bright green cytoplasmic inclusions

Q: What is the importance of bright green cytoplasmic inclusions?

Answer: Usually associated with high mortality (and certain death)

Bright green cytoplasmic inclusions can be seen in neutrophils or monocytes. These patients are usually sick and have high mortality. They are also called "critical green inclusions"

These inclusions usually test negative for iron, bilirubin, and myeloperoxidase on special stains.

Most patients with such findings during COVID-19 died within days of the finding. Similar findings were reported in a septic patient who died.

Most of these patients also have increased transaminases.

#Hematology

#pathology

References: 

1. Jazaerly T, Gabali AM. Green neutrophilic inclusions could be a sign of impending death! Blood 2014; 123:614.

2. Harris VN, Malysz J, Smith MD. Green neutrophilic inclusions in liver disease. J Clin Pathol 2009; 62:853.

3. Cantu MD, Towne WS, Emmons FN, et al. Clinical significance of blue-green neutrophil and monocyte cytoplasmic inclusions in SARS-CoV-2 positive critically ill patients. Br J Haematol 2020; 190:e89.

4. Hodgson TO, Ruskova A, Shugg CJ, et al. Green neutrophil and monocyte inclusions - time to acknowledge and report. Br J Haematol 2015; 170:229.