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【中英對照/補圖】外周血紅細胞形態特徵的命名和分級標準化建議
ICSH外周血細胞形態特徵的命名和分級標準化建議之紅細胞
說明：本圖文的內容取自於《ICSH外周血細胞形態特徵的命名和分級標準化建議》，並採取中英對照的形式（英文在前，有蘋果綠的底色）。
GRADING OF MORPHOLOGICAL FEATURES
形態學特徵分級
The grading of morphology elements should provide the clinician with useful information regarding the status of any abnormality in the peripheral blood. This means that it is the responsibility of the laboratory to provide information to assist in the differential diagnosis instead of providing bits of data that are not clinically significant. Therefore, the morphology grading table included contains a two-tiered grading system, for 2+ (moderate) and 3+ (many). The designation for 1+ (few/rare) is reserved only for schistocytes, as the observation even in small numbers is clinically significant. Each laboratory and laboratory system should have policies in place to ensure the consistent application of the grading criteria (Table 1).
形態學分級應能為臨床醫生提供關於外周血任何異常狀態的有用信息。這意味著，實驗室有責任提供信息，以協助鑑別診斷，而不是提供沒有臨床意義的數據。因此，形態學分級表包括兩層分級系統，為2+（中等）和3+（較多）。1+（少許/罕見）僅對裂紅細胞有效，即使見到少量也有臨床意義。每個實驗室和實驗室系統應該有制度來確保貫徹分級標準的應用（表1）。
WHITE BLOOD CELLS
白細胞
In nearly all cases, modern haematology analysers provide accurate white cell counts and white cell differentials. The differential may be suppressed or inaccurate when there are abnormal white cell populations present but this will cause abnormal flags to be triggered. Automated instruments cannot enumerate and classify abnormal white cell populations or recognize many significant morphological abnormalities necessitating the microscopic examination of a well made and well-stained peripheral blood film for accurate white cell differentiation and classification.
在幾乎所有的病例中，現代的血液分析儀可提供精確的白細胞計數和分類。當存在異常白細胞群時可出現不分類或分類不準確，這時會出現異常標識。自動化儀器不能計數和分類異常白細胞群或者識別一些顯著的形態異常，需要鏡檢製作和染色良好的外周血塗片進行準確地白細胞分類。
White cell differentiation involves the classification of white cells based on size, nuclear shape, chromatin pattern and cytoplasmic appearance and content. Morphological qualitative abnormalities of the cell nucleus or cytoplasm and/or the size of the white cells can be congenital or acquired in the course of various diseases.
白細胞分類是根據白細胞的大小、核形、染色質特徵和胞質的外觀和內容物進行分類。胞核或胞質形態上質的畸形和（或）白細胞大小的異常可以是先天性的，也可以是在各種疾病過程中獲得的。
The 2008 World Health Organisation (WHO) Classification of Tumours of Haemopoietic and Lymphoid Tissues recommends a 200 white cell peripheral blood cell differential be performed as part of the diagnostic work-up in acute myeloid leukaemia (AML) and myelodysplastic syndromes; however, a 100 white cell differential is more usual in the routine haematology laboratory.
2008年WHO造血與淋巴組織腫瘤分類建議在急性髓細胞白血病（acute myeloid leukaemia，AML）和骨髓增生異常症候群（myelodysplastic syndromes，MDS）的診斷中白細胞分類需計數200個外周血白細胞；然而，常規血液學實驗室分類時大多計數100個白細胞。
一、Normal myeloid development and morphology
一、正常的髓系發育和形態
（一）Myeloblast
Blast cells in normal myeloid maturation have a diameter of 12–20 um and a relatively large round or oval nucleus with a fine chromatin pattern and one or more distinct nucleoli. The cytoplasm is basophilic with an absent Golgi zone and granules may or may not be present.
（一）原始粒細胞
正常分化成熟的原始粒細胞（Myeloblast）直徑約12～20μm，有相對大的圓形或卵圓形胞核，染色質細緻並有一至多個明顯核仁。胞質呈嗜鹼性無高爾基區，顆粒有或無。
【小編注】原始粒細胞：
該圖由溫州醫科大學 王霄霞教授提供
（二）Promyelocyte
Normal promyelocytes are 15–25 um in diameter, have an oval or round nucleus with fine/intermediate chromatin and a usually visible and prominent nucleolus. The cytoplasm is basophilic and contains blue-violet and red (primary) granules. A pale area equating to the Golgi zone is present adjacent to the nucleus.
（二）早幼粒細胞
正常早幼粒細胞（Promyelocyte）直徑15～25μm，卵圓形或圓形核伴細緻或稍粗的染色質和通常可見的核仁。胞質嗜鹼性，並含藍紫色和紅色（初級）顆粒。近核處有一個淡染區相當於高爾基區。
【小編注】早幼粒細胞：
該圖由溫州醫科大學 王霄霞教授提供
（三）Myelocyte
The myelocyte is slightly smaller than the promyelocyte (10–18 um) with a round or oval nucleus which may be eccentrically placed. The nuclear chromatin shows a moderate degree of coarse clumping and
nucleoli are not seen. There is a moderate amount of blue-pink cytoplasm which contains numerous red-violet granules. As the myelocyte matures, the secondary granules develop definite neutrophilic, eosinophilic or basophilic characteristics.
（三）中幼粒細胞
中幼粒細胞（Myelocyte）比早幼粒細胞略小（10～18μm），圓形或卵圓形胞核可偏心分布。核染色質顯示中等程度粗糙而凝集，核仁不見。中等量藍粉色的胞質中含大量的紅紫色顆粒。成熟至中幼粒細胞階段時次級顆粒發育，可區分出中性粒細胞、嗜酸性粒細胞或嗜鹼性粒細胞。
【小編注】
以下兩圖由溫州醫科大學 王霄霞教授提供：
1、中性中幼粒細胞：
2、嗜酸性中幼粒細胞：
（四）Metamyelocyte
The metamyelocyte is smaller than the myelocyte with an indented or kidney-shaped nucleus. Nucleoli are not observed. The cytoplasm is usually clearly pink and contains granules that are clearly differentiated as neutrophilic, eosinophilic or basophilic.
（四）晚幼粒細胞
晚幼粒細胞（Metamyelocyte）較中幼粒細胞小，伴凹陷或腎形核，核仁不見。胞質常呈清晰的粉紅色，並含中性、嗜酸性或嗜鹼性顆粒。
N.B. Immature granulocytes (promyelocytes, myelocytes and metamyelocytes) are not usually seen in normal peripheral blood.
