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Green neutrophilic inclusions in liver disease
  1. V N Harris1,
  2. J Malysz2,
  3. M D Smith3
  1. 1
    William Beaumont Hospital, Royal Oak, Michigan, USA
  2. 2
    Anatomic Pathology, Penn State Milton South Hershey Medical Center, Hershey, Pennsylvania, USA
  3. 3
    Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan, USA
  1. Correspondence to Marc D Smith, Director, Coagulation Laboratory, Department of Clinical Pathology, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA; mdsmith{at}beaumont.edu

Abstract

Acute hepatic failure is traditionally diagnosed on the basis of clinical presentation, historical information, and a collection of abnormal laboratory findings including elevated aspartate aminotransferase, alanine aminotransferase, prothrombin time, serum bilirubin and α-fetoprotein. Non-specific haematological findings such as anaemia, thrombocytopenia and changes in erythrocyte morphology are well documented in patients with liver failure. It is believed, however, that there are no specific morphological findings on peripheral blood smears directly linked to liver failure. This report decribes two patients diagnosed with acute hepatic failure, both having coarse, bright-green cytoplasmic inclusions identified within their neutrophils. One previous case of a patient with similar neutrophil findings and concurrent liver disease has been reported in the literature; however, a direct relationship to liver failure was not proposed. It is suggested that the findings may be directly related to liver failure and may also serve as a prognostic indicator of impending death.

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Footnotes

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval Ethics approval was obtained from the Human Investigation Committee, William Beaumont Hospital.

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