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2019v1.0
SIXTH EDITION

CLINICAL
HEMATOLOGY
ATLAS
Jacqueline H. Carr, MS MT(ASCP)SH
Laboratory Manager (Retired)
Department of Pathology and Laboratory Medicine
Indiana University Health
Indianapolis, Indiana
Elsevier
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St. Louis, Missouri 63043

CLINICAL HEMATOLOGY ATLAS, SIXTH EDITION ISBN: 978-0-323-71192-0

Copyright © 2022 by Elsevier, Inc. All rights reserved

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Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluat-
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Publishing Services Manager: Julie Eddy
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Design Direction: Ryan Cook

Printed in Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 Dedicated to my dear friend and colleague,
Bernadette Rodak,
who ended her battle with cancer on March 22, 2016.
Also
My husband,
Charles Carr,
who has supported me through this adventure
as well as our daughters,
Kimberly Mayrose and Alexis Carr.
REVIEWERS

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
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PREFACE

B
ecause the emphasis of an atlas is morphology, the Clinical Hematology Atlas
is intended to be used with a textbook, such as Rodak’s Hematology, sixth edi-
tion, that addresses physiology and diagnosis along with morphology. This atlas
is designed for a diverse audience that includes clinical laboratory science students,
medical students, residents, and practitioners. It is also a valuable resource for clinical
laboratory practitioners who are being retrained or cross-trained in hematology. It is
not intended to be a detailed, comprehensive manual for diagnosis.
In this concise format, every photomicrograph and word has been evaluated
for value to the microscopist. All superuous information has been excluded in an
attempt to maintain focus on signicant microscopic ndings while correlating this
information with clinical diagnosis. What started as a primer for Clinical Laboratory
Science students with no previous hematology education has evolved into an inter-
nationally recognized reference for multiple levels of expertise, from entry level to
practicing professionals.

ORGANIZATION

As is frequently expounded, morphology on a peripheral blood lm is only as good as

the quality of the smear and the stain. Chapter 1 reviews smear preparation, staining,
and the appropriate area in which to evaluate cell distribution and morphology. A
table that summarizes the morphology of leukocytes found in a normal differential,
along with multiple examples of each cell type, facilitates early instruction in blood
smear review.
Chapter 2 schematically presents hematopoietic features of cell maturation.
General cell maturation, along with an electron micrograph with labeled organelles,
will help readers correlate the substructures with the appearance of cells under light
microscopy. Visualizing normal cellular maturation is essential to the understanding
of disease processes. This correlation of schematic, electron micrograph, and Wright-
stained morphology is carried throughout the maturation chapters. Figure 2-1 has
been formatted to reect recent hematopoietic theory. In addition, the chart aids
readers in recognizing the anatomical sites at which each stage of maturation nor-
mally occurs.
Chapters 3 to 9 present the maturation of each cell line individually, repeating
the respective segment of the overall hematopoietic scheme from Chapter 2, to
assist the student in seeing the relationship of each cell line to the whole. In these
chapters, each maturation stage is presented as a color print, a schematic, and an
electron micrograph. A description of each cell, including overall size, nuclear-to-
cytoplasmic ratio, morphologic features, and reference ranges in peripheral blood and
bone marrow, serves as a convenient summary. The nal gure in each of these chap-
ters summarizes lineage maturation by repeating the hematopoietic segment with
the corresponding photomicrographs. Multiple nomenclatures for erythrocyte mat-
uration are used to accommodate use in multiple settings and demographic groups.

viii
 Preface ix

Chapters 10 to 12 present discrete cellular abnormalities of erythrocytes, that is,