注意：正常外周血通常不見未成熟粒細胞（早幼粒細胞、中幼粒細胞和晚幼粒細胞）。
【小編注】
以下兩圖由溫州醫科大學 王霄霞教授提供：
1、中性晚幼粒細胞：
2、嗜酸性晚幼粒細胞：
（五）Band neutrophil
Band neutrophils are 10–14 um in diameter and have a nucleus that is nonsegmented or has rudimentary lobes that are connected by a thick band rather than a thread. Cytoplasm is abundant, pink and contains many small violet-pink neutrophilic or secondary granules distributed evenly throughout the cell.
（五）杆狀核中性粒細胞
杆狀核中性粒細胞（Band neutrophil）的直徑10～14μm，胞核不分葉或由粗帶相連的分葉雛形，不以細絲相連。胞質豐富、粉紅色並含許多均勻分布於整個細胞的細小的紫-粉色中性顆粒或次級顆粒。
Many laboratories do not report band neutrophils on adult patients or children due to interobserver variation in band neutrophil classification; this is a well recognized and acceptable practice.
許多實驗室因為各觀察者之間對杆狀核中性粒細胞的分類有出入，對成人或兒童患者不報告杆狀核中性粒細胞；這是一個公認的和可以接受的做法。
It is recommended that band neutrophils be counted as segmented neutrophils in the differential. Appropriate comments may be made if increased numbers are seen in the blood film.
建議在白細胞分類時杆狀核中性粒細胞計入分葉核中性粒細胞中。如血片中數量增加可以進行適當備註。
【小編注】中性杆狀核粒細胞：
圖片來自人民衛生出版社《臨床檢驗基礎（第5版）》
（六）Segmented neutrophil
A granulocyte that is 10–14 um in diameter with a lobulated nucleus (usually 3–4 lobes, but small numbers of 2 and 5 lobed neutrophils may also be seen) connected by a thin thread of chromatin. The chromatin is coarse, stains violet and is arranged in clumps. Small nuclear appendages may be seen. There is abundant pink cytoplasm with many small secondary granules.
（六）分葉核中性粒細胞
分葉核中性粒細胞（Segmented neutrophil）的直徑10～14μm，分葉核（通常3～4葉，但可見少量分為2葉或5葉）之間由一條染色質細絲相連。染色質粗糙、染紫色並呈塊狀。或可見小的核附屬物。大量粉紅色胞質中有許多細小的次級顆粒。
【小編注】分葉核中性粒細胞：
圖片來自人民衛生出版社《臨床檢驗基礎（第5版）》
（七）Eosinophil
The diameter of the eosinophil is 12–17 um. The nucleus usually only has 2 lobes with coarsely clumped, violet-staining chromatin. There is abundant cytoplasm containing many eosinophilic (orange) secondary granules that are larger than neutrophil granules and more uniform in size.
（七）嗜酸性粒細胞
嗜酸性粒細胞（Eosinophil）的直徑約12～17μm，胞核通常僅2葉，染色質粗糙成塊染紫色。胞質豐富有許多嗜酸性（橙色）的次級顆粒，比中性粒細胞顆粒大且大小均一。
【小編注】嗜酸性粒細胞：
圖片由溫州醫科大學 王霄霞教授提供
（八）Basophil
A basophil is 10–16 um in diameter with pale blue cytoplasm containing purple-black secondary granules. These granules are water soluble and may dissolve on staining leaving clear areas in the cytoplasm. The nucleus is segmented but is often obscured by basophilic granules which may vary in number, size and shape.
（八）嗜鹼性粒細胞
嗜鹼性粒細胞（Basophil）的直徑10～16μm，淡藍色胞質中含有紫黑色的次級顆粒。這些顆粒為水溶性，在染色時可被溶解，胞質中僅剩透亮區。胞核分葉，常可被數量、大小和形狀不一的嗜鹼性顆粒遮蓋。
【小編注】嗜鹼性粒細胞：
圖片由溫州醫科大學 王霄霞教授提供
（九）Monocyte
Monocytes are the largest cell in the peripheral blood, variable in size but usually 15–22 um in diameter. The nucleus is irregular in outline (often kidney shaped), and the chromatin is arranged in fine strands with sharply defined margins. The cytoplasm is light blue-grey and contains numerous fine dust-like granules. Some cells may contain a small number of red-violet granules. Vacuolation may be present.
（九）單核細胞
單核細胞（Monocyte）是外周血中最大的細胞，大小不一，通常直徑為15～22μm。胞核輪廓不規則（通常腎形），而染色質呈細股狀有清晰的邊緣。胞漿淡藍-灰色，含大量的細小粉塵狀顆粒。一些細胞可含少量的紅紫色顆粒，可有空泡。
【小編注】單核細胞：
圖片由溫州醫科大學 王霄霞教授提供
二、Normal lymphocyte development and morphology
二、正常的淋巴細胞發育和形態
（一）Lymphoblast
The lymphoblast has a diameter of 8–20 um. The nucleus is round or oval with fine granular chromatin and one or more indistinct nucleoli. The cytoplasm is scanty and basophilic, and cytoplasmic granules are absent. It cannot be reliably distinguished from some types of undifferentiated or minimally differentiated myeloblasts and therefore should be counted as a blast cell.
（一）原始淋巴細胞
原始淋巴細胞（Lymphoblast）的直徑8～20μm，胞核圓形或橢圓形伴細顆粒狀染色質和一或多個模糊核仁，胞質少、嗜鹼性，無胞質顆粒。不能與某些類型的未分化或微分化的原始粒細胞明確區分，因此應計為原始細胞。
【小編注】原始淋巴細胞：
圖片由溫州醫科大學 王霄霞教授提供
（二）Prolymphocyte
The nucleus is round and contains a single prominent nucleolus. It has more cytoplasm than a lymphoblast and the chromatin is more condensed.
（二）幼稚淋巴細胞（Prolymphocyte）
此類細胞的胞核呈圓形，並含一個突出的核仁，較原始淋巴細胞的胞質更多，染色質更濃集。
N.B. Lymphoblasts and prolymphocytes are not usually seen in the normal peripheral blood.
注意：原始淋巴細胞和幼淋巴細胞通常不見於正常外周血中。
【小編注】幼稚淋巴細胞：
圖片由溫州醫科大學 王霄霞教授提供
（三）Lymphocyte
Lymphocytes seen in the peripheral blood are predominantly small (10–12 um), or, less frequently large(12–16 um).
