Cytoplasmic Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Cytoplasmic and links to relevant pages within the course.

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CLIA Chemistry / Urinalysis Review
The cell indicated by the arrow is a:	View Page

CLIA Microbiology / Serology Review
Label the parts of this prototypical bacterium:	View Page

Erythrocyte Inclusions - Wright Stained Smears
Degenerated erythrocyte cytoplasmic organelles which contain iron are:	View Page

HIV: Structure and Replication
Which of the following is NOT a possible cause of cell death after HIV infection?	View Page
Destruction of the Host Cell The mechanism of host cell destruction remains under investigation, but three possibilities have been proposed:Viral budding tears a hole in the host cell's membrane, causing cytoplasmic leakage.The supply of useful T-lymphocytes is depleted, resulting from the formation of huge, functionless syncytia.Some mechanisms cause the provirus to provoke the synthesis of a large number of new HIV particles, causing the rapid depletion of cellular components and with it the destruction of the cell.	View Page

Introduction to Bone Marrow
Megakaryoblast This slide shows an example of the youngest cell in the megakaryocyte series, the megakaryoblast. Megakaryoblasts have a fine chromatin structure with multiple nucleoli, and scant basophilic cytoplasm. Cytoplasmic tags are frequently seen. It may vary 20-50 microns in diameter.	View Page

Normal Peripheral Blood Cells
Lymphs contain many specific cytoplasmic granules.	View Page
When Lymphocytes Transform Lymphocytes "transform" in response to antigenic stimuli.Their nuclei becomes larger with more open chromatin and a greater degree of nuclear folding.The cytoplasm becomes abundant, the number of azurophilic granules may be increased and vacuoles may be present.The cytoplasmic membrane may be easily indented by surrounding red blood cells, resulting in a scalloped appearance of the cell's outer edge.These lymphocytes may also be referred to as reactive, activated or stimulated.	View Page
Glossary of Terms N through Z. N:C Ratio - Nuclear: cytoplasmic Ratio - The ratio of nuclear volume to cytoplasmic volume within any one cell.Neoplasm - Any new and abnormal growth, such as a tumor.Neutrophilic Granules - Specific granules present in the cytoplasm of neutrophils. These granules resemble pencil stippling and stain a lilac color due to their affinity for both basic and acid dyes.Phagocyte - Any cell that ingests microorganisms or other cells and foreign particles.Phagocytosis - The ingestion and destruction of microorganisms or other foreign particles.Plasma - The fluid portion of blood in which the various blood cells are suspended.PF3 (platelet Factor 3) - A lipoprotein component of the platelet membrane; functions as a surface catalyst during blood coagulation.Pseudopod - A temporary protrusion of the cytoplasm of a cell.Refractile - Capable of refracting or changing the direction of light.Senescence - The process or condition of growing old.Serotonin - A constituent of blood platelets and other cells and organs; induces constriction of the blood vessels.Specific Granules - Granules found in cells of the more mature stages of the granulocytic series. They have distinct staining reactions which differ with each type of granulocyte.T-cell - Thymus derived lymphocyte which mediates cellular immunity.Thrombocyte (Platelet) - A circular or oval disk found in the blood; concerned with hemostasis.Thymus - A ductless gland-like body situated in the anterior mediastinal cavity; reaches its maximum development during the early years of childhood.Vacuole - Any small space or cavity formed in the cytotoplasm of a cell.	View Page
The Chromatin Pattern of the Basophil Nucleus The chromatin pattern of the basophil nucleus is not quite as coarse as that of the neutrophil or eosinophil nuclei. Although the nucleus is usually segmented, the lobes are often difficult to discern because they tend to crowd together and are obscured by the cytoplasmic granules.	View Page
Segmented and Band Nuclei The granulocytes found in normal peripheral blood are neutrophils, eosinophils and basophils.Most have segmented nuclei, and are therefore classified as being at the "segmented" stage of development. Some that are a little less mature have unsegmented nuclei. These are classified as "bands." Generally, we differentiate between the band and segmented forms of neutrophils, but since eosinophils and basophils are present in such low numbers, and since their nuclei are often obscured by cytoplasmic granules, we usually don't concern ourselves with designating the band forms.Since hematologists and textbooks use several different terms for these cells, synonyms for each term will be given and then may be used interchangeably throughout the course.	View Page
Differentiating Bands from Segs When viewing a confusing cell, it is helpful to focus through several planes, taking special note of overall chromatin structure, appearance or presence of any filaments, and general cytoplasmic characteristics.For example, here we see a neutrophilic cell that is folded over itself making exact identification difficult.However, due to the thickness of the nucleus and the absence of a filament, we would classify it as a band.	View Page
Cytoplasmic Vacuoles Frequently, cytoplasmic vacuoles are present. These vacuoles appear as unstained areas or "holes" in the cytoplasm.	View Page
Large Lymphocytes Large lymphocytes have abundant pale blue transparent cytoplasm.If you imagine putting a printed page behind the cell, the cytoplasm looks as though you could see through it to read the words.Although there are usually no cytoplasmic granules present, a few large well-defined azurophilic granules (lysozomes) can occasionally be seen.	View Page
Monocytes are Extremely Motile Cells Because monocytes are extremely motile cells, blunt pseudopods may be seen. These should not be confused with the apparent cytoplasmic projections produced when large lymphocytes are indented by surrounding cells.	View Page

