Sample Question from White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions, presented by MediaLab

White Blood Cell Disorders and Platelets:: 4. Intra-cytoplasmic Inclusion Bodies

The May -Hegglin anomaly

Illustrated in the upper photograph is a cytoplasmic inclusion somewhat resembling a Doehle body. Note that this inclusion is well defined and there is no evidence of toxic granulation in the cytoplasm.
When Doehle-like bodies are identified, May-Hegglin anomaly should be considered in the differential diagnosis even though this entity is rare.
The May-Hegglin anomaly is an inherited dominant condition in which large 2 - 5 um, basophilic and pyronophilic inclusions are present in granulocytes, including neutrophils, eosinophils, basophils, and monocytes.
Similar to Doehle bodies, the May-Hegglin inclusions also are composed of RNA, probably derived from the rough endoplasmic reticulum.
May-Hegglin anomaly includes giant platelets containing few fine granules (lower photograph).
Sometimes the platelets have bizarre shapes and variable sizes. Variable degrees of thrombocytopenia complicated by mild bleeding problems and purpura may accompany the aberrant platelets.

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