（三）淋巴細胞
外周血中的淋巴細胞主要為小淋巴細胞（10～12μm），以及較少見的大淋巴細胞（12～16μm）。
1、Small lymphocytes are usually round in outline, and the nucleus is round with coarse, densely staining chromatin. Cytoplasm is scanty.
1、小淋巴細胞通常呈圓形，胞核圓形伴粗糙、緻密染色的染色質，胞質很少。
【小編注】小淋巴細胞：
圖片由溫州醫科大學 王霄霞教授提供
2、Large lymphocytes are usually irregular in outline, and the nuclear chromatin is not as coarse as in small lymphocytes. Cytoplasm is abundant and tends to be light sky blue in colour.
2、大淋巴細胞通常外形不規則，核染色質不如小淋巴細胞粗糙，胞質豐富，趨向淡天藍色。
【小編注】大淋巴細胞
圖片由溫州醫科大學 王霄霞教授提供
3、Large granular lymphocytes (LGLs) are of the same appearance as large lymphocytes but the cytoplasm contains prominent small red-violet granules. These cells can comprise up to 10–20% of the peripheral blood lymphocytes in normal subjects. LGLs are not routinely counted as a separate lymphocyte population.
3、大顆粒淋巴細胞（Large granular lymphocytes，LGL）外觀同大淋巴細胞，只是胞質中含突出的紅紫色小顆粒。此類細胞可佔正常人外周血淋巴細胞的10～20％。LGL不常規計為單獨的淋巴細胞群。
Image S17: large granular lymphocyte
Large granular lymphocyte from a normal individual
J. Burthem, M. Brereton
圖17: 大顆粒淋巴細胞
正常個體中的大顆粒淋巴細胞。
圖片由J. Burthem, M.Brereton提供。
It is recommended that LGLs be counted as lymphocytes but may be commented on if they are present in increased numbers. This may prompt further investigations such as flow cytometry.
建議LGL計入淋巴細胞，但如果增多時可加以備註。這可能會促使進一步檢查，如流式細胞儀。
N.B. Lymphocytes predominate in the blood films of infants and children until 4 years of age. These lymphocytes are more pleomorphic than those seen in normal adult blood films.
注意：在4歲之前的嬰兒和兒童的血片中，淋巴細胞佔多數。這些淋巴細胞比正常成人血片中的更加多形性。
三、Quantitative abnormalities
三、數量異常
Neutrophilia, neutropenia, lymphocytosis, lymphopenia, monocytosis, monocytopenia, eosinophilia, eosinopenia, basophilia, basopenia.
（包括）中性粒細胞增多、中性粒細胞減少、淋巴細胞增多、淋巴細胞減少、單核細胞增多、單核細胞減少、嗜酸性粒細胞增多、嗜酸性粒細胞減少，嗜鹼性粒細胞增多、嗜鹼性粒細胞減少。
WBC differential counts can be performed by automated analysers or manual microscopic visual examination of a blood film. Automated analysers use multiple parameters and methods such as impedance technology and fluorescence flow cytometry to differentiate and count the 5 major white cell types found in the peripheral blood – neutrophils, lymphocytes,monocytes, eosinophils and basophils. Many modern analysers also now provide a 6 part differential with the enumeration of immature granulocytes (promyelocytes, myelocytes and metamyelocytes).
白細胞分類計數可經自動分析儀或血片人工鏡檢實現。自動分析儀使用多種參數和方法，如阻抗技術和螢光流式細胞術來區分並計數外周血中5種主要的白細胞類型：中性粒細胞、淋巴細胞、單核細胞、嗜酸性粒細胞和嗜鹼性粒細胞。許多現代分析儀現在還提供了6分類，同時可計數未成熟粒細胞（早幼粒細胞、中幼粒細胞和晚幼粒細胞）。
The automated WBC differential count is less timeconsuming and expensive than the manual method and as an analyser counts thousands of cells compared to the usual 100–200 WBC by the microscopic method, it will also be more precise in the absence of abnormal cell populations. Very low or high white cell counts may also cause the manual differential to be less accurate and reproducible.
自動化白細胞分類比手工法省時而貴，因為分析儀要數幾千個細胞，而鏡檢法通常分類100～200個白細胞。在無異常細胞群時前者也更為精確。非常低或高的白細胞數可能也會引起手工分類準確性和重複性下降。
Each laboratory should establish their own reference ranges as these will vary depending on population, laboratory, instrumentation and methods used.
各實驗室應建立自己的參考值範圍，因為它們因人群、實驗室、儀器和使用的方法不同而有差別。
It is recommended that the automated analyser WBC differential count be reported in patients with normal cell populations in the absence of analyser flags or abnormal cell populations that cannot be reliably differentiated and classified by automated instruments. The automated differential may also be reported after viewing a blood film due to flags or other indicators where the automated values are found to be accurate.
建議在正常細胞群的患者中——無分析儀異常標識或不存在自動儀器不能可靠分類的異常細胞群，以自動分析儀白細胞分類的結果報告。有異常標識或其他血片復檢指徵者，經鏡檢發現自動化分類準確時，仍可報告自動分類的結果。
四、Qualitative abnormalities in myeloid cells
四、髓細胞質量異常
（一）Cytoplasmic abnormalities
（二）胞質異常
1、Auer rod.
A sharply defined red rod or needle-like cytoplasmic inclusion formed by abnormal primary granule development. Found mainly in leukaemic myeloblasts or abnormal promyelocytes, they stain positively for myeloperoxidase and are a specific marker for myeloid lineage neoplasms. There may be several in a cell and may be arranged in bundles (faggots).
1、Auer小體
是一種邊界清楚的紅色小棒或針狀胞質內含物，主要由異常的初級顆粒發育而形成。主要見於白血病性原始粒細胞或異常早幼粒細胞。髓過氧化物酶染色陽性，是髓系腫瘤的特異性標記物。在一個細胞可有多個，也可排列為柴棒狀（柴捆細胞）。
The recommendation is to report the presence of Auer rods when seen.
建議見到時報告可見Auer小體。
Image S18: Auer rods
AML – two blast cells containing relatively blunt-ended, single and multiple Auer rods
J. Burthem, M. Brereton
圖18: Auer 小體
AML – 2個原始細胞含相對鈍的，單個和多個Auer小體。
圖片由J. Burthem, M. Brereton提供。
2、Dohle body.
Pale light blue or grey, single or multiple, cytoplasmic inclusions found near the periphery of the neutrophil. Dohle bodies are a non-specific reactive change but may also indicate May-Hegglin anomaly if associated with thrombocytopenia and giant platelets. Dohle bodies may also be seen in patients on growth factor therapy such as granulocyte colony-stimulating factor (G-CSF).
