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• Hypersegmentation


  Larger-than-normal neutrophils with six or five or more nuclear segments (hypersegmented neutrophils). Neutrophils with five or more lobes are early indicators of megaloblastic anemia
• Functional leukocyte abnormalities are almost always inherited and can be accompanied by morphologic abnormalities
• Alder-Reilly anomaly is an inherited condition characterized by the presence of large purplish granules in the cytoplasm of all leukocytes. These disorders are characterized by incompletely degraded mucopolysaccharides and appear as large granules
• Toxic granules

  Toxic granules are large, deeply stained, blue-black primary granules in the cytoplasm of segmented neutrophils and sometimes in bands and metamyelocytes. Can be seen in acute infection, burns, drug poisoning
• Automated hematology analyzers do not detect or flag Leukocyte morphologic abnormalities
• Chédiak-Higashi syndrome
• Pyknotic Nucleus or Cell


  Pyknotic or apoptic nucleus are found in dying neutrophils in blood. The nuclear becomes dense and begins to fragment in sphere of dark staining nuclear chromatin
• Pelger-Huët Anomaly


  The neutrophil nucleus does not segment beyond the two-lobed stage and can appear as a single, round nucleus with no segmentation
• Laboratory professionals must microscopically evaluate stained blood smears to identify cytoplasmic and/or nuclear morphologic abnormalities in Leukocyte
• Döhle bodies


  Döhle bodies are light gray-blue oval inclusions in the cytoplasm of neutrophils and eosinophils. They can be seen in severe infections, burns, and cancer and as a result of toxic drugs
• Granulocyte functional abnormalities should be suspected in patients with recurrent, severe infections, abscesses, delayed wound healing, and antibiotic-resistant sepsis
• Cytoplasmic Vacuoles

  Vacuoles are areas of the cytoplasm which do not stain and appear as holes in the cytoplasm. Their composition may vary; some will contain remnants of bacterial digestion, autodigestion in an aging cell, while others may contain fat. Associated with bacterial or fungal infection, poisoning, burn, chemotherapy
• Pelger-Huët Anomaly


  The neutrophils in Pelger-Huët anomaly are frequently hypogranular because of a lack of secondary granules. Pelger-Huët anomalies can be used to aid in the diagnosis of myelodysplasia and malignancy
• Chronic Granulomatous Disease (CGD)

  • Results from mutations in genes encoding subunits of NADPH oxidases
  • Neutrophils unable to destroy ingested pathogens
  • Neutrophils can phagocytize microorganisms but cannot kill them
  • Patients suffer from recurrent, life-threatening infections with opportunistic pathogens, formation of granuloma
• May-Hegglin Anomaly

  • Rare, inherited, autosomal dominant trait
  • Granulocytes contain inclusions mainly of RNA in cytoplasm
  • Neutrophils with Dohle-like structure, variable thrombocytopenia with giant platelets
• Inherited conditions characterized by the presence of large purplish granules in leukocytes

  • Alder-Reilly Anomaly
  • Chédiak-Higashi Syndrome
  • May-Hegglin Anomaly
• Myeloperoxidase Deficiency (MPO)


  • Benign autosomal recessive disorder characterized by absence of myeloperoxidase in neutrophils and monocytes
  • Patients with MPO deficiency and diabetes mellitus can experience disseminated fungal infections
• Chédiak-Higashi Syndrome

  • Rare autosomal recessive disorder associated with non-working copy of the gene
  • Skin hypopigmentation, silvery hair, photophobia from abnormality of melanosomes
  • Giant gray-green peroxidase-positive bodies and giant lysosomes in cytoplasm of leukocytes
• Alder-Reilly Anomaly


  • Large purplish granules in the cytoplasm of all leukocytes
• Leukocyte Adhesion Deficiency (LAD)


  • Immunodeficiency disorder involving both B and T cells
  • Inability of leukocytes to migrate to site of infection to kill offending microbes