Detection and significance of green inclusions in peripheral blood neutrophils and monocytes

Merino, Anna; Molina, Ángel; Rodríguez-García, María Juliana; Vicente‐Steijn, Rebecca; Tomé, Adrià; Maduell, Francisco; Xipell, Marc; Castro, Pedro

doi:10.1111/ijlh.13421

Cited by 10 publications

(6 citation statements)

References 7 publications

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“…All patients who died also had infectious complications, seizures, or sepsis, such as previously described. [1][2][3] All seven patients presented high levels of transaminases and LDH, as observed in patients with these inclusions reported in the literature. 4 The unique patient who survived developed severe disease and was discharged after 32 days of hospitalization.…”

Section: Median Age Of Patients Was 46 Years (Interquartile Range [Iqr]supporting

confidence: 69%

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Blue‐green cytoplasmic inclusions in neutrophils/monocytes of patients with yellow fever

Martins¹,

Jardim

Pereira

et al. 2022

Int J Lab Hematology

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Section: Median Age Of Patients Was 46 Years (Interquartile Range [Iqr]supporting

confidence: 69%

“…Although such inclusions are associated with impending death, it has been described cases with recovery. 1,4 Table 1 shows the clinical characteristics and laboratorial parameters of the patients with the blue-green inclusions.…”

Section: Median Age Of Patients Was 46 Years (Interquartile Range [Iqr]mentioning

confidence: 99%

Blue‐green cytoplasmic inclusions in neutrophils/monocytes of patients with yellow fever

Martins¹,

Jardim

Pereira

et al. 2022

Int J Lab Hematology

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“…Our study regarding samples from patients with infection showed that the simultaneous display of all WBC on the screen by the MC-80 and DM9600 were valuable in helping the morphologist detect visual abnormalities, such as Leishmania parasites, Maurer pigment, or green crystals in neutrophils. Furthermore, as we previously reported using the CellaVision DM96, 32,33 digital morphology analysers were useful for the visual identification of green inclusions within neutrophils and monocytes.…”

Section: Discussionmentioning

confidence: 59%

Performance of the new MC‐80 automated digital cell morphology analyser in detection of normal and abnormal blood cells: Comparison with the CellaVision DM9600

Merino,

Laguna,

Rodríguez‐García

et al. 2023

Int J Lab Hematology

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IntroductionMindray MC‐80 is an automated system for digital imaging of white blood cells (WBCs) and their pre‐classification. The objective of this work is to analyse its performance comparing it with the CellaVision® DM9600.MethodsA total of 445 samples were used, 194 normal and 251 abnormal: acute leukaemia (100), myelodysplastic syndromes/myeloproliferative neoplasms (33), lymphoid neoplasms (50), plasma cell neoplasms (14), infections (49) and thrombocytopenia (5). WBC pre‐classification values with the MC‐80 and DM9600 were compared with (1) the microscope, (2) Mindray BC‐6800Plus differentials in only normal samples, and (3) confirmed or reclassified images (post‐classification). Pearson's correlation, Lin's concordance, Passing‐Bablok regression, and Bland–Altman plots were used. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for abnormal cells using the MC‐80 were calculated.ResultsThe PPV and NPV were above 98% and 99%, for normal samples. For immature granulocytes (IG), NPV and PPV were 100% and 74.2%. When comparing the WBC differentials using the MC‐80, the microscope and the BC‐6800Plus, no differences were found except for basophils and IG. Our results showed good agreement between the pre‐ and post‐classification of normal WBC, including IG, quantified by high correlation and concordance values (0.91–1). Sensitivity and specificity for blasts were 0.984 and 0.640. The MC‐80 detected abnormal lymphocytes in 30% of the smears from patients with lymphoid neoplasm. Plasma cell identification was better using the DM9600. The sensitivity and specificity for erythroblast detection were 1 and 0.890.ConclusionWe found that the MC‐80 shows high performance for WBC differentials for both normal samples and patients with haematological diseases.

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“…Notably, GI-positive cells have been identified in cases of acute liver failure caused by various pathogens, including Streptococcus pneumoniae, Clostridium perfringens, Escherichia coli, Enterococcus, Plasmodium falciparum, Aspergillus fumigatus, and even in the context of acute liver failure associated with SARS-CoV-2. [4–7] Patients with acute liver injury who present GI-positive cells typically experience a rapid escalation in transaminase levels, worsening clinical conditions within a short timeframe, and alarmingly high mortality rates. [8]…”

Section: Discussionmentioning

confidence: 99%

The green bad omen in blood smear and the potential of blood purification therapy: A case report

Chen,

Ni,

2024

Medicine

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Rationale: Green inclusions (GI) are distinct morphological features found in phagocytic cells like neutrophils and monocytes. These intracellular structures exhibit bright green color with unclear boundaries, and their origin and clinical significance are still not fully understood. GI carriers, often middle-aged to elderly with liver dysfunction, face higher mortality rates, earning them the nickname “inclusions of death.” This report presents a rare GI-related pediatric case, demonstrating a favorable response to blood purification therapy. Patient concerns: A 10-year-old girl was admitted with recurrent fever, abdominal pain, and neurological symptoms, culminating in a transient cardiac arrest. Blood tests revealed multi-organ injury and a high risk of disseminated intravascular coagulation, while peripheral blood smear detected GI within neutrophil cytoplasm. Diagnosis: The patient was diagnosed with acute necrotizing encephalopathy, severe sepsis, and multiple organ failure. Interventions and outcomes: After receiving multiple sessions of blood purification therapy, peripheral blood GI levels markedly decreased, accompanied by improvements in various laboratory parameters and signs of neurological recovery. Unfortunately, due to financial constraints, the family opted to transfer the patient back to their local hospital, where she succumbed shortly after discharge. Lessons: This case underscores the complexities in managing GI-related pediatric cases. Moreover, it emphasizes the potential benefits of blood purification therapy in such scenarios. Notably, this study highlights a potential correlation between the level of GI in peripheral blood and disease severity, particularly in pediatric cases. While these findings hold clinical significance for the treatment and management of GI-related patients, further research focusing on middle-aged and elderly individuals is imperative to elucidate the fundamental relationship between peripheral blood GI quantity and clinical presentation and to evaluate the efficacy of blood purification in GI-related cases.

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Detection and significance of green inclusions in peripheral blood neutrophils and monocytes

Cited by 10 publications

References 7 publications

Blue‐green cytoplasmic inclusions in neutrophils/monocytes of patients with yellow fever

Blue‐green cytoplasmic inclusions in neutrophils/monocytes of patients with yellow fever

Performance of the new MC‐80 automated digital cell morphology analyser in detection of normal and abnormal blood cells: Comparison with the CellaVision DM9600

The green bad omen in blood smear and the potential of blood purification therapy: A case report

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