見於中性粒細胞靠近外周處的蒼白淡藍色或灰色的單個或多個胞質內含物。杜勒小體是一種非特異性的反應性改變，但如果伴有血小板減少和巨型血小板還可提示May-Hegglin異常。杜勒小體還可見於生長因子——如粒細胞集落刺激因子治療的患者。
The recommendation is to grade Dohle bodies when seen.
建議見到杜勒小體時進行分級。
【小編注】杜勒小體：
圖片來自人民衛生出版社《臨床檢驗基礎（第5版）》
3、Hypergranulation – neutrophil, (toxic granulation).
Coarse, purple staining primary (azurophilic) neutrophil cytoplasmic granules which occur as a response to infection and inflammation. A non-specific reactive change, it is a result of abnormal primary granule maturation with retention of their azurophilic staining properties.
3、中性粒細胞顆粒過多（中毒顆粒）
粗糙、紫染的初級（嗜天青）中性胞質顆粒，作為感染和炎症反應而出現。作為一種非特異性反應性改變，是異常的初級顆粒成熟導致嗜天青染色性的滯留。
The recommendation is to grade hypergranulation when seen.
建議見到中性粒細胞顆粒過多時進行分級。
Image S19: hypergranulation(neutrophils)
Hypergranular neutrophils post G-CSF treatment
J. Burthem, M. Brereton
圖19: 顆粒過多(中性粒細胞)
G-CSF治療後的顆粒過多中性粒細胞。
圖片由J. Burthem, M.Brereton提供。
4、Hypogranulation – neutrophil
Reduced or absent neutrophil granulation causing the cytoplasm of mature neutrophils to appear bluegrey.
4、中性粒細胞顆粒過少
中性粒細胞顆粒減少或缺如導致成熟中性粒細胞的胞質呈現藍灰色。
The recommendation is to grade hypogranulation when seen.
建議見到中性粒細胞顆粒過少時進行分級。
Image S20: hypogranulation(neutrophils)
Myelodysplasia – hypogranular neutrophils. Note also the atypical nuclear forms
G. Rozenberg. Copyright: Microscopic haematology: a practical guide for the laboratory 3e (c) 2011, Sydney, Elsevier Australia
圖20: 顆粒過少(中性粒細胞)
骨髓增生異常-顆粒過少中性粒細胞。還要注意不典型的核形態。
圖片由G. Rozenberg提供，選自: Microscopic haematology: a practical guide for thelaboratory 3e (c) 2011, Sydney, Elsevier Australia。
5、Vacuolation – neutrophil. Neutrophil cytoplasmic
vacuolation in infection is due to granule fusion with a phagocytic vacuole and release of lysosomal contents to kill bacteria. This vacuolation may appear as 『pin-hole』 vacuolation – small, discrete vacuoles, but the vacuoles may be larger. Other causes of neutrophil vacuolation include alcohol toxicity and prolonged exposure to EDTA anticoagulant (storage artefact).
5、中性粒細胞胞質空泡形成
在感染中，中性粒細胞胞質空泡形成是由於顆粒融合伴吞噬小泡並釋放溶酶體內容物以殺死細菌。這種空泡可呈現為「針孔樣」空泡——小而分散的空泡，但空泡也可較大。中性粒細胞空泡形成的其他原因包括酒精中毒，長時間接觸EDTA抗凝劑（存儲引起）。
The recommendation is to grade neutrophil vacuolation when seen.
建議見到中性粒細胞空泡形成時進行分級。
【小編注】中性粒細胞胞質空泡：
圖片來自人民衛生出版社《臨床檢驗基礎（第5版）》
（二）Nuclear abnormalities
（二）核異常
1、Hypersegmented neutrophils.
Normal neutrophils usually have 3–4 lobes (occasionally 2 and 5 lobes). Hypersegmented neutrophils have an increased number of distinct nuclear lobes with increased numbers of neutrophils having 5 or more nuclear segments.
1、分葉過多的中性粒細胞
正常中性粒細胞通常為3～4個核葉（偶爾2或5葉）。分葉過多中性粒細胞的核葉增多，5葉或5葉以上核的中性粒細胞數量增多。
Neutrophil hypersegmentation is defined as any neutrophil having 6 or more lobes or more than 3% of neutrophils having 5 lobes, when 100 neutrophils are examined.
中性粒細胞分葉過多定義為當檢查100個中性粒細胞時，發現有6葉或6葉以上核的中性粒細胞，或者3％以上的中性粒細胞有5葉核。
The recommendation is to comment on the presence of hypersegmented neutrophils when seen.
建議見到分葉過多的中性粒細胞時進行備註。
【小編注】中性粒細胞分葉過多：
圖片來自衛生部臨床檢驗中心2009年第2次血細胞形態學檢查室間質量評價
2、Hyposegmented neutrophils – hypolobated neutrophils(Pelger-Huet neutrophils).
Hyposegmented neutrophils are marked by the failure of normal nuclear lobe development during terminal differentiation and have coarse clumped nuclear chromatin.
2、分葉過少的中性粒細胞（Pelger-Huet 中性粒細胞）
分葉過少中性粒細胞（Hyposegmented neutrophils）是在終末分化過程中正常核葉發育障礙，而核染色質已粗糙凝聚。
It is important that these hyposegmented neutrophils not be confused with myelocytes, metamyelocytes or band neutrophils. They are mature neutrophils and can be differentiated by their smaller nucleus and lower nuclear:cytoplasmic ratio (N:C ratio) and condensed nuclear chromatin.
重要的是，這些分葉過少中性粒細胞不與中、晚幼或杆狀核中性粒細胞相混淆。它們為成熟的中性粒細胞，可通過其較小的胞核，較低的核質比和固縮的核染色質相鑑別。
It is recommended that hyposegmented neutrophils be counted and reported as mature segmented neutrophils but with a suitable interpretive comment.
建議將分葉過少的中性粒細胞計入並報告為成熟分葉核中性粒細胞，但應加以合適的備註。
Image S21: Pelger Huet neutrophils
Pelger Huet anomaly – classic bi-lobed cells with dense chromatin condensation but normal granulation
J. Burthem, M. Brereton
圖21: Pelger Huet中性粒細胞
Pelger Huet 異常- 經典的雙葉核細胞伴緻密的染色質凝聚但正常的胞質顆粒。
圖片由J. Burthem, M.Brereton提供。
（三）Myeloid cells in haematological neoplasms
（三）血液腫瘤中的髓細胞
1、Leukaemic myeloblasts.