Red Cell Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
Pappenheimer bodies Pappenheimer bodies are iron-containing granules that aggregate with mitochondria and are deposited in RBC or normoblast cytoplasm. Small and irregular, they are found only in pathological states as thalassemia and sideroblastic anemias(upper image). Wright-Giemsa stain defines the cytoplasmic content (protein), but Prussian blue staining is necessary to define the iron content, the essence of the Pappenheimer body (lower image). Pappenheimer bodies lie typically in small clusters (upper image) and tend to locate at the periphery of the red cell cytoplasm. A cluster is typically smaller than a single Howell-Jolly body.	View Page
The peripheral blood smear represented by this field was submitted for hematologic review. The RBC inclusions most likely are:	View Page

Semen Analysis

Abnormal forms

There are a number of abnormalities of sperm morphology. Abnormal heads can include enlarged head, double head, round head, constricted head, amorphous head, pinhead, and acute tapering forms. There are also heads with abnormal numbers of vacuoles. Midpiece abnormalities include distended and thin midpiece regions. Abnormal tails include short tails, double, triple or multiple tails, coiled tails, broken tails, or absent tail. Cytoplasmic droplets are also seen in some specimens. These are large regions of cytoplasm just below the head assumed to represent failure of complete sperm maturation or a sign of either toxicity or oxidation. There have also been reports that cytoplasmic droplets may be artifacts from the fixation and staining for morphology analysis.

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The Urine Microscopic: Microscopic Analysis of Urine Sediment

Urine Sediment

Urine sediment may also contain white blood cells (WBCs). Most of the WBCs in urine are segmented neutrophils. Since it is possible that lymphocytes, monocytes, and/or eosinophils may be present, the cells in urine can be stained if it is necessary to differentiate them. The segmented neutrophil just above center of the image to the right shows a distinct nucleus. When viewing urinary sediment under the microscope, the fine focus adjustment must be used to identify white blood cells. White blood cells swell in dilute alkaline urine and the cytoplasmic granules exhibit brownian movement resulting in “glitter cells.” These cells lyse rapidly. “Glitter cells” are most easily seen when viewed under phase-contrast microscopy.

