Pelger-Huët anomaly in cats

The feline blood film

Practical relevance: Many veterinary practices have invested in quality automated hematology instruments for use in-house. However, regardless of their specific choice of analyzer, there are important hematology findings that can only be determined by microscopic examination of stained blood films. For this reason, and also for the purpose of quality control for the analyzer, a quick blood film review should be performed alongside every automated complete blood count. Even those practices that submit their blood samples to outside diagnostic laboratories for evaluation, still require the capability to examine stained blood films in emergency situations. Series outline: This is the second of a two-part article series that aims to familiarize the practitioner with normal findings on feline blood films, with a particular focus on unique features in the cat, as well as to assist with interpretation of common abnormalities. Part 2 focuses on the morphology of feline leukocytes and platelets in health and disease. Evidence base: The information and guidance offered is based on the published literature and the author's own extensive clinical pathology research.

Pelger-huet anomaly and a mild skeletal phenotype secondary to mutations in LBR

The Lamin B receptor (LBR) gene has been described to encode a bifunctional protein. Mutations in the LBR gene can affect neutrophil segmentation and sterol reductase activity and have been associated with two different recognized clinical conditions, Pelger-Huet anomaly (PHA) and Greenberg skeletal dysplasia. PHA is a benign autosomal co-dominant laminopathy resulting in bilobed neutrophil nuclei in heterozygotes, and unsegmented (ovoid) neutrophil nuclei in homozygotes. Some putative PHA homozygotes have been reported with minor skeletal malformations. Greenberg skeletal dysplasia is a severe autosomal recessive, perinatal lethal dwarfing disorder in which heterozygous carriers are usually without clinical manifestations. We here report a girl who has bilobed neutrophil nuclei and a mild skeletal dysplasia. Mutation analysis showed two novel mutations in the LBR gene: c.651_653 delinsTGATGAGAAA (p.Ile218Aspfs*19) and c.1757G > A (p.Arg586His). These mutations were found to be in trans, and, thus, she is a compound heterozygote. Sterol analysis found trace amounts of cholesta-8,14-dien-3beta-ol, which is normally undetected in healthy individuals. This and previously reported cases suggest that mutations in LBR can result in a continuum of phenotypic manifestations.

Neutrophil function in small animals

Neutrophils are highly mobile phagocytes that serve as the initial effectors against pathogens and are actively recruited to sites of inflammation. Chemoattractants guide them toward the inflammation, and their interaction with endothelial cells directs them through postcapillary venules and into the tissues. Once they have reached their destination, they can efficiently kill many microbes via phagocytosis, extracellular release of granule contents, and the formation of NETs. They also actively produce cytokines and other mediators to promote or suppress inflammation, repair tissues, and modulate the immune response. The importance of neutrophil function in host health is emphasized through discussion of inherited disorders of neutrophil function such as leukocyte adhesion deficiency and cyclic hematopoiesis.

Pelger-Huët anomaly in two related mixed-breed dogs

A 6-month-old male mixed-breed dog weighing 12.6 kg weight was presented for evaluation of a subcutaneous nodule on the dorsum. The medical history indicated trimethoprim-sulfamethoxazole treatment 2 months before presentation at the veterinary hospital. The initial complete blood cell count (CBC) results included an apparent left shift. Microscopic examination of a blood smear (Panoptic stain) revealed granulocytes with hyposegmented nuclei, coarse mature chromatin, and a nuclear shape varying from round to bilobed (pince-nez) or slightly indented. Occasional neutrophils and eosinophils had typical segmentation of nuclei. Abnormalities were not present in limited serum biochemical testing. The CBC was repeated 17 and 120 days later, and the results were similar to those observed in the first examination. The parents of the patient were located, and a CBC was performed on both animals. The dam, but not the sire, had nuclear hyposegmentation of granulocytes, confirming the diagnosis of Pelger-Huët anomaly.

Congenital Pelger-Huët anomaly in a Danish/Swedish Farmdog: case report

A 13 year old Danish/Swedish Farmdog from Denmark was evaluated in a veterinary clinic in Warsaw, Poland for evaluation of an orthopedic problem. Radiographs revealed spondylosis and degenerative vertebral disease, which responded to treatment with anti-inflammatory medications. A predominance of hyposegmented neutrophils and eosinophils containing condensed chromatin and normal cytoplasm were identified on a routine CBC. Follow-up blood film evaluations over the course of 12 months confirmed that the hyposegmented granulocytes persisted. The majority of neutrophils contained Grade 2 nuclei (slightly indented), and the mean nuclear score varied from 1.9 to 2.3. Pelger-Huët anomaly (PHA), presumably congenital, was diagnosed based on persistent hyposegmented granulocytes in the absence of an underlying cause for acquired PHA; genetically related dogs were unavailable for testing to confirm vertical transmission. To the authors' knowledge this is the first report of PHA in a Danish/Swedish Farmdog.