variations in size, color, shape, and distribution, as well as inclusions found in eryth-
rocytes. Each variation is presented along with a description of the abnormality, or
composition of the inclusion, and associated disorders.
Because diseases are often combinations of the cellular alterations, Chapter 13
integrates morphologic ndings into the diagnostic features of disorders primarily
affecting erythrocytes.
In Chapter 14, nuclear and cytoplasmic changes in leukocytes are displayed and
correlated with non-malignant leukocyte disorders.
Diseases of excessive or altered production of cells may be caused by maturation
arrest, asynchronous development, or proliferation of one cell line, as presented in
Chapters 15 to 19. Cytochemical stains are presented with disorders in which they
are useful.
The therapeutic use of myeloid growth factors causes morphologic changes that
mimic severe infections or malignancies. Chapter 20 presents examples of peripheral
blood morphology following G-CSF or GM-CSF. It is the authors’ design that the cel-
lular defects in leukocyte disorders be visually compared with the process of normal
hematopoiesis for a more thorough comprehension of normal and altered develop-
ment. Readers are encouraged to refer to the normal hematopoiesis illustration, Figure
2-1, for comparison of normal and abnormal cells and the progression of diseases.
Microorganisms, including parasites, may be seen on peripheral blood smears.
A brief photographic overview is given in Chapter 21. Readers are encouraged to
consult a microbiology reference, such as Mahon CM, Lehman DC, Manuselis G:
Textbook of Diagnostic Microbiology, fth edition, for a more detailed presentation.
Chapter 22 includes photomicrographs that are not categorized into any one
particular area, such as fat cells, mitotic gures, metastatic tumor cells, and artifacts.
Chapter 23 describes ndings expected in the peripheral blood of neonates, includ-
ing anticipated variations in morphology and cellular distribution. Comparison of the
hematogone, normal for newborns, with the blast cell of acute leukemia is included.
Chapter 24 is intended to be an overview of the most frequent microscopic nd-
ings in body uids. It is not proposed as a comprehensive review of the cytology of
human body uids, but rather a quick reference for the beginning microscopist as
well as the seasoned professional.
As with previous editions, the sixth edition features spiral binding, making the
atlas more convenient when used at the microscope bench.
All of these chapters combine into what we believe is a comprehensive and valu-
able resource for any clinical laboratory. The quality of the schematic illustrations,
electron micrographs, and color photographs stand for themselves. We hope that
this atlas will enrich the learning process for the student and serve as an important
reference tool for the practitioner.

EVOLVE

The Evolve website provides free materials for both students and instructors.
Instructors have access to an electronic image collection featuring all of the images
from the atlas. Students and instructors have access to student review questions and
summary tables.
ACKNOWLEDGMENTS

A
s in previous edition, the faculty and staff of the Department of Pathology
and Laboratory Medicine, Indiana University School of Medicine have been
supportive off this effort. An incredibly special thanks is owed to George
Girgis who willingly and unselshly shared his vast knowledge of microscopy in
blood cell and body uid morphology. Without his help and support, this edition
of the Clinical Hematology Atlas would not have been possible. A special thanks to
Linda Marler and Jean Siders who once again allowed us to publish their microbi-
ology images.
The professionals at Elsevier who been incredibly patient during the last year as
this atlas began to come to life. The following people deserve my gratitude for their
kind assistance and advice:
Heather Bays-Petrovic, Content Strategist
Abigail Bradberry, Senior Project Manager
Maria Broeker, Senior Content Development Specialist

x
CONTENTS

Section 1 Introduction
1 Introduction to Peripheral Blood Film Examination 1

Section 2 Hematopoiesis
2 Hematopoiesis 11
3 Erythrocyte Maturation 17
4 Megakaryocyte Maturation 31
5 Neutrophil Maturation 41
6 Eosinophil Maturation 55
7 Basophil Maturation 65
8 Monocyte Maturation 69
9 Lymphocyte Maturation 79

Section 3 Erythrocytes
10 Variations in Size and Color of Erythrocytes 89
11 Variations in Shape and Distribution of Erythrocytes 93
12 Inclusions in Erythrocytes 107
13 Diseases Affecting Erythrocytes 115

Section 4 Leukocytes
14 Nuclear and Cytoplasmic Changes in Leukocytes 131
15 Acute Myeloid Leukemia 141
16 Precursor Lymphoid Neoplasms 161
17 Myeloproliferative Neoplasms 165
18 Myelodysplastic Syndromes 175
19 Mature Lymphoproliferative Disorders 185
20 Morphologic Changes After Myeloid Hematopoietic Growth Factors 195

Section 5 Miscellaneous
21 Microorganisms 199
22 Miscellaneous Cells 207
23 Normal Newborn Peripheral Blood Morphology 219
24 Body Fluids 223

Glossary 245
Index 265

xi
This page intentionally left blank
CHAPTER 1

INTRODUCTION TO PERIPHERAL
BLOOD FILM EXAMINATION
2 SECTION 1 Introduction

A
properly prepared blood lm is essential to accurate assessment of cellular
morphology. A variety of methods are available for preparing and staining
blood lms, the most common of which are discussed in this atlas. It is beyond
the scope of this atlas to discuss other methodologies; however, detailed descrip-
tions of these procedures can be found in textbooks on hematology, such as Rodak’s
Hematology: Clinical Principles and Applications, sixth edition.

