Pelger-Huet Anomaly Workup

  • Author: Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: Mar 28, 2012
 

Laboratory Studies

Examination of a peripheral blood smear in an individual heterozygous for Pelger-Huët anomaly (PHA) is remarkable for neutrophils with a predominance of bilobed, spectacle-shaped nuclei. This appearance is often described as pince-nez. Cells that contain twin, joined, and plump nuclei resembling dumbbells are predominant. A thin bridge, which is thinner than that observed in a normal band neutrophil, joins the 2 lobes. Although rare, homozygous individuals are described.

About 69-93% of the neutrophils show nuclear segmentation that is arrested at the bilobe level. A small population of neutrophils that possess a nonlobulated oblong or peanut-shaped nucleus is often present. Less than 10% of cells contain 3 lobes; 4 lobes are rare. Most neutrophils have excessively coarse clumping of the nuclear chromatin. The finding of similar abnormalities in the blood smear of other family members may help in establishing the diagnosis.

The homozygous state results in neutrophils that contain a single, round, eccentric nucleus with clumped chromatin and little or no nuclear segmentation. In contrast to the less than 40% of single-lobed neutrophils typically present in heterozygous individuals, most neutrophils in homozygous individuals are round or oval. In homozygous individuals, the basophils, eosinophils, and megakaryocytes also show dense nuclear chromatin and rounded nuclear lobes.

The bone marrow of homozygous patients reveals normal morphologic features in the myeloid precursors to the myelocyte stage.

Electron microscopy reveals persistence of nucleoli in the mature neutrophils that contain a single oval nucleus. This finding suggests altered and retarded nuclear maturation of the myeloid precursors.

When Pelger-Huët cells are identified, initially attempt to determine if the patient has a benign inherited anomaly, an acquired morphologic feature associated with a transient condition, or evolving myelodysplasia.

Acquired or pseudo–Pelger-Huët anomaly cells may appear morphologically similar to those observed in the hereditary form; therefore, determining whether detailed workup is necessary may be difficult.

In the hereditary form of Pelger-Huët anomaly, an autosomal dominant pattern should be present, and this finding in other family members may be helpful and reassuring.

In this condition, no other cell line should be involved. In contrast, if anemia or thrombocytopenia are observed, perform an evaluation to exclude a hematologic malignancy.

Pseudo–Pelger-Huët anomaly cells may be predicative of the clinical onset of myelodysplastic disorders and malignant conditions, such as acute myelogenous leukemia, chronic myelogenous leukemia, or myelofibrosis. Therefore, if clinical suspicion warrants it, bone-marrow aspiration and biopsy are necessary.

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Contributor Information and Disclosures
Author

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP  Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Specialty Editor Board

Sharada A Sarnaik, MBBS  Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Attending Hematologist/Oncologist, Children's Hospital of Michigan

Sharada A Sarnaik, MBBS is a member of the following medical societies: American Association of Blood Banks, American Association of University Professors, American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD  Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society

Disclosure: Nothing to disclose.

Samuel Gross, MD  Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Frank E Shafer, MD, to the original writing and development of this topic.

References

  1. Cohen TV, Klarmann KD, Sakchaisri K, et al. The lamin B receptor under transcriptional control of C/EBPepsilon is required for morphological but not functional maturation of neutrophils. Hum Mol Genet. Oct 1 2008;17(19):2921-33. [Medline].

  2. Cunningham JM, Patnaik MM, Hammerschmidt DE, Vercellotti GM. Historical perspective and clinical implications of the Pelger-Hüet cell. Am J Hematol. Feb 2009;84(2):116-9. [Medline].

  3. Kuriyama K, Tomonaga M, Matsuo T, Ginnai I, Ichimaru M. Diagnostic significance of detecting pseudo-Pelger-Huët anomalies and micro-megakaryocytes in myelodysplastic syndrome. Br J Haematol. Aug 1986;63(4):665-9. [Medline].

  4. Hoffmann K, Dreger CK, Olins AL, et al. Mutations in the gene encoding the lamin B receptor produce an altered nuclear morphology in granulocytes (Pelger-Huët anomaly). Nat Genet. Aug 2002;31(4):410-4. [Medline].

  5. Hoffmann K, Sperling K, Olins AL, Olins DE. The granulocyte nucleus and lamin B receptor: avoiding the ovoid. Chromosoma. Jun 2007;116(3):227-35. [Medline].

  6. Best S, Salvati F, Kallo J, et al. Lamin B-receptor mutations in Pelger-Huët anomaly. Br J Haematol. Nov 2003;123(3):542-4. [Medline].

  7. Ye Q, Callebaut I, Pezhman A, Courvalin JC, Worman HJ. Domain-specific interactions of human HP1-type chromodomain proteins and inner nuclear membrane protein LBR. J Biol Chem. Jun 6 1997;272(23):14983-9. [Medline].

  8. Cohen TV, Klarmann KD, Sakchaisri K, Cooper JP, Kuhns D, Anver M, et al. The lamin B receptor under transcriptional control of C/EBPepsilon is required for morphological but not functional maturation of neutrophils. Hum Mol Genet. Oct 1 2008;17(19):2921-33. [Medline].

  9. Matsumoto T, Harada Y, Yamaguchi K, et al. Cytogenetic and functional studies of leukocytes with Pelger-Huët anomaly. Acta Haematol. 1984;72(4):264-73. [Medline].

  10. Erice JG, Perez JM, Pericas FS. Homozygous form of the Pelger-Huët anomaly. Haematologica. Aug 1999;84(8):748. [Medline].

  11. Oosterwijk JC, Mansour S, van Noort G, et al. Congenital abnormalities reported in Pelger-Huët homozygosity as compared to Greenberg/HEM dysplasia: highly variable expression of allelic phenotypes. J Med Genet. Dec 2003;40(12):937-41. [Medline].

  12. Kalfa TA, Zimmerman SA, Goodman BK, et al. Pelger-Huët anomaly in a child with 1q42.3-44 deletion. Pediatr Blood Cancer. May 1 2006;46(5):645-8. [Medline].

 
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Neutrophils in this blood smear (original magnification X1500) have the 2 characteristics of the Pelger-Huët anomaly: the pince nezappearance of the bilobate nuclei and excessively coarse clumping of chromatin. Used with permission from Little, Brown.
 
 
 
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