CAP Pro Course - Hematology - White Blood Cell Inclusions (2026 & 2027)

Author: Margaret A. Reinhart, MS, MLS(ASCP)
Reviewers: Laurie Bjerklie, MA, MLS(ASCP)CM and Joshua J. Cannon, MS, MLS(ASCP)CMSHCM

Continuing Education Credits

Objectives

  • Recognize toxic morphologic changes associated with reactive neutrophilia.
  • Identify nuclear alterations observed in peripheral blood leukocytes.
  • Correlate various white blood cell inclusions with specific diseases and disorders.
  • Recognize and associate certain unusual or rarely seen inclusions with selected malignant conditions.

Course Outline

  • Recognize toxic morphologic changes associated with reactive neutrophilia.
      • Introduction to Toxic Changes in Granulocytes
      • Toxic Granulation
      • Toxic Vacuolization
      • Döhle Bodies
      • Artifactual Toxic Granulation and Toxic Vacuolization
      • Quick Reference Guide: Toxic Changes in Neutrophils
      • Toxic granulation of neutrophils can be caused by all of the following except:
      • A medical laboratory scientist (MLS) is examining a blood smear and sees several neutrophils such as those seen to the right. They are wondering wheth...
      • The cells on a peripheral smear show increased granulation throughout the smear, and the overall staining appears darker than normal. What is the next...
  • Identify nuclear alterations observed in peripheral blood leukocytes.
      • Artifacts: Pyknotic (Necrobiotic) Nuclei of Neutrophils
      • Hypersegmentation of Neutrophils
      • Barr Bodies
      • Hyposegmentation of Neutrophils (Pelger-Huët Anomaly)
      • Pelger-Huët Anomaly vs. Pseudo-Pelger-Huët
      • The arrowed cell in the image on the right was observed on a peripheral blood smear without any other notable findings. Identify the cell seen in this...
      • An MLS observes numerous neutrophils that look like the ones on the right. What is the likely cause, and how can she confirm this?
      • A 34-year-old woman with a high fever and flu-like symptoms was admitted to the emergency room. Many of the neutrophils seen on the blood smear contai...
  • Correlate various white blood cell inclusions with specific diseases and disorders.
      • Alder-Reilly Anomaly
      • Chediak-Higashi Syndrome
      • May-Hegglin Anomaly
      • Intracellular Bacteria
      • Intracellular Fungal Organisms
      • Anaplasma and Ehrlichia
      • Quick Reference Guide: White Blood Cell Inclusions
      • This image on the right is from the peripheral blood of a 32-year-old man who complains of intermittent fevers, night sweats, fatigue, and weight loss...
      • A patient is suspected of having a pleural effusion due to pneumonia. A thoracentesis is performed with the resulting pleural fluid sample sent to the...
      • All of the following involve changes or inclusions in the cytoplasm of mature neutrophils. Which of the four is associated with clinical symptoms lead...
  • Recognize and associate certain unusual or rarely seen inclusions with selected malignant conditions.
      • Auer Rods
      • Burkitt Cells
      • These inclusions were seen in a smear of a patient with a significantly increased white blood cell count and greater than 20% blasts in their peripher...
      • Each of these images are of malignancies involving cells with characteristic inclusions. Give the most likely diagnosis of each:Image AImage BImage C
  • References
      • References

Additional Information

Level of Instruction:  Intermediate
Intended Audience: Medical laboratory scientists, medical laboratory technicians, laboratory supervisors, and laboratory managers. This course is also appropriate for MLS and MLT students and pathology residents.
Author Information: Margaret Reinhart, MS, MLS(ASCP) is the MLS Program Director and Senior lecturer in Biological Sciences at the University of the Sciences in Philadelphia, PA where she teaches hematology, clinical immunology, parasitology, and other related courses. She is also an adjunct instructor in Hematology at Pennsylvania Hospital, Philadelphia, PA. She holds a Master's Degree in Biology and in Health Care Administration.
The author has no conflict of interest to disclose.  
Reviewer Information:
Laurie Bjerklie, MA, MLS(ASCP)CM is currently an Education Developer for MediaLab by Vastian. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held program director and faculty positions in both MLT and MLS programs.
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor of Science and Master of Science in Medical Laboratory Science from Thomas Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist and Specialist in Hematology certifications through the ASCP Board of Certification. He was a professor at Thomas Jefferson University for seven years before transitioning into his current role as Education Developer at MediaLab by Vastian. His areas of expertise and professional passions include clinical hematology and interprofessional education.

This course is part of the CAP Competency Assessment Hub.

See other included Pro courses

See other included instrument checklists