Mature polytypic b lymphocytes

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Polyclonal B cells, even in cases with monotypic light chain expression. This difference is crucial since promonocytes are blast equivalents and should be included in the blast count.

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Morphology is critical to enumerating monoblasts and the blast-equivalent promonocytes, and to distinguishing them from mature monocytes, both reactive and dysplastic.

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Cytochemical staining may be useful since it improves the sensitivity over morphology alone for the detection of monocytic cells. In rheumatoid arthritis, as in other autoimmune disease, monocytosis is seen in a significant minority of patients and is typically mild.

The Hematologist

Follicular atrophy Onion skinning of mantle zones Penetrating vessels in the germinal centers Plasma cell infiltrates. This is especially important in the assessment of neutrophils for dysplastic features, such as nuclear hyposegmentation and hypogranular cytoplasm. Flow cytometry is capable of unveiling subtle immunophenotypic aberrancies, but it is not able to reliably distinguish promonocytes blast equivalents or monoblasts from mature monocytes.

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