Howell-Jolly body-like inclusions in neutrophils.

Abstract

47-year-old white woman who had previously undergone lung transplant presented with a past medical history significant for chronic obstructive pulmonary disease, asthma, and diabetes mellitus. The patient was on multiple medications related to her lung transplant. Her blood smear was referred for pathologist review based on the presence of atypical cytoplasmic inclusions in the neutrophils. The white blood cell count was 2.6 3 10 3 /mL, hemoglobin 9.2 g/dL, mean corpuscular volume 89 fL, and platelets 202 3 10 3 /mL. Review of the smear revealed mild poikilocytosis of the red blood cells with occasional elliptocytes, acanthocytes, and rare schistocytes with a white blood cell differential of 6% band neutrophils, 80% segmented neutrophils, 2% lymphocytes, 11% monocytes, and 1% basophils. The neutrophils demonstrated toxic granulation, Dohle bodies, and Howell-Jolly body‐like inclusions (Figures 1 and 2). Bain 1 in 1989 described detached nuclear fragments within the cytoplasm of neutrophils as a feature of dysplastic granulopoiesis secondary to immunosuppressive