Which anomaly features bilobed neutrophils commonly seen in myelodysplasia or leukemia?

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Multiple Choice

Which anomaly features bilobed neutrophils commonly seen in myelodysplasia or leukemia?

Bilobed, hyposegmented neutrophils point to a Pseudo-Pelger-Huët anomaly. This acquired neutrophil nuclear morphology is classic in myelodysplastic syndromes and myeloid leukemias, where neutrophil maturation is disrupted and nuclei fail to segment normally, often appearing as two lobes connected by a thin bridge. It’s called “pseudo” because the pattern resembles the inherited Pelger-Huët anomaly, which is benign and not associated with marrow disease; in the disease-related form, the abnormal neutrophils reflect underlying dysplasia or leukemia. Alder-Reilly anomaly shows large, purple-blue cytoplasmic granules in neutrophils due to a storage disorder, not a nuclear shape issue. May-Hegglin anomaly features Dohle-like inclusions in neutrophils and thrombocytopenia with giant platelets, rather than bilobed nuclei. Chediak-Higashi syndrome has giant lysosomal granules in many cells and oculocutaneous albinism, not a neutrophil nuclear morphology finding. So the bilobed neutrophils in this setting most strongly indicate the Pseudo-Pelger-Huët anomaly.

Bilobed, hyposegmented neutrophils point to a Pseudo-Pelger-Huët anomaly. This acquired neutrophil nuclear morphology is classic in myelodysplastic syndromes and myeloid leukemias, where neutrophil maturation is disrupted and nuclei fail to segment normally, often appearing as two lobes connected by a thin bridge. It’s called “pseudo” because the pattern resembles the inherited Pelger-Huët anomaly, which is benign and not associated with marrow disease; in the disease-related form, the abnormal neutrophils reflect underlying dysplasia or leukemia.

Alder-Reilly anomaly shows large, purple-blue cytoplasmic granules in neutrophils due to a storage disorder, not a nuclear shape issue. May-Hegglin anomaly features Dohle-like inclusions in neutrophils and thrombocytopenia with giant platelets, rather than bilobed nuclei. Chediak-Higashi syndrome has giant lysosomal granules in many cells and oculocutaneous albinism, not a neutrophil nuclear morphology finding. So the bilobed neutrophils in this setting most strongly indicate the Pseudo-Pelger-Huët anomaly.

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