The presence of atypical inclusions within the cytoplasm of neutrophils and other leukocytes should lead to a clinical investigation of these findings. Atypical neutrophil inclusions may be seen in the following disorders: Chediak-Higashi syndrome, May-Hegglin anomaly, Alder-Reilly anomaly, Fechtner, Sebastian, Epstein, and Alport-like syndromes, and infectious and toxic conditions (in the form of Döhle bodies).
Although a specific entity may not be evident from an examination of the peripheral blood alone, hematology technologists must include a comment reporting on the presence of these inclusions or granules. A clinical investigation with further hematologic and genetic studies may be requested based on the hematologic findings.
Many disorders with atypical neutrophil cytoplasmic granules are also associated with platelet abnormalities, particularly giant platelets (lower image). Therefore, when atypical granules are recognized, scanning of the peripheral blood smear for atypical platelets may be revealed. These observations serve as readily identifiable markers for acquired and genetic human disorders and as a guide for unraveling the reasons for a patient's suffering and impaired health.
