May-Hegglin anomaly is an inherited dominant condition in which large (2 - 5 um) basophilic inclusions, resembling Döhle bodies, are present in granulocytes, including neutrophils, eosinophils, basophils, and monocytes. The inclusions are caused by accumulation of free ribosomes. A May-Hegglin body is indicated by the black arrow in the image on the right. Note that this inclusion is well-defined and there is no evidence of toxic granulation in the cytoplasm. When Döhle-like bodies are identified, May-Hegglin anomaly should be considered in the differential diagnosis, even though this entity is rare.
Giant platelets containing few fine granules are also characteristic of May-Hegglin anomaly. The red arrow in the image on the right points to a giant platelet, observed in the same field as a neutrophil containing a May-Hegglin body. 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.
