#00061179

A 52 year-old male was seen for an annual physical exam. The patient had history of asthma, sleep apnea, hyperlipidemia, and chronic back pain. He also reported a history of bleeding tendency and chronic thrombocytopenia which etiology had not been studied in the past. A complete blood count (CBC) and a peripheral blood smear  (PBS) were ordered in evaluation of his thrombocytopenia.

The CBC reported a mild leukocytosis with a white blood cell count of 11.1 x 10e3/uL and absolute neutrophilia of 8.55 x 10e3/uL; the hemoglobin and hematocrit were within normal limits (14.6 g/dL and 44.6% respectively); the platelet count was 61.0 x 10e3/uL with mean platelet volume of 12.3 fL, reflecting a moderate macrothrombocytopenia.  The PBS demonstrated large platelets (arrow) and neutrophils with prominent basophilic inclusions (Döhle-like bodies) (arrow head). These features may be seen in a group of disorders caused by a mutation in the gene myosin heavy chain 9 (MYH9, encoding for non-muscle myosin heavy chain IIA).