Leukaemic myeloblasts vary in appearance. They can be large or small in size. Some may have a high N:C ratio, uncondensed chromatin and usually one or more prominent nucleoli. Others may have a lower N:C ratio and a few red-purple granules or Auer rods. Nuclear and cytoplasmic irregularities may be present, for example nuclear folding, cytoplasmic basophilia and cytoplasmic blebbing or pseudopods.
1、白血病性原始粒細胞
白血病性原始粒細胞在外觀上有所不同。胞體可大可小。有些具有較高的核質比，未固縮的染色質，通常有一個或多個明顯的核仁。另一些可能有較低的核質比和一些紅紫色顆粒或Auer小體。可存在核和胞質的不規則，例如核摺疊、胞質嗜鹼性和細胞質起泡或偽足。
The recommendation is to count these as blasts and describe them in the film report with a suitable interpretive comment.
建議將這些細胞計入原始細胞，並在血片報告中給予解釋性備註。
Image S22: leukaemic myeloblasts
Acute myeloid leukaemia (AML) – hypogranular primitive blast cells
J. Burthem, M. Brereton
圖22: 白血病性原始粒細胞
急性髓細胞白血病（AML）- 少顆粒原始細胞。
圖片由J. Burthem, M.Brereton提供。
2、Abnormal promyelocytes in acute promyelocytic leukaemia (APL).
The promyelocytes in the hypergranular variant of APL have nuclei that vary in size and shape and are often kidney shaped or bilobed. The cytoplasm is packed with large coalescent pink-purple granules and may contain Auer rods. These may be grouped in bundles or 「faggots」 within the cytoplasm.
2、急性早幼粒細胞白血病中的異常早幼粒細胞
APL顆粒過多變異型中的早幼粒細胞的胞核大小、形態不一，通常為腎形或雙葉；胞質充滿大的融合的粉-紫色顆粒，可含Auer小體。有些可稱為「柴捆」細胞。
In the hypogranular or microgranular variant, the nuclear shape is usually bilobed but the cytoplasm contains few or no granules.
在少顆粒或微小顆粒變異型中，胞核形狀通常為雙葉，但胞質所含顆粒很少或沒有。
The recommendation is to count these abnormal promyelocytes as blast equivalents in the differential but it is important that a suitable description of the abnormal promyelocytes and an interpretive comment is added to the film report and a likely diagnosis of APL communicated directly to the clinician.
建議在分類時這些異常早幼粒細胞計入原始細胞等同細胞。但需要恰當地描述該類異常早幼粒細胞，並在血片報告中加上解釋性備註，還應將直接將可能的診斷（APL）傳達給臨床醫生，這非常重要。
Image S23: abnormal promyelocytes in APL (1)
APML – two hypergranular promyelocytes
J. Burthem, M. Brereton
圖23: APL中的異常早幼粒細胞 (1)
APML –2個顆粒過多早幼粒細胞。
圖片由J. Burthem, M.Brereton提供。
Image S24: abnormal promyelocytes in APL (2)
Abnormal promyelocyte containing multiple Auer rods (faggot cell)
G. Rozenberg. Copyright: Microscopic haematology: a practical guide for the laboratory 3e (c) 2011, Sydney, Elsevier Australia
圖24: APL中的異常早幼粒細胞 (2)
異常早幼粒細胞含多個Auer小體（柴棒狀細胞）。
圖片由G. Rozenberg提供，選自: Microscopic haematology: a practical guide for thelaboratory 3e (c) 2011, Sydney, Elsevier Australia。
【小編注】
急性早幼粒細胞白血病（APL）臨床表現兇險，易導致早期死亡，且治療上和其他類型AML有較大區別，因此及早告知臨床醫生意義重大。
相關閱讀：
3、Monoblasts
Monoblasts are larger than myeloblasts (20-30 um), with a round/oval nucleus, fine chromatin and one or two prominent nucleoli. The cytoplasm is basophilic and usually lacks granules.
3、原始單核細胞
原始單核細胞比原始粒細胞大（20-30μm），胞核圓形或橢圓形，染色質細緻，有一個或兩個明顯核仁；胞質嗜鹼性，通常無顆粒。
The recommendation is to count these as blasts and describe them in the film report with a suitable interpretive comment.
建議計入原始細胞，並在血片報告中加上解釋性備註。
Image S25: monoblasts
Acute monoblastic leukaemia – monoblasts and promonocytes
J. Burthem, M. Brereton
圖25: 原始單細胞（Monoblasts）
急性原始單細胞白血病 –原始單細胞和幼單核細胞。
圖片由J. Burthem, M.Brereton提供。
4、Promonocytes
Promonocytes may be rarely seen in the peripheral blood in reactive conditions as well as in some leukaemias. They are large cells with a nucleus that is convoluted/indented with a delicate, lace-like chromatin pattern and prominent nucleolus. The cytoplasm is blue-grey and may contain a small number of fine red-violet granules.
4、幼稚單核細胞
幼單核細胞罕見於反應性狀態以及某些白血病患者外周血中。此類細胞較大，胞核扭曲/縮進伴細緻、蕾絲狀染色質和突出的核仁。胞漿藍灰色可含少量紅紫色的細小顆粒。
The recommendation is to count promonocytes in the differential and comment on their presence with a suitable interpretive comment. Leukaemic promonocytes should be summated with blast cells when making a diagnosis of AML.
建議分類時計為幼單核細胞，並給予合適的解釋性備註。在診斷AML時，白血病性幼單核細胞應計入原始細胞等同細胞。
Image S26: abnormal promonocytes
Chronic myelomonocytic leukaemia (CMML)
G. Zini
圖26: 白血病性幼稚單核細胞（Leukaemic promonocytes）
慢性粒單核細胞白血病(CMML) 。
圖片由G. Zini提供
5、Abnormal monocytes
Monocytes produced under conditions of bone marrow stress or stimulation, for example infections, growth factor (GM-CSF) administration, show an increased N:C ratio, a more delicate chromatin pattern, nucleoli and increased numbers of vacuoles. Granulation and cytoplasmic basophilia may also be increased.
5、異常單核細胞
在骨髓應激或刺激情況下，例如感染、使用生長因子（GM-CSF）產生的單核細胞表現為核質比增加，染色質更加細緻，有核仁以及空泡增多。顆粒形成和胞質嗜鹼性也可增加。
Abnormal monocytes can be seen in a number of haematological neoplasms. In contrast to monoblasts and promonocytes, the abnormal monocytes are larger, have irregular nuclei and increased cytoplasm.
