Neutrophilic Leukemoid Reaction in Multiple Myeloma

Sun, 11 Jun 2023 10:35:00 +0300

✔Neutrophilic leukemoid reaction in multiple myeloma. ✅A 52-year-old man with asymptomatic multiple myeloma was referred for evaluation of high white blood cell and neutrophil counts. ✅He had already started taking hydroxyurea, and while on this medication at a dose of 2.5 g per day, his white blood cell count was 22.5 × 10^{9/L, and his neutrophil count was 18.9 × 10}9/L. 🧪He was found to have IgG λ paraprotein at a concentration of 80 g/L. 🔬A blood smear showed toxic granulation and Döhle bodies (photo below), although not all neutrophils were abnormal. Bone marrow aspirate showed 10-15% plasma cells and granulocytic hyperplasia. 🧬Molecular analysis for JAK2 V617F and CSF3R exon 14 and 17 mutations was negative. ✅A diagnosis of neutrophilic leukemoid reaction to multiple myeloma was made. ✅Isolated neutrophilia without dysplasia is characteristic of chronic neutrophilic leukemia (CNL). However, before making this diagnosis, an underlying plasma cell neoplasm must be ruled out. About a quarter of reported patients with either CNL or a condition resembling it had coexisting monoclonal gammopathy of undetermined significance or multiple myeloma. Very rarely, CNL and plasma cell neoplasms can coexist. ✅Patients with multiple myeloma and neutrophilia often have toxic granulation of neutrophils and Döhle bodies, as shown in this patient. ✅Granulocyte colony-stimulating factor (G-CSF) is synthesized by tumor plasma cells. And a high serum G-CSF level indicates that this is a reactive process driven by cytokines. Although similar changes are observed in CNL, in these patients, the cytological changes are likely the result of a mutation that directly affects neutrophil biology, specifically, a mutation in CSFR3, which encodes the G-CSF receptor.

Toxic Granulation and Döhle Bodies in Neutrophils

Sun, 09 Oct 2022 12:50:00 +0300

Neutrophils with toxic granulation, Döhle bodies, and cytoplasmic vacuolizations. Characteristic signs of reactive granulocytosis.

Toxic Granulation of Neutrophils: Morphology

Sat, 17 Sep 2022 15:45:00 +0300

TOXIC GRANULATION 👉🏻Occurs in neutrophils. 👉🏻Large, irregularly shaped, purple-violet granules. 👉🏻Increased staining intensity and number of granules. 👉🏻Granules are unevenly distributed. Source: official Cellavision website ❓Do you know the causes of such neutrophils appearing in the blood? Write in the comments!

Toxic Granulation on Leukoformula

Neutrophilic Leukemoid Reaction in Multiple Myeloma

Toxic Granulation and Döhle Bodies in Neutrophils

Toxic Granulation of Neutrophils: Morphology