WEDGE FILM PREPARATION

MAKING THE PERIPHERAL BLOOD FILM

Although some automated analyzers prepare and stain blood lms according to
established criteria, manual blood lm preparation is still used in many places. The
wedge lm is a convenient and commonly used technique for making peripheral
blood lms. This technique requires at least two 3 × 1-inch (75 × 25-mm) clean
glass slides. High-quality, beveled-edge microscope slides are recommended. One
slide serves as the blood lm slide, and the other as the spreader slide. These can
then be reversed to prepare a second lm. A drop of ethylenediaminetetraacetic
acid (EDTA) anticoagulated blood about 3 mm in diameter is placed at one end
of the slide. Alternatively, a similar size drop of blood directly from a nger or heel
puncture is acceptable. The size of the drop of blood is important. Too large a drop
creates a long or thick lm, and too small a drop often makes a short or thin lm.
In preparing the lm, the technician holds the pusher slide securely in front of the
drop of blood at a 30- to 45-degree angle to the lm slide (Figure 1.1A). The pusher
slide is pulled back into the drop of blood and held in that position until the blood
spreads across the width of the slide (Figure 1.1B). It is then quickly and smoothly
pushed forward to the end of the lm slide, creating a wedge lm (Figure 1.1C).
It is important that the whole drop of blood is picked up and spread. Moving the
pusher slide forward too slowly accentuates poor leukocyte distribution by pushing
larger cells, such as monocytes and granulocytes, to the very ends and sides of the
lm. Maintaining a consistent angle between the slides and an even, gentle pressure
is essential. It is frequently necessary to adjust the angle between the slides to pro-
duce a satisfactory lm. For higher than normal hematocrit, the angle between the
slides must be lowered so that the lm is not too short and thick. For extremely low
hematocrit, the angle must be raised. A well-made peripheral blood lm (Figure 1.2)
has the following characteristics:
1. About two-thirds to three-fourths of the length of the slide is covered by the lm.
2. It is slightly rounded at the feather edge (thin portion), not bullet shaped.
3. Lateral edges of the lm should be visible. The use of slides with chamfered (bev-
eled) corners may facilitate this appearance.
4. It is smooth without irregularities, holes, or streaks.
5. When the slide is held up to light, the feather edge of the lm should have a
“rainbow” appearance.
6. The whole drop is picked up and spread.
Figure 1.3 shows examples of unacceptable lms.
 CHAPTER 1 Introduction to Peripheral Blood Film Examination 3

30 – 45°

C
FIGURE 1.1 Wedge technique of making a peripheral blood lm. (A) Correct angle to hold spreader slide.
(B) Blood spread across width of slide. (C) Completed wedge lm.
(From Keohane E.A., Smith L., Walenga J. (Eds.) (2016). Rodak’s hematology: clinical principles and
applications. (5th ed.). St. Louis: Saunders Elsevier.)

FIGURE 1.2 Well-made peripheral

blood lm.
(From Keohane E.A., Smith L., Walenga
J. (Eds.) (2016). Rodak’s hematology:
clinical principles and applications. (5th
ed.). St. Louis: Saunders Elsevier.)
4 SECTION 1 Introduction

A B C D

E F G H
FIGURE 1.3 Unacceptable peripheral blood lms. Slide appearances associated with the most com-
mon errors are shown, but note that a combination of causes may be responsible for unacceptable
lms. (A) Chipped or rough edge on spreader slide. (B) Hesitation in forward motion of spreader slide.
(C) Spreader slide pushed too quickly. (D) Drop of blood too small. (E) Drop of blood not allowed to
spread across the width of the slide. (F) Dirt or grease on the slide; may also be caused by elevated
lipids in the blood specimen. (G) Uneven pressure on the spreader slide. (H) Time delay; drop of blood
began to dry.
(From Keohane E.A., Smith L., Walenga J. (Eds.) (2016). Rodak’s hematology: clinical principles and
applications. (5th ed.). St. Louis: Saunders Elsevier.)
 CHAPTER 1 Introduction to Peripheral Blood Film Examination 5

