Alder–Reilly anomaly

White blood cell abnormality

Alder–Reilly anomaly, or Alder anomaly, is an inherited abnormality of white blood cells associated with mucopolysaccharidosis. When blood smears and bone marrow preparations from patients with Alder–Reilly anomaly are stained and examined microscopically, large, coarse granules may be seen in their neutrophils, monocytes, and lymphocytes. The condition may be mistaken for toxic granulation, a type of abnormal granulation in neutrophils that occurs transiently in inflammatory conditions.^[1]^[2]^: 477^[3]

In addition to mucopolysaccharidosis, Alder–Reilly anomaly may occur in lipofuscinosis^[4]^: 32 and Tay–Sachs disease.^[5]^: 124 While the anomaly is generally considered to exhibit autosomal recessive inheritance,^[1]^[2]^: 477 it may also occur in carriers who are heterozygous for the Tay–Sachs mutation, although the inclusions are much less frequent than in homozygotes.^[5]^: 124 Alder–Reilly anomaly is not diagnostic of any disorder and does not correlate with disease severity.^[4]^: 32 Affected white blood cells function normally.^[2]^: 477

Alder–Reilly inclusions stain appear violet when treated with Wright–Giemsa stain and, in mucopolysaccharidosis, stain metachromatically with toluidine blue. Metachromatic staining is not seen in Tay–Sachs disease. The granules tend to be round or comma-shaped and may be surrounded by a clearing in the cytoplasm.^[5]^: 124

References

^ ^a ^b John P. Greer; Daniel A. Arber; Bertil E. Glader; Alan F. List; Robert M. Means; George M. Rodgers (19 November 2018). "Chapter 59: Qualitative disorders of leukocytes". Wintrobe's Clinical Hematology (14th ed.). Wolters Kluwer Health. ISBN 978-1-4963-6713-6.
^ ^a ^b ^c Elaine Keohane; Larry Smith; Jeanine Walenga (20 February 2015). Rodak's Hematology: Clinical Principles and Applications. Elsevier Health Sciences. ISBN 978-0-323-23906-6.
^ American Association for Clinical Chemistry (2018-12-09). "Blood Smear". Lab Tests Online. Retrieved 2019-12-25.
^ ^a ^b Lila Penchansky (6 December 2012). Pediatric Bone Marrow. Springer Science & Business Media. ISBN 978-3-642-18799-5.
^ ^a ^b ^c Barbara J. Bain (11 November 2014). Blood Cells: A Practical Guide. Wiley. ISBN 978-1-118-81729-2.

Blood film findings

Red blood cells

Size	Anisocytosis Macrocytosis Microcytosis
Shape	Poikilocytosis Membrane abnormalities Acanthocyte Codocyte Elliptocyte Hereditary elliptocytosis Spherocyte Hereditary spherocytosis Dacrocyte Echinocyte Schistocyte Degmacyte Sickle cell/drepanocyte Sickle cell disease Stomatocyte Hereditary stomatocytosis
Colour	Anisochromia Hypochromic anemia Polychromasia
Inclusion bodies	Developmental Howell–Jolly body Basophilic stippling Pappenheimer bodies Cabot rings Hemoglobin precipitation Heinz body
Other	Haemoconia Red cell agglutination Rouleaux

White blood cells

Lymphocytes	Reactive lymphocyte Smudge cell Russell bodies
Granulocytes	Hypersegmented neutrophil Arneth count Pelger–Huët anomaly Döhle bodies Toxic granulation Toxic vacuolation Critical green inclusion Alder–Reilly anomaly Jordans' anomaly Left shift
Other	Auer rod