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Variations in White Cell Morphology -- Granulocytes (Online CE Course)

(based on 1,681 customer ratings)

Authors: Marjorie A. Spahn, MT (ASCP); Barbara Minderman, MT (ASCP)
Reviewers: Rory Huschka, M.Ed., MT(ASCP); Dr. Linda Miller, PhD I, MBCM(ASCP)SI

This course covers all aspects of white blood cell morphology, including identifying changes in morphology in granulocytes. Addresses Barr bodies, Dohle bodies, Auer rods, vacuoles, hypersegmented granulocytes, and hyposegmented granulocytes. Excellent as a refresher or for clinical laboratory science students.

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Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 2 hour(s)
Approved through 11/30/2020
Approved through 9/1/2022


  • Explain the importance of identifying changes in granulocyte morphology.
  • Define, describe, and explain the relationship of Barr bodies to abnormal morphology.
  • Discuss nuclear hypersegmentation and hyposegmentation, with respect to: definition, appearance, composition, and significance.
  • Discuss nuclear hypersegmentation and hyposegmentation, with respect to: hypersegmented granulocytes and hyposegmented granulocytes.
  • Identify each of the following cytoplasmic variations: Dohle bodies, Auer rods, vacuoles, and abnormal granulation.
  • Identify and describe the morphological changes associated with Pelger-Huet anomaly, Chediak-Higashi anomaly, Alder-Reilly anomaly, and May-Hegglin anomaly.

Customer Ratings

(based on 1,681 customer ratings)

Course Outline

Click on the links below to preview selected pages from this course.
  • Introduction
  • Nuclear Variations
  • Cytoplasmic Variations
      • Döhle Bodies
      • Döhle Bodies, continued
      • Toxic Granulation
      • Toxic Granulation and Vacuolation
      • Cytoplasmic Vacuolation
      • Neutrophil with Normal Granulation
      • Toxic granulation is seen most frequently in:
      • Auer Rods
      • Auer Rods, continued
      • Which of the following inclusions may be seen in the cytoplasm of myeloblasts and promyelocytes?
      • Auer rods are significant when they are seen in the cytoplasm of blast cells because they are diagnostic for:
      • Chediak-Higashi Anomaly
      • Albinism and Chediak-Higashi Anomaly
      • Chediak-Higashi Anomaly vs. Toxic Granulation
      • Chediak-Higashi Anomaly Inclusions
      • Chediak-Higashi anomaly is characterized by which of the following?
      • May-Hegglin Anomaly
      • Alder-Reilly Anomaly
      • Alder-Reilly Anomaly, continued
      • Alder-Reilly anomaly inclusions may be found in which of the following white blood cell types?
      • Which of the following inclusions has a similar appearance on a Wright's stained smear to a Döhle body?
      • The inclusions that are frequently seen on the same peripheral blood smear with toxic granulation include: (Choose ALL that apply)
      • What type of inclusions are present in the cell that is indicated by the arrow?
      • The cell in this image is typical of other neutrophils on this peripheral blood smear from a patient with sepsis. Which morphologic term describes the...
  • References
      • References

Additional Information

Level of instruction: Intermediate
Intended Audience: clinical laboratory science students, medical technologists, and medical laboratory technicians seeking review or continuing education. It is also appropriate for medical students, pathology residents, and pathologists.
Course Description: This course covers morphologic variations observed in granulocytes, including nuclear and cytoplasmic variations.
Authors: by Marjorie A. Spahn, MT (ASCP) and Barbara Minderman, MT (ASCP).
Reviewer: Rory Huschka, M.Ed., MT(ASCP), has over 25 years of combined experience as a medical technologist, technical supervisor, professor, and manager. He is a former Director of Medical Laboratory Science and Medical Laboratory Technician Programs. He is currently a Program Director at MediaLab, Inc. Rory holds a BS degree in Medical Technology from North Dakota State University and a Masters in Educational Leadership. 
Reviewer: Dr. Linda Miller, PhD I, MBCM(ASCP)SI, is an Assistant Editor for the Immunohematology section of Lab Medicine. She received her BS degree in Biology from Syracuse University and her PhD in Immunology from SUNY Upstate Medical University. She holds certifications as a Technologist in Immunology, Specialist in Immunology, and Technologist in Molecular Biology from the ASCP. Dr. Miller is a professor of Clinical Laboratory Science at Upstate Medical University and the Director of the Medical Biotechnology program in the same department. There, she teaches courses in Immunology, Human Genetics, Molecular Methods, and Medical Biotechnology. She has served as a member of the ASCP Immunology Exam Committee and the ASCP Lab Q Editorial Board as Associate Editor of Clinical Immunology. Dr. Miller has written numerous continuing education exercises and book chapters in clinical immunology and is co-author of the 4th edition of the textbook, Clinical Immunology and Serology: A Laboratory Perspective (FA Davis). 

Alder normal neutrophils arrow
Alder Reilly 2
Auer rod
Barr body
Hyposegmented neutrophil
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Alder normal neutrophils arrow

Alder Reilly 2

Auer rod

Barr body

Hyposegmented neutrophil