Pelger-Huët anomaly in an Arabian horse

A 9-year-old Arabian mare was evaluated for a 7-day history of malaise. Results of a CBC included a leukocyte concentration within the reference interval (8.4 x 10(3)/microL, reference interval 6.0-14.0 x 10(3)/microL) with an apparent degenerative left shift (segmented neutrophils 1.2 x 10(3)/microL, reference interval 2.5-7.5 x 10(3)/microL; hyposegmented neutrophils 1.8 x 10(3)/microL, reference interval 0.0-0.2 x 10(3)/microL). Serum clinical chemistry results included increased aspartate transaminase, alkaline phosphatase, and gamma-glutamyltransferase activities. A presumptive diagnosis of hepatitis or cholangiohepatitis was made. The horse was treated with antimicrobials and the malaise quickly resolved. However, in a recheck CBC on day 13, the apparent degenerative left shift remained. Further evaluation of the blood smear revealed many hyposegmented granulocytes with coarse mature chromatin and normal cytoplasmic features. On the basis of the microscopic examination, the horse was diagnosed with Pelger-Huët anomaly. The patient's offspring was subsequently also diagnosed with Pelger-Huët anomaly on the basis of blood film examination. Neutrophil, eosinophil, and basophil mean nuclear scores in both affected horses (mare, range 1.5-2.6; offspring, range 1.6-3.2) were lower than those in 2 unrelated Arabian horses (range, 2.8-5.0) and 5 non-Arabian control horses (range, 2.8-5.0). Results of immunophenotyping and phagocytosis/oxidative burst assays via flow cytometry showed no difference in the expression of myeloid-specific or adhesion molecules or in neutrophil function between affected and control horses. This is the second known report of equine Pelger-Huët anomaly, both of which affected Arabian horses.

The granulocyte nucleus and lamin B receptor: avoiding the ovoid

The major human blood granulocyte, the neutrophil, is an essential component of the innate immunity system, emigrating from blood vessels and migrating through tight tissue spaces to the site of bacterial or fungal infection where they kill and phagocytose invading microbes. Since the late nineteenth century, it has been recognized that the human neutrophil nucleus is distinctly not ovoid as in other cell types, but possesses a lobulated (segmented) shape. This deformable nucleus enhances rapid migration. Recent studies have demonstrated that lamin B receptor (LBR) is necessary for the non-ovoid shape. LBR is an integral membrane protein of the nuclear envelope. A single dominant mutation in humans leads to neutrophils with hypolobulated nuclei (Pelger-Huet anomaly); homozygosity leads to ovoid granulocyte nuclei. Interestingly, LBR is also an enzyme involved in cholesterol metabolism. Homozygosity for null mutations is frequently lethal and associated with severe skeletal deformities. In addition to the necessity for LBR, formation of the mature granulocyte nucleus also depends upon lamin composition and microtubule integrity. These observations are part of a larger question on the relationships between nuclear shape and cellular function.

Clinical assessment of leukocytosis: distinguishing leukocytoses caused by inflammatory, glucocorticoid, physiologic, and leukemic disorders or conditions

The four major types of leukocytoses are inflammatory, glucocorticoid-associated, catecholamine-associated, and neoplastic. These leukocytoses are distinguished by leukocyte concentrations, microscopic features of leukocytes, and associations with other laboratory data. All laboratory findings need to be interpreted within the context of the case information, including signalment, history, and physical examination findings. Newer assays are being used to differentiate the different forms of leukocyte neoplasia and to distinguish between hyperplastic and neoplastic proliferations.

New insights into the mechanisms of nuclear segmentation in human neutrophils

During human neutrophil differentiation, large portions of the genome condense and associate with the nuclear envelope to form filament-like structures. As a result, the nucleus of the mature neutrophil typically consists of a linear array of three or four lobes joined by thin, DNA-containing filaments. Despite the medical significance of neutrophil nuclear morphology, little is known about the events regulating neutrophil nuclear differentiation and its pathological states. This work presents a new model of the mechanisms governing nuclear filament formation in human neutrophils. This model is based on recent chromosome mapping studies in human neutrophils and on studies of genetic and pathological conditions affecting neutrophil nuclear shape. According to this model, filament assembly is initiated by factors that interact with specific regions of the genome in a hierarchical and dose-dependent manner. In this regard, the strategies governing the molecular interactions responsible for filament formation appear to resemble those involved in transcriptional silencing, a phenomenon that also affects the properties of extended chromosomal regions. According to the silencing paradigm, bound filament control Factors must recruit additional Filament Foehn factors which spread along adjacent DNA to mediate filament formation. A better understanding of the factors that shape the neutrophil nucleus may lead to new clinical tools for the diagnosis and manipulation of abnormal neutrophil differentiation.

Neutrophil phagocyte dysfunction in a weimaraner with recurrent infections

A five-and-a-half-month-old male weimaraner with severe recurrent bacterial infections was assessed for immunocompetence. Results revealed a low serum immunoglobulin G concentration and defective neutrophil phagocytosis.

Clinical interpretation of leukocyte responses

Basic information has been presented concerning leukocyte (neutrophil, monocyte, lymphocyte, eosinophil, and basophil) function, production, kinetics, and response to various physiological and disease states. Using this information, veterinary practitioners should be able to interpret leukogram data from sick and healthy dogs and cats. Specifically, characteristic leukogram patterns such as physiological leukocytosis, corticosteroid-associated changes, and the presence of infection or severe inflammation should be recognized. In addition, interpretation of individual leukocyte responses should be possible. Several tables have been provided to assist in constructing a differential diagnosis to explain increases or decreases in absolute leukocyte numbers that lie outside of expected reference intervals.