Bilirubin Crystals in Neutrophils

Neutrophils on peripheral smear provide subtle findings or clues to the diagnosis of haematological disorders. The presence of toxic granules, hypersegmentation, pelgerhuet anamoly, green inclusions provide valuable information for clinicians. One of the rarer inclusions in neutrophils are bilirubin crystals. They are usually seen in children with hyperbilirubunemia and sepsis. We present a case of incidentally detected bilirubin crystals in neutrophils of a three day old child with elevated levels of serum bilirubin. Identification of these crystals should alert the clinician about the possible bilirubin toxicity and poor prognosis.