STAINING OF PERIPHERAL BLOOD FILMS

The purpose of staining blood lms is to identify cells and recognize morphology
easily through the microscope. Wright or Wright-Giemsa stains are the most com-
monly used for peripheral blood and bone marrow lms. These stains contain both
eosin and methylene blue and are therefore termed polychrome stains. The colors
vary slightly from laboratory to laboratory, depending on the method of staining.
Slides must be allowed to dry thoroughly before staining. The cells are xed to
the glass slide by the methanol in the stain. Staining reactions are pH dependent,
and the actual staining of the cellular components occurs when a buffer (pH 6.4)
is added to the stain. Free methylene blue is basic and stains acidic cellular compo-
nents, such as RNA, blue. Free eosin is acidic and stains basic components, such as
hemoglobin or eosinophilic granules, red. Neutrophils have cytoplasmic granules
that have a neutral pH and accept some characteristics from both stains. Details
for specic methods of staining peripheral blood and bone marrow lms, including
automated methods, may be found in a standard textbook of hematology.
An optimally stained lm (Figure 1.4) has the following characteristics:
1. The red blood cells (RBCs) should be pink to salmon.
2. Nuclei are dark blue to purple.
3. Cytoplasmic granules of neutrophils are lavender to lilac.
4. Cytoplasmic granules of basophils are dark blue to black.
5. Cytoplasmic granules of eosinophils are red to orange.
6. The area between the cells should be colorless, clean, and free of precipitated stain.
A well-stained slide is necessary for accurate interpretation of cellular morphology.
The best staining results are obtained from freshly made slides that have been pre-
pared within 2 to 3 hours of blood collection. Box 1.1 lists common reasons for
poorly stained slides and may be used as a guide when troubleshooting.

FIGURE 1.4 Optimally stained peripheral blood

lm demonstrating the appropriate area in
which to perform the white blood cell differ-
ential and morphology assessment and the
platelet estimate. Only the center of the eld is
shown; an entire eld would contain 200 to 250
red blood cells (original × 1000).
6 SECTION 1 Introduction

Box 1.1
Troubleshooting Poorly Stained Blood Films
First Scenario
Problems
• Red blood cells appear gray
• White blood cells are too dark
• Eosinophil granules are gray, not orange

Causes
• Stain or buffer too alkaline (most common)
• Inadequate rinsing
• Prolonged staining
• Heparinized blood sample

Second Scenario
Problems
• Red blood cells too pale or red color
• White blood cells barely visible

Causes
• Stain or buffer too acidic (most common)
• Underbuffering (time too short)
• Over-rinsing

From Keohane E.A., Smith L., Walenga J. (Eds.) (2016). Rodak’s

hematology: clinical principles and applications. (5th ed.).
St. Louis: Saunders Elsevier.

PERIPHERAL FILM EXAMINATION

10 × EXAMINATION
Examination of the blood lm is a multistep process. Begin the lm examination
with a scan of the slide using the 10 × or low-power objective (total magnication
= 100 ×). This step is necessary to assess the overall quality of the lm, including
abnormal distribution of RBCs, suggesting the presence of rouleaux or autoagglu-
tination, and/or the presence of a disproportionate number of large nucleated cells
such as monocytes or neutrophils at the edges of the lm. If the latter exists, another
lm should be prepared. In addition, the 10 × lm examination allows for the rapid
detection of large abnormal cells such as blasts, reactive lymphocytes, and parasites.

