Case Follow-up from White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions, presented by MediaLab

White Blood Cell Disorders and Platelets:: 2. Leukocytosis Case Study

Case Follow-up

Illustrated in the upper and lower photographs are two-lobed, eye glass ("pince nez") nuclei of neutrophils typical for patients with Pelger-Huet anomaly.
In addition to the characteristic two lobes connected by a delicate bridge, the dense, homogeneous nuclear chromatin helps to define Pelger-Huet anomaly.
Since the peripheral blood smear did not support the diagnosis of appendicitis in this patient, and since abdominal pain localized to the right lower quadrant never developed, the boy was hydrated with intravenous fluid and observed.
After hydration, his constitutional symptoms improved and the abdominal pain subsided. In fact, the lad was back on the ski slopes the next afternoon.
People entering high altitude where the humidity may be very low are susceptible to dehydration and may experience symptoms related to mountain sickness.
Therefore, close observation and hydration may be the best practice in monitoring patients with stories and findings similar to this one.
A further lesson here is that technologists must be alert to the possibility of Pelger-Huet anomaly if a high white blood cell count with a high percentage of band neutrophils with strikingly uniform morphology and without toxic granulation are found.
Inappropriate therapy or an invasive procedure as was contemplated here may be avoided by a proper smear assessment and clinical corroboration.

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