I thought some members might like to see these images of what the various 'normal' white blood cells look like. As you can see there is a variability of morphology within each type of cell. Bands are a slightly immature form of neutrophil and as it matures the nucleus becomes more segmented into lobes like the pictures in the neutrophils line.
Lymphocytes are either large or small and the first four from the left in this photograph are small lymphs and the two on the right are large lymphs. Large lymphs are often T cells and have more cytoplasm, often with a few granules in it. Activated T cells which are generally large with expansive, dark cytoplasm are often noted as atypical lymphs on blood reports and can be indicative of infection.
Monocytes are extremely variable and the nucleus may be indented or not and the cytoplasm may have vacuoles in it, or not. Large lymphs and monocytes can sometimes be hard to distinguish but as a rule of thumb, monocytes are bigger (but not always) and large lymphs may have a few pink granules (but may not).
The pink/orange discs in the back ground are red cells and that's a whole new morphology game . Platelets are the smallest cells in the blood and they are actually just fragments that have broken off from 'buds' that form on the precursor megakaryocyte cells in the bone marrow. They have no nucleus and can vary hugely in size from tiny specs to the size of a lymphocyte. If you look at the lymphocyte's line then the fourth from the left has two platelets at approx 10/11 o'clock and in the monocyte's line, the second from the left has a larger platelet at about 3 o'clock.
Importantly, all these cells were photographed at the same magnification so you can actually see the relative sizes.
Morphology is fascinating because the cells don't read the morphology books and just do their own thing! I hope you've found this interesting.
Jackie
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They are pretty aren't they. I never got tired of looking at them.
The stain is Wright's stain, a type of Romanowsky stain, they are neutral stains composed of a mixture of methylene blue (azure) dyes and Eosin Y (orange) dyes. The mix produces a wide range of shades depending on pH of the internal structural material so it's possible to differentiate between cells.
Bone marrow smears are generally stained with another Romanowsky stain, usually MayGrunwald and Geimsa in a two stain process. Timing of the staining and the pH of the buffer used to rinse the slides is crucial.
You must have had such an interesting job Jackie. Do you think knowing as much as you do has helped you or is the ‘ignorance is bliss’, like me, a better way to be ?
I can't tell you how much I loved my job Peggy. Did it help? - well, it's a double edged sword because I knew all the worst things and that's what you tend to focus on but I think, overall, it has helped me. My former medical colleagues have been a fantastic support to me over the years, especially initially and I knew who were the really excellent medics that I wanted to look after me.
When I was diagnosed 7 years ago my life expectancy with unmutated del 11q was very different to what it is now. Targeted treatments have changed the landscape immeasurably for us CLLers over the last few years as access has improved. I'm grateful to have been able to contribute to that through the advocacy work I do with the CLL Support charity and NICE/SMC.
Thank you Jackie for all you do. You have been a great help to me when I needed it most at the beginning, when I was very confused about all what was happening to me.
I am sure that, I am not the only one feeling this way.
This post and the kind of personal statements made in regard to experience and background are what, to me, make this forum outstanding. I haven't found another forum with the kind of relating this site has engendered between members.
I do find this interesting, and I love your statement about cells not reading books.
I have read that "DNA reads DNA" someway somehow?, and then replicates accordingly. I have also read that research is repairing instructions in DNA that are the cause of sickle cell anemia. I am fascinated with that concept also.
We must find the secret instructions that propagate CLL, interpret them, and provide the correction to produce the healthy cells like those that you illustrate, so that our bone marrow will appropriate an accurate desirable response.
You told Peggy about how much you loved your job, I like that too.
I think you're thinking of CRISPR gene editing and yes, it could hold the 'cure' for many inherited genetic disorders, such as sickle cell disease, where we know exactly what the amino acid substitution is in a gene on a chromosome. Sickle is one gene but CLL is so multifactorial that it will take longer to unravel it's secrets but one day, it will come.
Exciting times ahead for medicine and genetics. Let's hope it's used wisely and not recklessly like the chinese Dr who used this to edit the genes of twin baby girls.
Yes, I absolutely loved my job and now I get to share some of that here for the benefit of members
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. Platelets are the smallest cells in the blood and they are actually just fragments that have broken off from 'buds' that form on the precursor megakaryocyte cells in the bone marrow. They have no nucleus and can vary hugely in size from tiny specs to the size of a lymphocyte. If you look at the lymphocyte's line then the fourth from the left has two platelets at approx 10/11 o'clock and in the monocyte's line, the second from the left has a larger platelet at about 3 o'clock.
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