40 × OR 50 × EXAMINATION
Using the 40 × (high dry) objective or the 50 × oil objective (400 × and 500 × total
magnication, respectively), nd an area of the lm in which the RBCs are evenly dis-
tributed and barely touching one another (two or three cells may overlap; Figure 1.5).
Scan 8 to 10 elds in this area of the lm, and determine the average number of
white blood cells (WBCs) per eld. Although an exact factor varies with the make
 CHAPTER 1 Introduction to Peripheral Blood Film Examination 7

FIGURE 1.5 Correct area of blood lm in

which to evaluate cellular distribution
and perform white blood cell estimate
(× 400).

and model of microscope, in general, an approximate WBC count per cubic milli-
meter can be determined by multiplying the average number of WBCs per high-
power eld by 2000 (if 40 × is used), or 2500 (if 50 × is used). This estimate is a
useful quality-control tool for validating WBC counts from hematology analyzers.
Any discrepancy between the instrument WBC count and the slide estimate must
be resolved. Some reasons for discrepancies include the presence of WBC or platelet
clumps, brin strands, severe RBC agglutination, cryoglobulin and giant platelets, in
addition to a mislabeled lm, a lm made from the wrong patient’s sample, and an
instrument malfunction.

100 × EXAMINATION
The next step in lm evaluation is to perform the WBC differential. This is done
in the same area of the lm as the WBC estimate but using the 100 × oil immer-
sion objective (1000 × total magnication). When the correct area of the lm
from a patient with a normal RBC count is viewed, about 200 to 250 RBCs per oil
immersion eld are seen (see Figure 1.4). Characteristically, the differential count
includes counting and classifying 100 consecutive WBCs and reporting these classes
as percentages. The differential count is performed in a systematic manner using
the “battlement” track (Figure 1.6), which minimizes WBC distribution errors. The
results are reported as percentages of each type of WBC seen during the count.
An example of a WBC differential count is 3% bands, 55% segmented neutrophils,
30% lymphocytes, 6% monocytes, 4% eosinophils, and 2% basophils (Table 1.1).
Any WBC abnormalities, such as toxic changes, Döhle bodies, reactive lymphocytes,
and Aüer rods, are also reported. When present, nucleated red blood cells (NRBCs)
are counted and reported as number of NRBCs per 100 WBCs. The RBC, WBC,

FIGURE 1.6 ”Battlement” pattern for

performing a white blood cell differential.
(From Keohane E.A., Smith L., Walenga
J. (Eds.) (2016). Rodak’s hematology:
clinical principles and applications.
(5th ed.). St. Louis: Saunders Elsevier.)
 8 SECTION 1 Introduction

TABLE 1.1
Cells Found in a Normal White Blood Cell Differential
Adult Reference Range
Cell
Size Peripheral
Cell Type (μm) Nucleus Chromatin Cytoplasm Granules Blood (%) Cells × 109/L
Segmented 10 to 2 to 5 lobes Coarsely Pale pink, 1°: Rare 50 to 70 2.3 to 8.1
neutrophil 15 connected by clumped cream colored, 2°: Abundant
(Seg), thin laments or colorless
polymor- without visible
phonuclear chromatin
neutrophil
(Poly, PMN)
Band 10 to Constricted, Coarsely Pale blue to 1°: Few 0 to 5 0.0 to 0.6
neutrophil 15 but chromatin clumped pink 2°: Abundant
(Band) must be visible
within the
thinnest part

Lymphocyte 7 to Round to oval; Condensed Scant to ± Few azurophilic 20 to 40 0.8 to 4.8

(Lymph) 18* may be slightly to deeply moderate; sky
indented; condensed blue
occasional
nucleoli

Monocyte 12 to Variable; may Moderately Blue-gray; Many ne granules, 3 to 11 0.5 to 1.3
(Mono) 20 be round, clumped; lacy may have frequently giving the
horseshoe, or pseudopods; appearance of ground
kidney shaped; vacuoles may glass
often has folds be absent or
producing numerous
“brainlike”
convolutions
Eosinophil 12 to 2 to 3 lobes Coarsely Cream to 1°: Rare 0 to 5 0.0 to 0.4
(Eos) 17 connected by clumped pink; may 2°: Abundant red to
thin laments have irregular orange, round
without visible borders
chromatin

