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Case of acquired or pseudo-Pelger-Huët anomaly.

Ayan MS, Abdelrahman AA, Khanal N, Elsallabi OS, Birch NC - Oxf Med Case Reports (2015)

Bottom Line: It does not cause neutrophilia, but it can cause a false increase in band forms.During the next 2 days, the patient did not have any fever or any new symptoms.The presented case showed that we should think of PHA\PPHA in any case with normal total WBC count and significant shift to the lift with no apparent explanation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Internal Medicine Department , Creighton University Medical Center , Omaha, NE , USA.

ABSTRACT
Pelger-Huët anomaly (PHA) is a rare benign autosomal-dominant anomaly with an incidence of ∼1 in 6000. It does not cause neutrophilia, but it can cause a false increase in band forms. It should be differentiated from acquired or pseudo-Pelger-Huët anomaly (PPHA), which has similar morphology, however; it is associated with different pathological states like Myelodysplastic syndrome, as well as with certain infections and drugs. We report a case of a 67-year-old Caucasian gentleman with past medical history of rheumatoid arthritis, type II diabetes mellitus and hypothyroidism, who presented with 1 day history of fever (101°F) and night sweats. Medications include ibuprofen, methotrexate, hydroxychloroquine and levothyroxine. Patient denied any other symptoms. His work-up showed normal WBC count (8.6) and increase in bands (24%). The patient was admitted for further evaluation. During the next 2 days, the patient did not have any fever or any new symptoms. Peripheral blood smear was done as part of his work-up for bandemia, showed findings suggestive of PHA. Ibuprofen was discontinued. Follow-up few weeks later showed normal blood smear. Diagnosis of PPHA was made. The presented case showed that we should think of PHA\PPHA in any case with normal total WBC count and significant shift to the lift with no apparent explanation. Looking at smears directly under the microscopes is crucial to make diagnosis.

No MeSH data available.


Related in: MedlinePlus

Pseudo-Pelger-Huët cells, hyposegmentation of the neutrophil nucleus and excessive chromatin clumping.
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OMV025F1: Pseudo-Pelger-Huët cells, hyposegmentation of the neutrophil nucleus and excessive chromatin clumping.

Mentions: Physical examination on admission showed temperature 97.8°F, pulse 80 per minute, thick hands without joint swelling and otherwise unremarkable examination. Lab studies showed normal WBC with 84% neutrophils and an increase in bands. ESR (38), CRP (7.3), urinalysis and chest X-ray were normal. The patient was admitted to the hospital with impression of possible sepsis. Over the course of 2 days in the hospital he was afebrile and had no new signs or symptoms. His bands normalized. A peripheral blood smear done showed normal mature chromatin condensation and normal granulation, 20% of the neutrophils show bi-lobed nuclei with a thin filament connecting the lobes also known as Pelger-Huët cells. (Figs. 1 and 2). The remaining 80% of the neutrophils also showed bi-lobed nuclei but without thin filament. With the impression of pseudo Pelger Huet abnormality secondary to ibuprofen, his ibuprofen was discontinued. On follow-up visit after discharge,his repeat Peripheral blood smear showed normal neutrophil morphology and the diagnosis of pseudo Pelger Huet abnormality secondary to ibuprofen was confirmed.


Case of acquired or pseudo-Pelger-Huët anomaly.

Ayan MS, Abdelrahman AA, Khanal N, Elsallabi OS, Birch NC - Oxf Med Case Reports (2015)

Pseudo-Pelger-Huët cells, hyposegmentation of the neutrophil nucleus and excessive chromatin clumping.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664885&req=5

OMV025F1: Pseudo-Pelger-Huët cells, hyposegmentation of the neutrophil nucleus and excessive chromatin clumping.
Mentions: Physical examination on admission showed temperature 97.8°F, pulse 80 per minute, thick hands without joint swelling and otherwise unremarkable examination. Lab studies showed normal WBC with 84% neutrophils and an increase in bands. ESR (38), CRP (7.3), urinalysis and chest X-ray were normal. The patient was admitted to the hospital with impression of possible sepsis. Over the course of 2 days in the hospital he was afebrile and had no new signs or symptoms. His bands normalized. A peripheral blood smear done showed normal mature chromatin condensation and normal granulation, 20% of the neutrophils show bi-lobed nuclei with a thin filament connecting the lobes also known as Pelger-Huët cells. (Figs. 1 and 2). The remaining 80% of the neutrophils also showed bi-lobed nuclei but without thin filament. With the impression of pseudo Pelger Huet abnormality secondary to ibuprofen, his ibuprofen was discontinued. On follow-up visit after discharge,his repeat Peripheral blood smear showed normal neutrophil morphology and the diagnosis of pseudo Pelger Huet abnormality secondary to ibuprofen was confirmed.

Bottom Line: It does not cause neutrophilia, but it can cause a false increase in band forms.During the next 2 days, the patient did not have any fever or any new symptoms.The presented case showed that we should think of PHA\PPHA in any case with normal total WBC count and significant shift to the lift with no apparent explanation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Internal Medicine Department , Creighton University Medical Center , Omaha, NE , USA.

ABSTRACT
Pelger-Huët anomaly (PHA) is a rare benign autosomal-dominant anomaly with an incidence of ∼1 in 6000. It does not cause neutrophilia, but it can cause a false increase in band forms. It should be differentiated from acquired or pseudo-Pelger-Huët anomaly (PPHA), which has similar morphology, however; it is associated with different pathological states like Myelodysplastic syndrome, as well as with certain infections and drugs. We report a case of a 67-year-old Caucasian gentleman with past medical history of rheumatoid arthritis, type II diabetes mellitus and hypothyroidism, who presented with 1 day history of fever (101°F) and night sweats. Medications include ibuprofen, methotrexate, hydroxychloroquine and levothyroxine. Patient denied any other symptoms. His work-up showed normal WBC count (8.6) and increase in bands (24%). The patient was admitted for further evaluation. During the next 2 days, the patient did not have any fever or any new symptoms. Peripheral blood smear was done as part of his work-up for bandemia, showed findings suggestive of PHA. Ibuprofen was discontinued. Follow-up few weeks later showed normal blood smear. Diagnosis of PPHA was made. The presented case showed that we should think of PHA\PPHA in any case with normal total WBC count and significant shift to the lift with no apparent explanation. Looking at smears directly under the microscopes is crucial to make diagnosis.

No MeSH data available.


Related in: MedlinePlus