異常單核細胞可見於一些血液腫瘤。與原始單核細胞和幼單核細胞相比，異常單核細胞較大，有不規則的胞核以及胞質增多。
The recommendation is to count these as monocytes with a comment on their morphology and a suitable interpretive comment.
建議計入單核細胞，描述其形態並給予合適的解釋性備註。
相關閱讀：
國際骨髓增生異常症候群形態學工作組（IWGM-MDS）則將單核細胞系統分為原始/未成熟/幼稚/成熟四類
6、Dysplastic changes.
Dysplasia refers to morphologically abnormal cells or tissues that are due to abnormal cell development and maturation. Examples of dysplasia include abnormally large or small cells, nuclear hyposegmentation (hypolobation), nuclear hypersegmentation, hypogranulation, hypergranulation and abnormal granulation (large fused granules, Auer rods).
6、病態造血改變
病態造血是指由於異常的細胞發育和成熟導致的形態異常的細胞或組織。病態造血包括異常大或小的細胞、核分葉過少、核分葉過多、顆粒過少和顆粒過多以及異常顆粒形成（大的融合顆粒、Auer小體）。
The recommendation is to comment on the presence of dysplasia with a suitable interpretive comment.
建議見到病態造血改變時報告可見病態造血，並予合適的解釋性備註。
It should be noted that the diagnosis and classification of myelodysplastic syndrome as per the WHO classification 2008 requires a percentage count of dysplastic changes per lineage. This, however, is not routinely performed by the scientist reviewing the peripheral blood film. Further investigations and clinical correlation by the clinician is required.
應當指出的是，按照2008版WHO分類診斷和分類骨髓增生異常症候群需要計數每一系細胞中病態造血改變的百分比。然而，在外周血片複查時並不常規進行這種分類。需要臨床醫生進一步的調查並綜合臨床相關性。
【小編注】
WHO造血與淋巴組織分類在2016年已有新版，MDS部分的變化較大。相關內容可參考「相關閱讀」
相關閱讀：
骨髓增生異常症候群中國診斷與治療指南（2019年版）
骨髓增生異常症候群（MDS）的最低診斷標準
世界衛生組織（WHO）2016版骨髓增生異常症候群（MDS）修訂分型
中英對照：病態造血的形態學表現（Morphological manifestations of dysplasia）
五、Qualitative abnormalities in lymphoid cells
五、淋巴細胞質量異常
Lymphocyte morphology is subject to wide variability due to various immunological stimuli both in inflammatory and infectious diseases (particularly viral) as well as in neoplastic disorders (leukaemias and lymphomas), resulting in circulating lymphocytes with morphological abnormalities in various quantities. Terminology for these lymphocytes has been varied and confused with many different terms being used to describe the same thing including variant, reactive, abnormal, activated and atypical lymphocytes, Downey cells Type1–3, Turk cells, immunoblasts and even combinations of cells, for example monocytoid lymphocytes. This highlights a need to simplify this terminology.
在炎性和感染性疾病（尤其是病毒性）中各種免疫刺激下，以及在腫瘤性疾病（白血病和淋巴瘤）中，淋巴細胞形態具有很大的可變性，導致循環中出現數量不等的形態異常淋巴細胞。這些淋巴細胞的術語一直在變，用來描述同樣東西的不同術語產生混淆，包括變異型、反應性、異常的、活化的和異型（不典型）淋巴細胞，1～3型Downey細胞、Turk細胞、免疫母細胞，甚至組合名稱，例如單核細胞樣淋巴細胞。這突出了簡單化這一術語的必要性。
It is recommended that reactive lymphocyte is used to describe lymphocytes with a benign aetiology and abnormal lymphocyte with an accompanying description of the cells is used to describe lymphocytes with a suspected malignant or clonal aetiology.
建議用反應性淋巴細胞描述良性病因的淋巴細胞，以異常淋巴細胞用於描述疑為惡性或克隆性病因的淋巴細胞，並對細胞形態加以論述。
（一）Reactive lymphocytes (atypical lymphocyte, suspect reactive – European LeukemiaNet classification) .
Abnormalities include increased cell size, immaturity of the nucleus including a visible nucleolus and lack of chromatin condensation, irregular nuclear outline or lobulation, cytoplasmic basophilia and vacuolation and irregular cell outline. The cytoplasm may be abundant with staining varying from pale blue to markedly basophilic especially at points of contact with adjacent cells.
（一）反應性淋巴細胞（或稱為不典型淋巴細胞，疑為反應性——歐洲白血病網分類，見圖27）
異常包括細胞增大，胞核不成熟（包括可見核仁、染色質不固縮），核輪廓不規則或分葉，胞質嗜鹼性以及空泡形成以及細胞輪廓不規則。胞質可能豐富，染色從淡藍到顯著嗜鹼性（尤其接觸鄰近細胞處）不等。
The recommendation is to comment on the presence of reactive lymphocytes. They may be counted as a separate population in the differential if they are present in significant numbers.
建議備註可見反應性淋巴細胞，顯著增多時單獨分類。
Image S27: reactive lymphocytes
Infectious mononucleosis – typical reactive lymphocytes with flowing basophilic cytoplasm
J. Burthem, M. Brereton
圖27: 反應性淋巴細胞
傳染性單核細胞增多症——典型的伴流動的嗜鹼性胞質的反應性淋巴細胞。
圖片由J. Burthem, M.Brereton提供。
（二）Abnormal lymphocytes (atypical lymphocyte, suspect neoplastic – European LeukemiaNet classification)
A comprehensive classification and description of lymphocytes in malignant lymphoid neoplasms is beyond the scope of this article. For this, the reader is advised to refer to the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Fourth Edition.
（二）異常淋巴細胞（或稱為不典型淋巴細胞，疑為腫瘤性——歐洲白血病網分類）
綜合分類和描述惡性淋巴腫瘤中的淋巴細胞已超出了本文的範圍。建議讀者參閱WHO造血和淋巴組織腫瘤分類（第4版）。
【小編注】
WHO造血與淋巴組織分類已有修訂第4版（藍皮書已於2017年面世），相關內容可參考：
簡單回顧WHO造血與淋巴組織腫瘤分類的變遷
It is recommended that abnormal lymphoid cells that can be identified as a particular neoplastic cell type (as described below), for example hairy cells, lymphoma cells and prolymphocytes (based on distinctive morphology and confirmed by immunophenotyping), and plasma cells in plasma cell myeloma or other plasma cell dyscrasias be included in the differential as that cell class. Other abnormal lymphoid cells can be described in the film comment and counted as a separate population of 『abnormal lymphocytes』 in the differential if present in significant numbers.