Basophil 10 to Usually Coarsely Lavender to 1°: Rare 0 to 1 0.0 to 0.1

(Baso) 14 two lobes clumped colorless 2°: Lavender to dark
connected by purple; variable in
thin laments number with uneven
without visible distribution; may
chromatin obscure nucleus
or wash out during
staining, giving the
appearance of empty
areas in cytoplasm
*
The difference in size from small to large lymphocyte is primarily a result of a larger amount of cytoplasm. See Chapter 9 for more detailed
information on lymphocyte size.
1°, Primary; 2°, secondary.
CHAPTER 1 Introduction to Peripheral Blood Film Examination 9
10 SECTION 1 Introduction

platelet morphology evaluation, and platelet estimates are also performed under the
100 × oil immersion objective. RBC inclusions, such as Howell-Jolly bodies, and
WBC inclusions, such as Döhle bodies, can be seen at this magnication. Each labo-
ratory should have established protocols for standardized reporting of abnormalities.
Evaluation of the RBC morphology is an important aspect of the lm evalua-
tion and is used in conjunction with the RBC indices to describe cells as normal
or abnormal in size, shape, and color. Each laboratory should establish a standard
reporting protocol. Most laboratories use concise statements describing overall RBC
morphology that is consistent with the RBC indices. The microscopic evaluation of
RBC morphology must be congruent with the information given by the automated
hematology analyzer. If not, discrepancies must be resolved before reporting patient
results.
The nal step in the performance of the differential count is the estimation of the
platelet number. This is done under the 100 × oil immersion objective. In an area of
the lm where RBCs barely touch, the number of platelets in 5 to 10 oil immersion
elds is counted. The average number of platelets is multiplied by 20,000 to pro-
vide an estimate of the total number of platelets per cubic millimeter. This estimate
is reported as adequate if the estimate is consistent with a normal platelet count,
decreased if below the lower limit of normal for that laboratory, and increased if above
the upper limit of normal. A general reference range is 150,000 to 450,000/mm 3
(150–450 × 109/L). When a patient is extremely anemic or has erythrocytosis, a
more involved formula for platelet estimates may be used.
The estimate can be compared with an automated platelet count as an additional
quality-control measure. If the estimate and the instrument platelet count do not
agree, discrepancies must be resolved. Some causes for discrepancies include the
presence of giant platelets, many schistocytes (RBC fragments), and platelet satel-
litism. Notably, high-quality 40 × or 50 × oil immersion objectives can be used by
the experienced technologist to perform the differential analysis of the blood lm.
However, all abnormal ndings must be veried under the 100 × objective.

SUMMARY

A considerable amount of valuable information can be obtained from properly pre-

pared, stained, and evaluated peripheral blood lms. Many laboratories use lms
made by the wedge technique from EDTA anticoagulated blood and stained with
Wright or Wright-Giemsa stain. The lms should be evaluated in a systematic man-
ner using rst the 10 ×, then 40 × high dry or 50 × oil, and nally the 100 × oil
immersion objectives on the microscope. WBC differential and morphology and the
RBC morphology and platelet estimate are included in the lm evaluation.
CHAPTER 2

HEMATOPOIESIS
12 SECTION 2 Hematopoiesis

H
ematopoiesis is a vigorous process of blood cell production and maturation
that occurs primarily in the bone marrow in the adult. The process begins
with the pluripotential hematopoietic stem cell (multipotent progenitor),
which is capable of proliferation, replication, and differentiation. In response to
cytokines (growth factors), the pluripotential stem cell will differentiate into a com-
mon myeloid or common lymphoid progenitor. Both the myeloid and lymphoid
progenitors maintain their pluripotential capacity. The lymphoid progenitor pro-
liferates and differentiates into T, B, and natural killer cells. The myeloid progenitor
proliferates and differentiates into granulocyte, monocyte, erythrocyte, and mega-
karyocyte lineages. To this point in maturation, none of these stem cells can be
morphologically identied, although it is postulated that they appear similar to a
small resting lymphocyte. The light blue shaded area in Figure 2.1 highlights the
stem cell populations. Each lineage and maturation stage will be presented in detail
in the following chapters.
Hematopoiesis is a dynamic continuum. Cells gradually mature from one stage
to the next and may be between stages when viewed through the microscope. In
general, the cell is then identied as the more mature stage. General morphological
changes in blood cell maturation are demonstrated in Figure 2.2.
Figure 2.3A–B illustrate cell ultrastructure. A review of organelles will facilitate
correlation of morphological maturation with cell function. This topic is explored
in depth in hematology textbooks, such as Rodak’s Hematology: Clinical Principles
and Applications, sixth edition. Table 2.1 delineates the location, appearance, and
function of individual organelles.
 CHAPTEr 2 Hematopoiesis 13

