title: Green neutrophil and monocyte inclusions - time to acknowledge and report.
abstract: Bright green inclusions in neutrophils have been reported as a sign of impending patient death. Here we report a series of 20 patients in whom green inclusions were identified in neutrophils or monocytes. Thirteen (65%) of the patients died within days of the detection of the inclusions. A common feature to almost all patients was ischaemic or hypoxic hepatitis which, in fatal cases, was associated with lactic acidosis. Light and electron microscopy indicated that the inclusions were lipid-rich, probably derived from lipofuscin-like material released from necrotic liver parenchymal cells. The majority of patients were known to be seriously ill at the time of detection of neutrophil inclusions. We recommend that the detection of green inclusions, which we refer to as 'critical green inclusions', is acknowledged and reported by laboratories and correlated with clinical findings.
authors.affiliation: Southern Community Laboratories, Dunedin, New Zealand.
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Hodgson
authors.affiliation: LabPlus, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Anna
authors.initials: A
authors.lastname: Ruskova
authors.affiliation: Haematology Department, Melbourne Health Pathology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Shugg
authors.affiliation: Southern Community Laboratories, Dunedin, New Zealand.
authors.forename: Vivian J
authors.initials: VJ
authors.lastname: McCallum
authors.affiliation: Southern Community Laboratories, Dunedin, New Zealand.|Department of Pathology, University of Otago, Dunedin, New Zealand.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Morison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D015415:Biomarkers / Q000378:metabolism; D001774:Blood Chemical Analysis; D016638:Critical Illness; D005260:Female; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology* / Q000648:ultrastructure; D007958:Leukocyte Count; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology* / Q000648:ultrastructure; D009504:Neutrophils / Q000473:pathology* / Q000648:ultrastructure; D063868:Patient Outcome Assessment; D019452:Terminally Ill; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: inclusion bodies; ischaemic hepatitis; monocytes; morphology; neutrophils