (densely packed clumps) chromatin; nucleoli may be visible

Cytoplasm: sparse to abundant; pale to bright sky blue; may have azurophilic granules; maybe indented by surrounding cells

Increased in: Infectious mononucleosis, Infectious lymphocytosis, CMV infection, Acute viral hepatitis, Bordetella pertusis Infectection, Brucellosis & Toxoplasmosis

Decreased in: HIV infection (T lymphocytopenia)

Reactive lymphocytes show a range of morphologic features.  Reactive lymphocytes with immunoblast-like morphology are large cells with high nuclear-cytoplasmic ratios, condensed chromatin, and deeply basophilic cytoplasm.   Another type of reactive lymphocyte has less condensed chromatin and abundant, pale blue cytoplasm that may appear to "hug" adjacent red blood cells.  These cells are also called Downey type II cells.  They can be seen in a variety of conditions, but are often increased in infectious mononucleosis due to EBV infection.

Identify the structure pointed by arrow.

Answer explanation

Barr Body

Represents X chromosomes in females

Round projections of nuclear chromatin connected to the neutrophil nucleus by a fine strand of chromatin (drumstick appearance)

Seen in 2-3% of the neutrophils in females ONLY.

Identify the WBC.

Answer explanation

Small lymphocyte

•Small (size of RBC), medium (size of WBC)

•Small, 6-8 um; medium to large, 8-12 um

•The larger the lymphocyte, the larger the cytoplasm

A small resting lymphocyte is stimulated by antigen and begins to enlarge to form a medium to large lymphocyte. The nucleus reverts from a clumped to a delicate chromatin pattern with nucleoli. The cell is capable of dividing to form effector cells or memory cells.