S Multipotent progenitor
T hematopoietic stem cell
E
M

P
R Common Common
O myeloid progenitor lymphoid progenitor
G
E
N
I
T
O Granulocyte-monocyte Eosinophil-basophil Megakaryocyte-erythrocyte Pre-B Pre-T Natural
R progenitor progenitor progenitor killer cell

Myeloblast Monoblast Myeloblast Myeloblast Pronormoblast Megakaryoblast B lymphoblast T lymphoblast

Promyelocyte Promonocyte Promyelocyte Promyelocyte Basophilic Promegakaryocyte

normoblast

P Myelocyte Eosinophilic Basophilic Polychromatic

R myelocyte myelocyte normoblast
E Megakaryocyte
C
U
R Metamyelocyte
S Eosinophilic Basophilic Orthochromic
meta- meta- normoblast
O myelocyte myelocyte
R

Band
Polychromatic
Eosinophilic Basophilic erythrocyte
band band (reticulocyte)

P B Segmented Monocyte Eosinophil Basophil Erythrocyte Platelets B lymphocyte T lymphocyte

E L neutrophil
R O
I O
P D
H
E T
R I Macrophage Dendritic cell Mast cell Plasma cell
A S
L S
U
E
FIGURE 2.1 Chart of hematopoiesis.
14 SECTION 2 Hematopoiesis

A B C D E
FIGURE 2.2 General trends that affect the morphology of blood cells during the developmental process.
(A) Cell diameter decreases and cytoplasm becomes less basophilic.
• An exception to the diameter decreasing is observed in the granulocytic series, the promy
elocyte may be larger than its precursor, the myeloblast (see Chapter 5, Neutrophil Maturation).
• In the erythroid series, hemoglobin development in the cytoplasm imparts a pink/salmon color.
(B) Nuclear diameter decreases (N:C ratio decreases). Nuclear color changes from purplish red to
dark blue.
(C) Nuclear chromatin becomes coarser, clumped, and condensed.
• Nucleoli disappear.
• In the granulocytic series, the nuclear shape changes and the nucleus becomes segmented.
Granules appear in cytoplasm (see Chapter 5, Neutrophil Maturation).
• In the erythroid series, the nucleus becomes fully condensed and is ejected.
(D) Composite of changes during maturation process.
(E) Representative cells from the erythroid series, demonstrating maturation changes.
(Modied from Diggs, L.W., Sturm, D., Bell, A. (1985). The morphology of human blood cells. (5th ed.).
Abbott Park: Abbott Laboratories. Reproduction of The Morphology of Human Blood Cells has been
granted with approval of Abbott Laboratories, all rights reserved by Abbott Laboratories.)
 CHAPTEr 2 Hematopoiesis 15

Microfilaments Glycogen
aggregates

Golgi complex
Nuclear envelope
Centriole
Nuclear pore
Rough
endoplasmic
reticulum Microtubule
Vacuole
Mitochondria
Nucleolus
Euchromatin
Heterochromatin Lysosome

Nuclear pore

Golgi body
Nucleus

Nucleolus

Lysosomes

B Mitochondria Rough endoplasmic reticulum

FIGURE 2.3 (A) Schematic of electron micrograph. (B) Electron micrograph with labeled organelles.
([A] From Keohane E.A., Smith L., Walenga J. (Eds.) (2016). Rodak’s hematology: clinical principles and
applications. (5th ed.). St. Louis: Saunders Elsevier.)
TABLE 2.1
Summary of Cellular Components and Functions
Organelle Location Appearance and Size Function Comments

16
Membranes: Outer boundary of cell, Usually a lipid bilayer consisting of Separates various cellular Membrane must be resilient
plasma, nuclear, nucleus, endoplasmic proteins, cholesterol, phospholipids, components; facilitates and and exible

