Noor Ahmed Mirwani։ Howell Jolly Like Inclusions in Neutrophils
Noor Ahmed Mirwani, Master Trainer in Blood Transfusion at The Indus Hospital, shared a post on LinkedIn:
“Howell Jolly like inclusions in Neutrophils
- Residual nuclear DNA fragments retained within the cytoplasm of neutrophils.
- They arise from abnormal granulopoiesis (dysplastic granulopoiesis)
- Most commonly observed in patients receiving immuno suppressive therapy, certain antiviral agents, chemotherapy, or in those with HIV/AIDS or myelo dysplastic syndromes (MDS).
- These inclusions resemble Howell–Jolly bodies seen in red blood cells, although they occur in a different cell lineage.
Key characteristics
- Shape: Small, round to oval, and well defined
- Color: Dark blue to purple (basophilic) on Wright–Giemsa staining
- Location: Within the cytoplasm, often adjacent to the nuclear lobes
- Nature of the structure: Nuclear DNA remnants, not cytoplasmic granules
Pathophysiology
They result from defective Nuclear Maturation or incomplete removal of nuclear fragments during granulocyte development, reflecting the presence of Dysplastic Neutrophils.
Clinical significance
Indicator of abnormal granulopoiesis: Represents a sign of dysgranulopoiesis and underlying bone marrow dysfunction
Associated conditions include:
- Use of Immunosuppressive drugs and nucleoside analog antiviral agents
- Chemotherapy
- HIV/AIDS
- Myelodysplastic Syndrome (MDS)
- Occasionally observed in COVID-19 infection, possibly related to bone marrow stress or immune dysregulation
The presence of Howell Jolly like inclusions in Neutrophils is an abnormal and clinically significant finding, suggesting bone marrow pathology or myeloid neoplasms.
Careful peripheral blood smear review, correlation with complete blood count parameters, clinical data, and consideration of bone marrow examination are recommended when appropriate ․”
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