#00061593

The patient is a 33-year-old female with a history of Ph+ ALL s/p MRD allogeneic stem cell transplant. The patient has recently received growth factor (GCSF), and is now day +16 following transplant. The peripheral blood smear demonstrates leukopenia (2.7 K/uL), anemia (Hgb 7.8 g/dL), and thrombocytopenia (8 K/uL), with 2% blasts identified on differential. Of note, her segmented neutrophils exhibited increase granulation, as well as light blue-gray basophilic cytoplasmic inclusions consistent with Dohle bodies. The occasional blasts exhibited faint cytoplasmic granulation as well as Dohle bodies. Overall, these findings were deemed consistent with growth factor effect in the setting of recent GCSF therapy, seen in both the regenerative myeloid blasts and segmented neutrophils. In addition to instances of growth factor therapy, Dohle bodies can also be seen in the setting of infection (included in toxic changes), as well as in May-Hegglin anomaly (also known as macrothrombocytopenia with leukocyte inclusions), which is a rare autosomal dominant inherited disorder caused by mutation in the MYH9 gene leading to enlarged platelets and Dohle bodies within leukocytes.