LAUSR

A 50-year-old male patient was evaluated for leucopenia and neutropenia of six months duration. His blood count showed: leukocytes 2 36 9 10/l, neutrophils 0 12 9 10/l, Hb 95 g/l, mean cell volume 81 1 fl and platelets 244 9 10/l. Serology for HIV and blood cultures was negative. Films of a bone marrow aspirate showed 3 5% blast cells and multilineage dysplasia, with giant, hypogranular and dysmorphic neutrophils, several of which had Howell–Jolly body-like inclusions (images, 9100 objective). The karyotype was normal. Flow cytometry showed a reduction of cells of the granulocyte lineage (18 7% of total cellularity) with overexpression of CD64 by mature cells, increased CD13 expression by myelocytes and metamyelocytes and mild left-shifted granulopoiesis. The blast count (CD34/CD117) was 3%. A diagnosis of myelodysplastic syndrome (MDS) was made. Howell–Jolly like inclusions are small dense basophilic inclusions in the cytoplasm of neutrophils, resembling the Howell–Jolly bodies present in erythrocytes after splenectomy and with dysplastic erythropoiesis. They are nuclear fragments, present as a consequence of dysplastic granulopoiesis. They have been described in HIV infection and during therapy with immunosuppressive and antiviral agents. Their presence in MDS is uncommon.