Department of Pathology and Laboratory Medicine, United States
2 Division of Hematology and Oncology,
Corresponding author details:
Weijie Li, Assistant Professor
Department of Pathology and Laboratory Medicine
Children’s Mercy Hospital Kansas City, 2401 Gillham Rd, Kansas City
Copyright: © 2018 Li W, et al. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 international License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
A 4-year-old girl was found to have 50.8% “immature granulocytes” and 12% neutrophils in her peripheral blood. She had had a heart transplant for dilated cardiomyopathy nine months before. A peripheral blood film revealed many non-segmented neutrophils with round or oval nuclei, clumped nuclear chromatin, and adequate cytoplasmic granules (Figure 1, panels A- E). The size and nuclear-to-cytoplasmic ratio were comparable to those of segmented neutrophils (Figure 1, panel F). There were occasional Döhle bodies (panel B) and Howell–Jolly bodies (panel E). Neutrophil morphology had been normal before the use of tacrolimus for prevention of graft-versus-host disease. Pseudo-Pelger-Huët anomaly (PPHA) was diagnosed, and the differential white cell count was corrected.
PPHA is a dysplastic neutrophilic morphology seen in myeloid malignancies or certain
benign conditions. PPHA has been reported in transplant recipients, especially after taking
immunosuppressive drugs, tacrolimus and/or mycophenolate mofetil. Benign PPHA is
reversible and the hyposegmented neutrophils function normally. It is clinically significant
to recognize this morphologic change of neutrophils, and not to count these cells as
immature granulocytes or bands.