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Variations in White Cell Morphology - Granulocytes
Cytoplasmic Variations The cytoplasmic morphological changes included in this exercise are:Dohle bodiesMay-Hegglin bodiesAuer rodsVacuolesAbnormal granulationA general term used to describe these changes is white cell inclusions.	View Page
Dohle Body Dohle bodies are sometimes faintly stained, irregular in shape and are therefore easy to miss when examining a slide. The Dohle body in this cell can be seen near the edge of the cytoplasm. Notice that the cytoplasmic granules are somewhat heavier and darker than normal.	View Page
Chediak-Higashi Chediak-Higashi syndrome is a rare autosomal recessive disorder. It results from a mutation of the gene LYST which encodes a protein with multiple phosphorylation sites. This defect causes a cellular abnormality involving the fusion of cytoplasmic granules. Early in neutrophil maturation normal azurophilic granules form, but they fuse together to form megagranules. Later during the myelocyte stage, normal specific granules form. The mature neutrophils contain both normal specific granules and abnormal azurophilic granules. These large abnormal granules can be seen in the cytoplasm of neutrophils, eosinophils, basophils, monocytes and lymphocytes. These abnormal granules are able to kill bacteria in neutrophils and monocytes; however, the process is much less effective than in normal cells in part, because these neutrophils have impaired locomotion. For these reasons, individuals with Chediak-Higashi have recurrent infections. An accelerated lymphoma-like phase occurs, with lymphadenopathy, hepatosplenomegaly, and pancytopenia. Death often occurs at an early age.	View Page