建議可鑑定為特定的腫瘤性細胞類型的異常淋巴細胞，如多毛細胞、淋巴瘤細胞和幼淋巴細胞（根據獨特的形態學並以免疫分型證實），以及漿細胞骨髓瘤或其他漿細胞病中的漿細胞，該類細胞另歸一類。其他異常淋巴細胞可在血片報告備註中描述，如數量顯著分類時 「異常淋巴細胞」另歸一類。
The use of this nomenclature underlines the limited diagnostic value of morphology in the lymphoproliferative neoplasms where the final diagnosis is determined by immunophenotyping by flow cytometry.
使用這種命名法強調形態學在淋巴組織增生性腫瘤中的診斷價值有限，最終診斷由流式細胞免疫分型決定。
1、Hairy cells
Hairy cell leukaemia is a chronic B cell lineage leukaemia with morphologically distinctive neoplastic cells. Hairy cells are larger than normal lymphocytes and have abundant pale blue-grey cytoplasm with fine hair-like projections. The nucleus varies in shape and may be round, oval, bean-shaped or bilobed.
1、多毛細胞
多毛細胞白血病是一種具有獨特形態的腫瘤細胞的慢性B細胞系白血病。多毛細胞比正常淋巴細胞大，有豐富的淡藍-灰色胞質伴細毛狀突起。胞核形態不一，可圓形、橢圓形、豆形或雙葉。
It is recommended that hairy cells are counted as abnormal lymphocytes on first presentation with a detailed description of the cells included in the film comment. After immunophenotyping, the cells may be counted as hairy cells in the WBC differential.
建議在首次發現時，將多毛細胞計為異常淋巴細胞，並在血片報告的備註中詳細描述這些細胞。免疫分型後，這些細胞可在白細胞分類中計為多毛細胞。
Image S28: hairy cells
Hairy cell leukaemia
J. Burthem, M. Brereton
圖28: 多毛細胞
多毛細胞白血病。
圖片由J. Burthem, M.Brereton提供。
2、Lymphoma cells
Lymphoma is a neoplasm of B, T or Natural Killer(NK) lymphocytes and is more often found in tissues other than bone marrow and peripheral blood. Lymphoma may have a leukaemic phase, however, in which morphologically abnormal cells appear in the peripheral blood. A comprehensive classification of lymphoma is beyond the scope of this document, but some specific examples include the following:
2、淋巴瘤細胞
淋巴瘤是B、T或自然殺傷（Natural Killer，NK）淋巴細胞腫瘤，並且在組織中比骨髓和外周血中更常見。淋巴瘤可以有白血病期，此時這種形態異常細胞出現在外周血。淋巴瘤的綜合分類超出了本文範圍，此處僅舉一些特定例子：
（1）Follicular lymphoma
These lymphoma cells are often small with scanty, weakly basophilic cytoplasm and have nuclei with notches or deep narrow clefts. Sometimes the cells are larger and more pleomorphic with small but distinct nucleoli and nuclear clefts or notches.
（1）濾泡性淋巴瘤
此類淋巴瘤細胞常較小，很少的弱嗜鹼性胞質，胞核有切跡或深裂縫。有時細胞較大，更具多形性，有小而明顯的核仁以及核裂縫或切跡。
Image S29: follicular lymphoma cells
Circulating follicular lymphoma cells – note the small cells with cleaved nuclei and sparse cytoplasm
J. Burthem, M. Brereton
圖29: 濾泡性淋巴瘤細胞
循環中的濾泡性淋巴瘤細胞 - 注意小細胞伴裂核和稀少的胞質。
圖片由J. Burthem, M.Brereton提供。
（2）Mantle cell lymphoma
These lymphoma cells are pleomorphic varying in size and N:C ratio. Chromatin condensation is less than in CLL lymphocytes and some cells may appear blastic with cleft or irregular nuclei and a prominent nucleolus.
（2）套細胞淋巴瘤
此類淋巴瘤細胞為多形性，大小和核質比不一。染色質較CLL的淋巴細胞不固縮，某些細胞可表現為伴有裂縫或不規則核和一個突出核仁的原始細胞性。
【小編注】
一組MCL的淋巴瘤細胞，大部分表現為小淋巴細胞，但也存在一個具有原始細胞性的大細胞：
另一組MCL的淋巴瘤細胞，這一組細胞均有一個突出核仁，具有原始細胞性（來自2019年第七期華西Proficiency細胞形態網絡實訓，HXC12）：
（3）Burkitt lymphoma
These lymphoma cells are large with dispersed nuclear chromatin, one or more prominent nucleoli and moderately abundant, deeply basophilic and vacuolated cytoplasm.
（3）Burkitt淋巴瘤
此類淋巴瘤細胞為大的，伴有分散的核染色質，一個或多個明顯的核仁，胞質中等豐富、深嗜鹼性含有空泡。
【小編注】Burkitt淋巴瘤細胞，圖片來自網絡：
儘管如今已經知道Burkitt淋巴瘤是一種成熟B淋巴細胞腫瘤，但小編認為，單純從形態學的角度來看，將Burkitt淋巴瘤細胞劃入原始細胞也是沒有問題的。
（4）Sezary syndrome
Sezary syndrome is a mature Tcell lymphoma with neoplastic T lymphocytes in the peripheral blood. The cells are present in variable numbers ranging from a few cells to a frankly leukaemic picture with a marked leucocytosis. The cells may be large or small but the nuclear morphology, classically described as cerebriform, is the characteristic cytological feature of both cell types. The nucleus has deep narrow clefts with superimposed and folded lobes giving it a very convoluted appearance.
（4）Sézary症候群
Sézary症候群是一種在外周血中出現腫瘤性T淋巴細胞的成熟T細胞淋巴瘤。這些細胞出現的數量不等，可出現少許或白細胞顯著增多的明顯白血病像。細胞可大或小，核形經典地描述為腦回狀，為典型的細胞學特徵。胞核有深而窄的裂縫，伴重疊和摺疊的核葉，一種扭曲的外觀。
【小編注】Sézary細胞：
圖片來自衛生部臨床檢驗中心2009年第3次血細胞形態學檢查室間質量評價
（5）Adult T-cell leukaemia/lymphoma (ATLL)
ATLL is characterized by a broad spectrum of cytological features but the characteristic ATLL cells have been described as 『flower cells』 with many nuclear convolutions and lobules.
