Year: 2026 | Month: July | Volume: 16 | Issue: 7 | Pages: 74-82
DOI: https://doi.org/10.52403/ijhsr.20260708
Pseudoeosinophilia Associated with Blue-Green Neutrophilic Inclusions: An Eight-Case Series with Poor Prognostic Significance
Anant Kulkarni1, Jitendra Khedkar2, Rajesh Phatale3, Maithili Kavathekar4
1,2,3Consultant Pathologist, 4Director, Lab Services;
Sahyadri Speciality Labs, Sahyadri Hospitals Private Ltd. (A Network Hospital of Manipal hospitals), Kothrud, Pune, India.
Corresponding Author: Dr. Anant Kulkarni
ABSTRACT
Background: Pseudoeosinophilia is an uncommon analytical phenomenon in which automated hematology analyzers report increased eosinophil counts despite the absence of eosinophilia on peripheral blood smear examination. Blue-green cytoplasmic inclusions in neutrophils and monocytes are rare morphological findings associated with severe systemic illness and poor clinical outcomes.
Aim: To describe the clinicopathological characteristics, hematological findings, analyzer abnormalities, and prognostic implications of pseudoeosinophilia associated with blue-green cytoplasmic inclusions.
Materials and Methods: A retrospective case series was conducted on eight critically ill patients who demonstrated pseudoeosinophilia on an automated hematology analyzer along with abnormal white blood cell scattergram patterns. Clinical data, biochemical parameters, complete blood counts, analyzer findings, and peripheral blood smear features were reviewed.
Results: The patients ranged in age from 37 to 73 years and presented with diverse underlying conditions, including malignancy, severe sepsis, renal failure, hepatic dysfunction, dengue infection, acute pancreatitis, and post-transplant immunosuppression. Automated hematology analysis reported eosinophil counts ranging from 7.0% to 25.0%. Peripheral blood smear examination consistently failed to demonstrate true eosinophilia and instead revealed toxic neutrophilic changes with characteristic blue-green cytoplasmic inclusions in neutrophils and monocytes. Most patients showed elevated liver enzymes, increased lactate and lactate dehydrogenase levels, metabolic acidosis, thrombocytopenia, and evidence of multiorgan dysfunction. Six of the eight patients died despite intensive supportive treatment.
Conclusion: Pseudoeosinophilia associated with blue-green cytoplasmic inclusions represented an important diagnostic pitfall in critically ill patients. Recognition of characteristic scattergram abnormalities and careful peripheral blood smear review prevented misinterpretation of eosinophil counts and served as an early indicator of severe systemic injury and adverse clinical outcome.
Key words: Pseudoeosinophilia; Blue-green cytoplasmic inclusions; Neutrophils; Automated hematology analyzer; Peripheral blood smear; Critical illness.