PMC6437814_01
The white blood cell scattergrams (Sysmex XN1000 ,WDF stands for White cell differential channel, WNR stands for White cell nucleated channel) (a)Normal patient's white blood cell scattergram (b) White blood cell scattergrams of the patient; the WNR scattergrams are abnormal
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F1
The scatter plot on White cell nucleated channel (WNR scattergram) showed an abnormal scatter when compared with normal patients [Figure 1].
(a) The X-ray skull shows thickening of skull bones and "J-" shaped sella turcica. (b) Tapering of proximal metacarpals were found on the X-ray of Hands. (c and d) The photomicrograph shows neutrophils and lymphocytes showing Alder-Reilly anomaly. The Red blood cells series and platelets were morphologically unremarkable (Wright-Giemsa, x1000)
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F2
On peripheral examination, almost all the neutrophils showed dense blue/purple black granules in the cytoplasm partially obscuring the nucleus; these were resembling toxic granulations [Figure 2c and d]. On radiological evaluation, spatula-shaped ribs, tapering of proximal metacarpal, thickening of skull bones with J-shaped sella turcica were also observed [Figure 2a and b].