（5）成人T細胞白血病/淋巴瘤
該病的特徵為寬泛的細胞學特徵，但特徵性的細胞被描述為迴旋狀或分葉核的花樣細胞。
【小編注】ATLL細胞：
圖片來自人民衛生出版社《臨床血液學檢驗（第5版）》配套光碟
It is recommended that lymphoma cells are counted as abnormal lymphocytes on first presentation with a detailed description of the cells included in the film comment. After immunophenotyping, the cells may be counted as lymphoma cells in the WBC differential.
建議首次發現淋巴瘤細胞時，將其計為異常淋巴細胞，並在血片報告的備註中詳細描述這些細胞。免疫分型後，這些細胞可在白細胞分類中計為淋巴瘤細胞。
3、Plasma cells
A plasma cell is larger than a normal small lymphocyte, has deeply basophilic cytoplasm, an eccentric round or oval nucleus, coarsely clumped chromatin and a pale Golgi zone or perinuclear halo adjacent to the nucleus.
3、漿細胞
漿細胞比正常小淋巴細胞要大，胞質深嗜鹼性，胞核呈偏心的圓形或橢圓形，染色質粗糙結塊，胞核附近有蒼白的高爾基區或核周暈。
It is recommended that plasma cells be counted as a separate population in the WBC differential.
建議在白細胞分類時，將漿細胞單獨計為一類。
Image S30: plasma cells
Plasma cell leukaemia. Note also the background protein staining and the associated red cell rouleaux. Note that one plasma cell has features of immaturity and may be regarded as a plasmablast.
J. Burthem, M. Brereton
圖30: 漿細胞
漿細胞白血病。還要注意背景蛋白染色和伴隨的紅細胞緡錢狀。注意，1個具有不成熟特徵的漿細胞，並可視為原始漿細胞。
圖片由J. Burthem, M.Brereton提供。
4、Prolymphocytes
B-prolymphocytes are twice the size of a lymphocyte and have a round nucleus, moderately condensed nuclear chromatin, a prominent central nucleolus and a relatively small amount of faintly basophilic cytoplasm.
4、幼淋巴細胞
B幼淋巴細胞的大小是小淋巴細胞的兩倍，具有圓形核，核染色質適度固縮，一個突出的中央核仁和較少量的微嗜鹼性胞質。
T prolymphocytes are smaller and more pleomorphic than B prolymphocytes. Nuclei are irregular or lobulated. The cytoplasm is scanty and moderately basophilic and cytoplasmic blebs may be present. Nucleoli are usually not as large or prominent as Blineage
prolymphocytes.
T幼淋巴細胞較B幼淋巴細胞要小且更具多形性。核不規則或分葉狀。胞質少量和適度嗜鹼性並可出現胞質小泡（突出）。核仁通常不如B幼淋巴細胞那麼大或顯著。
It is recommended that prolymphocytes be counted as a separate population in the WBC differential.
建議在白細胞分類時，將幼淋巴細胞單獨計為一類。
【小編注】
PLL的幼淋巴細胞和具有原始細胞性的MCL細胞不易區分，小編認為將其報告為「異常淋巴細胞」也是可以的。
Image S31: prolymphocytic leukaemia cells
B-Prolymphocytic leukaemia
J. Burthem, M. Brereton
圖31: 幼淋巴細胞白血病細胞
B-幼淋巴細胞白血病。
圖片由J. Burthem, M. Brereton提供。
5、Smudge cells (smear cells)
Smudge cells result from shearing forces on the cells during the spreading of blood films. They are the disrupted nuclei of fragile cells. A repeat film made with one part albumin added to four parts blood may prevent cell disruption and allow identification of the fragile cells and their inclusion in the WBC differential.
5、塗抹細胞
塗抹細胞是在推血片時剪切力作用於細胞導致的。是脆弱的細胞被破壞的胞核。1份白蛋白加入4份血液重新推片可防止細胞破壞，可以鑑定這些脆弱的細胞並計入白細胞分類中。
When the nature of the smear cell is apparent, it is recommended that they should be counted as the cell from which they are derived. Large numbers of smudge cells may be seen in CLL PB films. It is recommended that the automated differential be reported if available in this instance but the presence of smudge cells may be commented on in the film report.
當塗抹細胞的性質顯而易見時，建議計入它們的來源細胞。大量塗抹細胞可見於CLL的外周血片中。在這種情況下，若自動化分類可用，建議以自動化分類的結果進行報告，在血片報告中可以備註存在塗抹細胞。
Image S32: chronic lymphocytic leukaemia cells
Typical CLL lymphocytes with a smudge cell
J. Burthem, M. Brereton
圖32: 慢性淋巴細胞性白血病細胞
7個典型的CLL淋巴細胞，1個塗抹細胞。
圖片由J. Burthem, M.Brereton提供。
6、Leukaemic lymphoblasts
Leukaemic lymphoblasts range from those with a high N:C ratio, clumped chromatin, inconspicuous nucleoli and scanty basophilic cytoplasm to those that are heterogeneous in appearance and have a nuclear chromatin pattern varying from finely dispersed to coarsely condensed. The nuclear outline may be irregular and nuclear clefting, indentation and folding are common. Nucleoli vary in size and number but are often indistinct. A small number of lymphoblasts may have more abundant cytoplasm containing coarse azurophilic granules.
6、白血病性原始淋巴細胞
白血病性原始淋巴細胞可以從具有高核質比、染色質凝聚、核仁不明顯和稀少的嗜鹼性胞質，到具有異質性外觀的和核染色質從細緻分散到粗糙固縮等各種不同形態。核輪廓可不規則，核裂縫、切跡和褶皺常見。核仁大小、數目不一，但常為模糊。少數原始淋巴細胞可有更豐富的胞質並含粗嗜天青顆粒。
Lymphoblasts cannot be reliably distinguished from myeloid blasts, lymphoma cells and sometimes, reactive lymphocytes. Additional information from cytochemical stains or immunophenotyping may be required to make an accurate diagnosis.
原始淋巴細胞不能與髓系原始細胞、淋巴瘤細胞明確區分，有時與反應性淋巴細胞也無法可靠區分。要作出準確診斷，可能需要細胞化學染色或免疫分型等額外信息。
The recommendation is to count and report these as blasts and describe them in the film report.
建議計入並報告為原始細胞，並在血片報告中描述。
【小編注】
腫瘤性原始淋巴細胞，圖片來自網絡：