Page 214 - Clinical Hematology Atlas

198 SECTION FOUR LEUKOCYTES

ytokine therapies such as erythropoietin, thrombopoietin, and myeloid growth factors
Csuch as granulocyte colony-stimulating factor (G-CSF) and granulocyte/macrophage-
colony stimulating factor are becoming common. There are characteristic changes in the
peripheral blood smear caused by these treatments. Although erythropoietin and thrombo-
poietin rarely create diagnostic challenges, the morphologic changes in the myeloid cell line
may mimic severe infection, acute myeloid leukemia, or myelodysplastic or myeloproliferative
neoplasm. Specific changes include transient leukocytosis with immature granulocytic cells,
vacuolated and giant neutrophils, toxic granulation, Döhle bodies, hypogranulation, nucle-
ated red blood cells, and as many as 5% blasts in the peripheral blood.*

A

B

FIGURE 20-1 Leukocytosis in response to G-CSF FIGURE 20-2 Neutrophils in peripheral
(×500). blood exhibiting toxic granulation (A), and
hypogranulation (B). A Döhle body is present
at the arrow.

*Arber DA. Acute myeloid leukemia. In: Hsi ED, editor. Hematopathology. In: Goldblum JR, series
editor. Foundations in Diagnostic Pathology. Philadelphia: Churchill Livingstone; 2007, p. 397–429.