Blood Journal
Leading the way in experimental and clinical research in hematology

Neutrophil alphabet

  1. Adam S. Morgan and
  2. David T. Yang
  1. University of Wisconsin School of Medicine and Public Health
This article has an Erratum 122(14):2525

An 80-year-old man was hospitalized with symptoms of progressive cough, fever, and dyspnea over a period of 5 days. Chest x-ray showed bilateral lobar pneumonia. A complete blood count revealed white blood cell count of 42.3 × 109/L, hemoglobin 12.4 g/dL, platelets 155 × 109/L, and mean corpuscular volume 91.2 fL. Morphologic examination of the peripheral blood smear revealed a manual leukocyte differential of 81% segmented neutrophils, 12% bands, 2% monocytes, and 5% lymphocytes. The patient was treated with antibiotics and his leukopenia resolved completely.

Features of prominent Dohle bodies (letters N and S); cytoplasmic vacuolation (letters L, M, and W); and toxic granulation (letters I and S) represent toxic changes consistent with reactive neutrophilia secondary to acute pneumonia. Atypical nuclear segmentation generated a complete modern English alphabet and is a result of accelerated neutrophil maturation.


  • For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit