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    A promyelocyte (#1) is a large cell that contains many purplish-red azurophilic granules in its blue cytoplasm. Its nucleus can be round or slightly indented and usually contains nucleoli.
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    • A lymphoblast (#1) has a very high N:C ratio with minimal bluish-staining cytoplasm surrounding a very young appearing nucleus. Several nucleoli may be present in the nucleus. This cell stage is the earliest recognizable form of lymphocyte development
    • A prorubricyte (labeled #2) is the cell stage of development between the rubriblast (#1) and the rubricyte (#3). Notice its dark blue cytoplasm.
    • The rubricyte (#3) is the stage of development between the prorubricyte (#2) and the metarubricyte (#4). The rubricyte cytoplasm contains a mixture of both red and blue colors which gives it a more gray appearance. The rubricyte in this image is in the early stages of rubricyte development
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    • tartrate-resistant acid phosphatase (TRAP) stain
    • Acid phosphatase isoenzyme activity in hairy cells (staining red-orange) is resistant to incubation with tartrate. Acid phosphatase isoenzyme activity in other cells is destroyed during incubation with tartrate. The TRAP stain is used in the diagnosis of hairy cell leukemia
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    Basophils contain large purplish-blue cytoplasmic granules which can obscure the nucleus. They are very few in number in peripheral blood
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    • The monoblast (#1) is the earliest recognizable form of monocyte development. It precedes the promonocyte stage (#2). The monoblast has a high N:C ratio with varying amounts of blue-gray cytoplasm surrounding a nucleus filled with fine, lacy chromatin. Nucleoli are often visible in the nucleus. 
    • The promonocyte (#2) is the stage of monocyte development following the monoblast stage (#1). The cytoplasm in the promonocyte is less blue than in the monoblast and represents a larger portion of the cell size. The nucleus is young in appearance with fine chromatin.
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    acute myelocytic leukemia - M0
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    The non-specific esterase (NSE) stain is used to differentiate cells of monocytic origin from other cells. Alpha naphthyl acetate or butyrate is used as a substrate for the stain. Monoblasts will contain diffusely positive orange granules.
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    Acid phosphatase enzyme is found in all cells. The reddish staining pattern for T cells and lymphoblasts is stippled or dotted
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    In May-Hegglin anomaly, neutrophils and monocytes contain large, blue-staining granules similar to Döhle bodies (RNA). A Döhle body can be seen in the cytoplasm of the segmented neutrophil near its inferior rim. Individuals with May-Hegglin anomaly also have thrombocytopenia with giant platelets. Four giant platlets are seen in this case.
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    Small lymphocytes (#2) are a little larger than a normal RBCs (7-9 microns). They have a very high N:C ratio and sometimes it is very difficult to see any cytoplasm. If present, the cytoplasm is usually dark blue or gray. The nucleus is very dense with clumped chromatin.
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    acute myelocytic leukemia - M5B
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    • Neutrophilia
    • This film shows an increase in the percentage of neutrophils in the blood with a "shift to the left" in the percentage of neutrophilic band forms.
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    • sea-blue histiocyte
    • The large cell with the eccentric nucleus and pale blue cytoplasm is found in the bone marrow, spleen and liver of individuals with sea-blue histiocytosis.
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    acute myelocytic leukemia - M7
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    • chronic myelocytic leukemia (CML, CGL)
    • CML is characterized by many immature stages of granulocytic development in the peripheral blood. These stages include myelocytes, metamyelocytes, bands and segmented forms. Myeloblasts and promyelocytes can be present but are fewer in numbers
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    • Chediak-Higashi syndrome
    • The large, dark granules in the neutrophilic segmented cell are abnormal lysosomal granules. These granules are found in granulocytes, lymphocytes, monocytes, platelets and melanocytes of individuals with Chediak-Higashi syndrome. They are the result of abnormal fusion of primary and secondary lysosomal granules. Abnormal granules result in ineffective enzyme release during phagocytosis.
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    • The neutrophilic myelocyte (#1) is the stage of development between the promyelocyte and the neutrophilic metamyelocyte (#2). It usually has a 1:1 N:C ratio with a round to slightly indented nucleus. This stage may also have a few nucleoli and is the last cell stage to divide in granulocytic development. A light area in the cytoplasm near the nucleus is the "hof" (Golgi) region. The cytoplasm of neutrophilic myelocytes stains bluish-gray and contains specific granules.
    • The neutrophilc metamyelocyte (#2) is the stage of development between the neutrophilic myelocyte (#1) and the neutrophilic band (#3). The nucleus in the metamyelocyte has started to indent but not as much as the band stage. The n. metamyelocyte contains many specific granules with fewer numbers of azurophilic granules. The nuclear chromatin becomes more condensed as the cells mature.
    • The neutrophilic band (#3) is the stage of development after the neutrophliic metamyelocyte (#2). The nucleus has indented and forms a "band" without any segmentation. The edges of the nucleus are practically parallel with each other. The cytoplasm contines to increase in the amount of specific granules with fewer azurophilic granules.