SECTION 2
mitochondrial, reticulum, mitochondria, and polysaccharides; membrane restricts cellular exchange of
and endoplasmic and other organelles thickness varies with cell or organelle substances
reticulum
Nucleus Within cell Usually round or oval but varies Control center of cell Governs cellular activity and
depending on cell; varies in size; containing the genetic transmits information for

Hematopoiesis
composed of DNA blueprint cellular control
Nucleolus Within nucleus Usually round or irregular in shape; Site of synthesis and Appearance varies with activity
2 to 4 μm in size; composed of RNA; processing of ribosomal RNA of the cells; larger when cell
there may be 1 to 4 within nucleus is actively involved in protein
synthesis
Golgi body Next to nucleus System of stacked, membrane Involved in modifying and Well developed in cells with
bound, attened sacs; horseshoe packaging macromolecules large secretion responsibilities
shaped; varies in size for secretion
Endoplasmic Randomly distributed Membranelined tubules that branch Stores and transports uids Two types: smooth with
reticulum throughout cytoplasm and connect to nucleus and plasma and chemicals no ribosomes, rough with
membrane ribosomes on the surface
Ribosomes Free in cytoplasm; Small granule, 100 to 300 Å; Site of production of Large proteins are synthesized
outer surface of rough composed of protein and nucleic acid proteins, such as enzymes from polyribosomes (chains of
endoplasmic reticulum and blood proteins ribosomes)
Mitochondria Randomly distributed in Round or oval structures; 3 to 14 nm Cell’s “powerhouse”; make Active cells have more present
cytoplasm in length; 2 to 10 nm in width; ATP, the energy source for than do inactive ones
membrane has two layers; inner layer the cell
has folds called cristae
Lysosomes Randomly distributed in Membranebound sacs; size varies Contain hydrolytic enzymes If the membrane breaks,
cytoplasm for cellular digestive system hydrolytic enzymes can
destroy the cell
Microlaments Near nuclear envelope Small, solid structure approximately Support cytoskeleton and Consist of actin and myosin
and within proximity of 5 nm in diameter motility (contractile proteins)
mitotic process
Microtubules Cytoskeleton, near Hollow cylinder with protolaments Maintains cell shape, motility, Produced from tubulin
nuclear envelope and surrounding the outside tube; 20 to and mitotic process polymerization; make up
component part of 25 nm in diameter, variable length mitotic spindles and part of
centriole near Golgi body structure of centriole
Centriole In centrosome near Cylinders; 150 nm in diameter, 300 to Serves as insertion point for Composed of nine sets of
nucleus 500 nm in length mitotic spindle bers triplet microtubules

(From Keohane E.A., Smith L., Walenga J. (Eds.) (2016). Rodak’s hematology: clinical principles and applications. (5th ed.). St. Louis: Saunders Elsevier.)
ATP, Adenosine triphosphate; DNA, deoxyribonucleic acid; RNA, Ribonucleic acid.
Another random document with
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 6
Sunset was flaming red in the west once more when Clinton and
Stevens stood together again on the submarine's narrow deck,
watching the preparations for its homeward voyage. Behind it floated
a bare dozen of other long steel craft, as scarred and battered as
itself, flung up and saved like itself by that last great convulsion of the
waters—a dozen only, the last remnant of the mighty fleet of
hundreds that had dived to the attack a scant few hours before. Even
as they watched, three of those craft were moving away on their own
homeward journey, toward the west, toward the sunset, over the
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last rejoicing farewells came faintly over those waters as they went,
and then they were passing from sight, dark blots against the
brilliance of the western sky, dwindling and vanishing.
There came into the minds of both men, as they gazed across the
peaceful waters, a wonder as to what frantic outbursts of joy were
shaking the peoples of earth to see those waters calmed thus, to see
their terrible rise thus halted. There came into their minds a vision of
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turning faster and faster, little waves breaking from either side of their
prows as they clove the sea. The brilliance faded from the sky behind
the two men, as the little fleet moved on, and the gathering night
closed down upon the world, star-embroidered. But the two standing
there alone on the little vessel's deck were silent still, and unmoving,
gazing out into the darkness across the calm waters with the silence
of men whose minds held things too great for speech.
 *** END OF THE PROJECT GUTENBERG EBOOK THE SEA
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