White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
An increase in peripheral blood monocytes with an appearance similar to the cell in the photograph is highly suggestive of infectious mononucleosis.	View Page
The upper photograph of a peripheral blood smear reveals RBC rouleaux formation. Nucleated cells evident in both upper and lower photographs comprise approximately 5% of the total white blood cell count. The most probable underlying condition is:	View Page
A peripheral blood smear with many myeloid cells (photograph) was presented for morphology review. Toxic vacuoles in the neutrophil and monocyte most likely represent:	View Page
Alder- Reilly Anomaly Large inclusions in leukocyte cytoplasm appear with Alder-Reilly syndrome. Inheritance patterns are not completely clear. The condition is characterized by larger than usual azurophilic and deeply violet staining granules clustered throughout the cytoplasm (even covering the nucleus)in all granulocytes. There are variations in which some lymphocytes and monocytes may be affected. These inclusions represent partially degraded mucopolysaccharides within lysosomes.Alder-Reilly bodies may be found independently of genetic mucopolysaccharidoses as an inherited anomaly (Jordan's anomaly). Cytoplasmic vacuoles of toxic origin are not present in Alder-Reilly cells. The background condition in Alder-Reilly syndrome is mucopolysaccharidosis with various types of bone and cartilage disorders, reported first in gargoylism, then in Hunter and Hurler syndromes. Accompanying conditions are hepatosplenomegaly, corneal opacities, and mental retardation. Reference: Brunning, Richard D. Morphologic Alterations in Nucleated Blood and Marrow Cells in Genetic Disorders. Human Pathol: 99-124, March, 1970	View Page
WBC inclusions: summary The presence of atypical inclusions within the cytoplasm of neutrophils and other leukocytes should lead to a clinical investigation of the setting for these findings.Atypical neutrophil inclusions may be seen in the following disorders: Chediak-Higashi syndrome, May-Hegglin anomaly, Alder-Reilly anomaly, Fechtner , Sebastian, Epstein and Alport-like syndromes and in infectious and toxic conditions (in the form of Doehle bodies).Although a specific entity may not be evident from examination of the peripheral blood alone, it is important that hematology technologists include a comment reporting on the presence of these inclusions or granules. A clinical investigation with further hematologic and genetic studies may then appropriately be considered.Many of the disorders with atypical neutrophil cytoplasmic granules are also associated with platelet abnormalities, particularly giant platelets (lower photograph).Therefore, when atypical granules are recognized, scanning of the peripheral blood smear for atypical platelets may be revealing. These observations serve as readily identifiable markers for acquired and genetic human maladies, and as a guide for unraveling the reasons for a patient's suffering and impaired health.	View Page
The pale-staining cytoplasmic bodies marked by the arrow in the photograph may be seen in each of the following conditions except:	View Page
The cell illustrated in the photograph is known as a faggot cell.	View Page
The May -Hegglin anomaly Illustrated in the upper photograph is a poorly defined cytoplasmic inclusion somewhat resembling a Doehle body. Note, however, that this inclusion is well defined and there is no evidence of toxic granulation in the cytoplasm.When Doehle-like bodies are identified, May-Hegglin anomaly should be considered in the differential diagnosis even though this entity is rare.The May-Hegglin anomaly is an inherited dominant condition in which large 2 - 5 um, basophilic and pyronophilic inclusions are present in granulocytes, including neutrophils, eosinophils, basophils, and monocytes.Similar to Doehle bodies, the May-Hegglin inclusions also are composed of RNA, probably derived from the rough endoplasmic reticulum. May-Hegglin anomaly includes giant platelets containing few fine granules (lower photograph).Sometimes the platelets have bizarre shapes and variable sizes. Variable degrees of thrombocytopenia complicated by mild bleeding problems and purpura may accompany the aberrant platelets.	View Page
The cytoplasmic inclusion illustrated at the tip of the blue arrow is characteristic of:	View Page
Doehle Bodies: Review Doehle bodies are discrete, round or oval aggregates at the cytoplasmic periphery of neutrophils (blue arrows in figures). They stain sky blue with Romanowsky's stain and often may be deceivingly inconspicuous. In electron-micrographs, Doehle bodies are recognized as lamellar aggregates of rough endoplasmic reticulum. Although not considered a marker for leukemia, Goudsmit, et al (Brit J Hematol 20:447-562, 1971)reported their presence in family members, 2 sisters and 3 brothers. Two of the brothers died of acute myeloblastic leukemia. These testimonials indicate that Doehle bodies, when identified in peripheral blood smears, should be taken seriously so as to stimulate a clinical investigation of the patient.	View Page
The granulated neutrophil shown in the photograph may be found in each of the following conditions except:	View Page
The neutrophil on the peripheral blood smear in this photograph is a mast cell.	View Page
Basophils A basophil and a small lymphocyte are compared in the same field of the upper photograph, A single basophil is shown in the lower photograph.The cytoplasmic granules of the basophil are larger than the granules of toxic granulation.They contain chemical mediators of immediate hypersensitivity, and are found in the cytoplasm and overlying the nucleus (better seen in the lower photograph). Basophilic granules stain metachromatically with toluidine blue indicating the presence of acid mucopolysaccharide or proteoglycans, both thought to be heparin or heparin-like substances.Basophils are related to tissue mast cells, each involved in hypersensitivity responses and following anaphylactic episodes.Under the stimulation of complement components C3a and C5a, many mediators are released from the basophil granules, including histamine, heparin, and eosinophil chemotactic factors of anaphylaxis, or ECF-A.Basophils are the least common neutrophils in the peripheral blood, comprising 2% or less of the differential count.The presence of large granules of irregular size in basophils and the admixture of eosinophilic granules may indicate dysplastic changes associated with myelodysplastic disorders and leukemia.	View Page
A peripheral smear was submitted for morphology/clinical because of the number of monocytes as captured in the upper and lower photographs. This picture is consistent with each of the following conditions except:	View Page
The peripheral smear photographed here was submitted for morphologic/clinical examination.The predominant cells comprised 70% of the total white blood cells and are consistent with lymphocytes in a 4 month old infant.	View Page
More about lymphocytes, their impostors and varied faces In this photograph of blood cells from yet another submitted slide, we find cells resembling lymphoblasts with increased nuclear/cytoplasmic ratios and dense, finely meshed nuclear chromatin. In addition, note the extrusion of delicate strands of cytoplasm from the outer cell membranes (blue arrow). These are cells connoting hairy cell leukemia (HCL). Under scanning electron microscopy, the cytoplasmic extensions appear to be either slender microvilli or delicate pseudopods. The most helpful confirmatory finding is the detection of acid phosphatase isoenzymne 5 in the cytoplasm of suspected hairy cells by staining. The enzyme concentrates primarily in golgi bodies and in the nuclear membrane and its staining is not inhibited by the addition of tartrate. Stated in another way, hairy cells on the peripheral smears are detected by their staining positively for tartrate-resistant acid phosphatase. Be suspicious of HCL if marrow resists aspiration-a consequence of reticulin fibrosis of the marrow in HCL.	View Page