Green neutrophil and monocyte inclusions – time to acknowledge and report

Summary Bright green inclusions in neutrophils have been reported as a sign of impending patient death. Here we report a series of 20 patients in whom green inclusions were identified in neutrophils or monocytes. Thirteen (65%) of the patients died within days of the detection of the inclusions. A c...

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Bibliographic Details
Published in:British journal of haematology 2015-07, Vol.170 (2), p.229-235
Main Authors: Hodgson, Timothy O., Ruskova, Anna, Shugg, Clare J., McCallum, Vivian J., Morison, Ian M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Autopsy
Biomarkers - metabolism
Blood Chemical Analysis
Critical Illness
Female
Humans
inclusion bodies
Inclusion Bodies - pathology
Inclusion Bodies - ultrastructure
ischaemic hepatitis
Leukocyte Count
Liver - pathology
Liver Function Tests
Male
Middle Aged
monocytes
Monocytes - pathology
Monocytes - ultrastructure
morphology
neutrophils
Neutrophils - pathology
Neutrophils - ultrastructure
Patient Outcome Assessment
Terminally Ill
Young Adult
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Summary:Summary Bright green inclusions in neutrophils have been reported as a sign of impending patient death. Here we report a series of 20 patients in whom green inclusions were identified in neutrophils or monocytes. Thirteen (65%) of the patients died within days of the detection of the inclusions. A common feature to almost all patients was ischaemic or hypoxic hepatitis which, in fatal cases, was associated with lactic acidosis. Light and electron microscopy indicated that the inclusions were lipid‐rich, probably derived from lipofuscin‐like material released from necrotic liver parenchymal cells. The majority of patients were known to be seriously ill at the time of detection of neutrophil inclusions. We recommend that the detection of green inclusions, which we refer to as ‘critical green inclusions’, is acknowledged and reported by laboratories and correlated with clinical findings.
ISSN:0007-1048
1365-2141
DOI:10.1111/bjh.13434