Howell-Jolly body-like inclusions in neutrophils of a patient with a myelodysplastic syndrome.

Abstract

A 50-year-old male patient was evaluated for leucopenia and neutropenia of six months duration. His blood count showed: leukocytes 2·36 × 109/l, neutrophils 0·12 × 109/l, Hb 95 g/l, mean cell volume 81·1 fl and platelets 244 × 109/l. Serology for HIV and blood cultures was negative. Films of a bone marrow aspirate showed 3·5% blast cells and multilineage dysplasia, with giant, hypogranular and dysmorphic neutrophils, several of which had Howell–Jolly body-like inclusions (images, ×100 objective). The karyotype was normal. Flow cytometry showed a reduction of cells of the granulocyte lineage (18·7% of total cellularity) with overexpression of CD64 by mature cells, increased CD13 expression by myelocytes and metamyelocytes and mild left-shifted granulopoiesis. The blast count (CD34+/CD117+) was 3%. A diagnosis of myelodysplastic syndrome (MDS) was made.