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Granulocytic Information and Courses from MediaLab, Inc.

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

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Chemical Screening of Urine by Reagent Strip
Granulocytic white blood cells

Granulocytic white blood cells in a urine sample suggest the presence of a urinary tract infection. Granulocytes, which include neutrophils, basophils and eosinophils, contain esterases. These esterases catalyze the strip reagent indoxylcarbonic acid ester to release indoxyl. Indoxyl reacts with a diazonium salt to produce a purple color. The intensity of the color produced is proportional to the amount of enzyme present.

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Leukocyte Esterase Dipstick Test

If leukocyte esterase is detected, a color change occurs on the reagent pad after the strip is dipped in the urine sample. Be sure to follow the manufacturer's directions for read-time and test interpretation. A positive leukocyte esterase test indicates the presence of granulocytic white blood cells. Lymphocytes do not contain granules, and would not produce a positive leukocyte esterase test. Positive results should be confirmed by performing a microscopic examination on the sediment; being aware that white blood cells may be absent if they are lysed, yet releasing their esterases into the specimen. Positive results may occasionally be found in random specimens from females due to contamination of the specimen by vaginal discharge.

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CLIA Hematology / Hemostasis Review
The WBC indicated by the arrow in this illustration is exhibiting:View Page
Identify the cell in this illustration indicated by the arrow:View Page

Introduction to Bone Marrow
Percentages of Myeloid and Erythroid Precursors

The normal cellularity has been described as 50%. Therefore, about 40% of the cells would be myeloid (granulocytic) and 10% erythroid. Since cellularity and distribution may vary from one area of the marrow to another, an acceptable range for percentages of myeloid and erythroid cells would be:Myeloid cells 25-55%Erythroid cells 8-14%

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Gaucher Cell

A Gaucher cell is a histiocyte (macrophage) whose cytoplasm is filled with linear or fibrillar material (kerasin). This cell is characteristic of the congenital glycolipid disorder, Gaucher's disease. Gaucher cells may also be seen in the marrow of patients with chronic granulocytic leukemia. When seen in this condition, they are referred to as pseudo-Gaucher cells.

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Normal Peripheral Blood Cells
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.

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Definition of a Band Cell

Any cell of the granulocytic series which has a nucleus that could be described as a curved or coiled band, no matter how marked the indentation, if it does not completely segment the nucleus into lobes connected by a filament, is considered a band form.It is differentiated from the segmented neutrophil by having no indentation which could be described as a filament.

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The Process of Phagocytosis

Neutrophils have a relatively short life span.They are produced in the bone marrow, and when they reach the band or segmented stages are released into the peripheral blood.They remain there for approximately ten hours before randomly entering body tissues.Neutrophils in the blood stream can be divided into circulating granulocyte pool(CGP) and marginating granulocytic pool (MGP).The white blood cell count reflects the cells in the circulating pool.The cells in the marginating pool move quickly into the circulating pool when needed.During an infection the neutrophil concentration of the peripheral blood can increase almost immediately due to the shift of these cells from the marginating pool and release from the bone marrow storage pool, if needed.Neutrophils then migrate to areas of tissue damage or infection.Neutrophils do not reenter the blood stream from the tissues, thus end their life in the tissues either as a result of phagocytosis or senescence.

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Variations in White Cell Morphology - Granulocytes
Auer Rods

Auer rods are red staining, needle-like bodies seen in the cytoplasm of myeloblasts, and/or progranulocytes in leukemia. Auer rods are cytoplasmic inclusions which result from an abnormal fusion of the primary (azurophilic) granules. Single or multiple Auer rods may be seen in the cytoplasm of a cell. If more than one is present, they are frequently close together and may even be overlapping. Their identification is very important because, if found, they can confirm the presence of myeloblasts indicating the presence of a myeloid (non-lymphoblastic) leukemia. They can also be seen in myeloid blast crisis in chronic granulocytic leukemia. Auer rods are never seen in lymphoblasts. This differentiation is important because the treatment of lymphoblastic and myeloblastic leukemia are different. Auer Rods always classified as pathological.

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White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions
The neutrophils illustrated in this photograph are representative of those seen in the smear. The total WBC was 28,500 cells/cumm. The appropriate report to be issued following a morphology consultation would be: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
The association of increased platelets accompanying neutrophilia and toxic granululation as illustrated in this photograph is called thrombocythemia.View Page
Leukemoid reaction revisited

The term leukemoid reaction is used to describe peripheral white blood cells that on the stained blood smear may have some resemblances to leukemia cells. Quantatively in a leukemoid reaction, the neutrophil count is >50,000 cumm with more immature cells, particularly myelocytes, than are usually present in toxic left shift syndromes. The presence of immature cells in a leukemoid reaction awakens thoughts of leukemia. Great care must be taken to make a distinct differentiation between aberrant white blood cell proliferations and a benign but exaggerated granulocytic proliferative response. Our material is from a 1-month-old girl with Down's syndrome. Her total white blood count was 37,000/mm3 interpreted as leukocytosis with left shift. Leukocytosis with a left shift, and leukemoid reactions with high alkaline phosphatase are conditions to be mindful of in patients with Down's syndrome. The alkaline phosphatase score is high in leukemoid reactions, low in granulocytic leukemia.

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