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    • myeloperoxidase (MPO) stain
    • Myeloperoxidase enzyme activity is found only in cells of myelocytic and monocytic origin. It is not found in cells of lymphocytic origin. MPO stain is used to differentiate myeloblasts from lymphoblasts. Myeloblasts that are positive for the enzyme will contain large amounts of darkly-staining granules (above). Lymphoblasts wiil show no staining positivity.
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    • megakaryocyte
    • The huge cell above is a megakayrocyte in a bone marrow preparation. The cytoplasm of megakaryocytes fragment off to form thrombocytes (platelets). Notice other developing RBCs and WBCs in the field
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    Sudan black B stains phospholipids black in membranes of primary and secondary granules in cells of myelocytic and monocytic origin. SBB is the most sensitive stain for myelocytic precursors and is used to differentiate myeloblasts from lymphoblasts.
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    Eosinophilia is an increase in the number of eosinophils in the blood. This film shows 3 eosinophils in this one field. Normally there are only 0-4 eosinophilis/100 WBCs and not one in every field.
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    acute myelocytic leukemia - M3
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    Monocytes are the largest leukocytes in peripheral blood. The cytoplasm of monocytes is pinkish-gray and may contain azurophilc granules and vacuoles. Psuedopod extensions may also be present. The nucleus in a monocyte is not as densely-staining as in a neutrophilic seg
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    acute myelocytic leukemia - M6
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    • periodic acid-Schiff (PAS) stain
    • PAS stains stains glycogen red in lymphocytes, granulocytes, and megakaryocytes. It is used for diagnosing erythroleukemia.
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    • The metarubricyte (#1) has cytoplasm that is pinkish-blue and similar to the cytoplasm in the diffusely basophilic erythrocyte (#2). The nucleus in a metarubricyte has a very dense chromatin pattern and is extruded at this stage of differentiation.
    • The diffusely basophilic erythrocyte (#2) has no nucleus and contains some RNA which gives its cytoplasm a slightly blue appearance with Wright's stain. It is the same cell as a reticulocyte when specially stained with new methylene blue supravital stain.
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    Specific esterase stain (naphthol AS-D chloroacetate esterase, CAE) is positive in neutrophilic granules and mast cells and helps to differentiate neutrophils from lymphocytes and monocytes. Notice the red stain is positive in some of the cells but negative in most of the other cells. The negative cells are lymphocytes.
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    Mature neutrophilic segmented cells have dense nuclei that contain 3-5 segments connected by thin filaments of nuclear chromatin. Their cytoplasm is filled with pinkish-gray specific granules.
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    The large bi-nucleated cell with the bluish-purple cytoplasm is a Gaucher cell. It is a histiocyte that may contain one or two nuclei and whose cytoplasm has been described as having a "crumpled paper" appearance. Individuals with Gaucher disease have a deficiency of beta glucocerebrosidase which results in abnormal accumulations of unmetabolized glucocerebrosides in the reticuloendothelial cells in the bone marrow and other organs
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    Plasma cells are found in multiple myeloma and during B-cell humoral immune responses. Notice the eccentric nucleus and dark-blue cytoplasm. The slightly lighter region in the cytoplasm near the nucleus contains the "hof" region (Golgi apparatus).
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    acute myelocytic leukemia - M2
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    A lymphoblast (#1) has a very high N:C ratio with minimal bluish-staining cytoplasm surrounding a very young appearing nucleus. Several nucleoli may be present in the nucleus. This cell stage is the earliest recognizable form of lymphocyte development
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    acute myelocytic leukemia - M4
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    • Döhle bodies
    • The neutrophil above contains a large pale-blue Döhle body in the lower right portion of its cytoplasm. Döhle bodies are collections of RNA that are associated with toxicity in the cell
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    Hypersegmentation occurs in neutrophlis when there are more than 5 connected segments in the nucleus. The lower cell is a neutrophil that contains one nucleus with 8 segments connected by thin filaments of nuclear material. The upper cell is a normal neutrophil with 4 segments in the nucleus.
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    Infectious mononucleosis is characterized by over 50% lymphocytes in the peripheral blood and a wide variety of lymphocyte morphologies. Many of the lymphocytes are reactive lymphocytes with bluish-pink cytoplasm and darkly staining edges. The cells in this case also have some small azurophilic granules in the cytoplasm.
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    Mature eosinophilic segmented cells contain bi-lobed nuclei and large reddish-granules in the cytoplasm.
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    Reactive lymphocytes, similar to the large nucleated cell in this field, can be 9-30um in diameter. They have abundant cytoplasm, unevenly stained blue cytoplasm with darkly staining edges, and possible azurophilic granulation (although not seen in this cell). Their single nucleus can be round or slightly oval to indented
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    • Niemann-Pick cell
    • The large cells with white, foamy cytoplasm are Niemann-Pick cells. They are histiocytes filled with lipid dropslets. Individuals with Niemann-Pick disease have a deficiency of sphingomyelinase and large accumulations of unmetabolized lipid sphingomyelin and cholesterol in their histiocytes.
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    Chronic lymphocytic leukemia is characterized by numerous small, dark lymphocytes that produce a "monotonous" blood picture.
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