Green neutrophilic inclusions in liver disease

Acute hepatic failure is traditionally diagnosed on the basis of clinical presentation, historical information, and a collection of abnormal laboratory findings including elevated aspartate aminotransferase, alanine aminotransferase, prothrombin time, serum bilirubin and alpha-fetoprotein. Non-specific haematological findings such as anaemia, thrombocytopenia and changes in erythrocyte morphology are well documented in patients with liver failure. It is believed, however, that there are no specific morphological findings on peripheral blood smears directly linked to liver failure. This report describes two patients diagnosed with acute hepatic failure, both having coarse, bright-green cytoplasmic inclusions identified within their neutrophils. One previous case of a patient with similar neutrophil findings and concurrent liver disease has been reported in the literature; however, a direct relationship to liver failure was not proposed. It is suggested that the findings may be directly related to liver failure and may also serve as a prognostic indicator of impending death.