Pseudo-Pelger-Huët Anomaly in Megaloblastic Anemia

The Pelger-Huët anomaly (PHA) is a morphologic abnormality of segmentation involving the neutrophils predominantly; however, all leucocytes may be variably affected; it is an autosomal dominant condition. It has a global prevalence; with certain Indian populations having a reported prevalence as high as 1 in 300. PHA should be considered when clinical labs suggest a profound left shift in the setting of normal leucocyte count. Clinically, PHA needs differentiation from the pseudo-Pelger-Huët anomaly (PPHA), which though morphologically similar is associated with multiple disease states such as; myelodysplasia, myeloproliferative disorders, leukemias, or drugs. PPHA with megaloblastic anemia is rarely seen. Reported herein, is a case of megaloblastic anemia with PPHA.