Cell Case #23

This Cell Case presents a 43-year-old female from Sri Lanka that was admitted because of recurrent thrombocytopenia. She had previously been diagnosed with Idiopathic Thrombocytopenic Purpura (ITP) and had undergone a splenectomy. Clinically the patient displayed no hemorrhagic diathesis.

Results from the cell counter:

  • A slight thrombocytopenia (110 x 109/L)
  • Hb: 11,7 g/dL
  • Leukocyte count: 15,6 x 109/L

Morphological analysis of the peripheral blood smear displayed various abnormal features.


What are your thoughts about the diagnosis?  Please post your suggestion!

/ The CellaVision Blog Team

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26 thoughts on “Cell Case #23”

  1. Neutrophil is observed with toxic toxic granulations which is more azurophilous than normal and is accompanied by good nuclear staining, also a Dhole body which are small cytoplasmic basophilic areas resulting from the aberrant aggregation of rough endoplasmic reticulum sheets. According to the patient from Sri Lanka with thrombocytopenia, without bleeding diathesis and leukocytosis I think that she suffer from an infectious condition.

  2. In the course of severe bacterial infections, neutrophil polynuclear cells may exhibit various associated cytoplasmic abnormalities: toxic granulations, intensification of granulations or, on the contrary, degranulation, presence of Döhle bodies (basophilic zone), vacuoles, as well as nuclear anomalies: Defect of segmentation or hyper-segmentation, double nuclei, gigantism. Germs and also parasites, yeasts, can be observed in pollinuclear neutrophils. Patient from Sri Lanka with an infectious picture.

    1. Correct, Thrombocytopenia with RNA inclusion bodies in cytoplasm of neutrophils ,particularly on the periphery of cytoplasm like dohle bodies are typical features of May-Hegglin Anomaly (MHA).

  3. MYH9 anomaly especially given size of “Dohle” body like structure, low plt.count. Can’t see if plts are enlarged in this field, but that would be consistent with MYH9.

  4. Neutrophil appears normogranular but with well-defined Dohlë body. MYH9 thrombocytopenia (May-Hegglin Anomaly). Would liked to have seen a large platelet in the snapshot just to ‘seal the deal’.

  5. Possible Toxic granulation with Dohle body. Platelets are not visible in this picture. If a low platelet count with giant platelets and a Dohle-like body, it would be May-Hegglin anomaly.

    1. If the platelets are abnormal and large with the dohle bodies with macro thrombocytes like then it could be May-Hegglin, But Also we see many toxic granulations that found in leukemic reaction and infectious diseases or inflammatory process

  6. This is an example of the May-Hegglin anomaly, now more specifically designated MYH9-related thrombocytopenia. Note the rather elongated May-Hegglin inclusion. It differs in shape (and ultrastructural features) from the Dohle body of infection

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