Correspondence

A Drumstick?

N Engl J Med 1996; 335:291July 25, 1996

Article

To the Editor:

Daoust and Schapiro describe a 41-year-old man with human immunodeficiency virus infection and histoplasmosis in their Image in Clinical Medicine (March 14 issue).1 Panel B is reported to show a segmented neutrophil with an intracellular, histoplasma-like organism. A drumstick, or Barr body, is easily discernible at the 11 o'clock position in the segmented neutrophil. One can thus conclude that it is either a transfused cell from a female donor or that the male patient had Klinefelter's syndrome. It is also interesting to note that, if transfused, this neutrophil remained viable and functionally capable of phagocytosis.

Leonard Kessler, M.D.
242 Merrick Rd., Rockville Centre, NY 11570

1 References

1. 1

   Daoust P, Schapiro B. Histoplasmosis. N Engl J Med 1996;334:700-700
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: In 1954, Davidson and Smith described a solitary chromatin nodule that becomes separated from the main nuclear lobe in a proportion of neutrophils in females.1 They termed this nodule a drumstick and defined it as having a solid round head joined to one lobe of the nucleus by a single, fine chromatin strand. We do not concur with Dr. Kessler's identification of the appendage in the neutrophil as a drumstick. The original description of drumsticks notes that they had to be distinguished from “minor lobes,” “small clubs,” “racket” formation, and sessile nodules,2 all of which can be observed in male neutrophils. The chromatin condensation seen in Panel B of our image lacks the fine chromatin strand characteristic of a drumstick. Instead, it has a wide base and the features of a sessile nodule.

In addition, even if the appendage were a drumstick, it would not be possible to determine sex on the basis of the single cell in our picture, since at least six drumsticks per 500 neutrophils must be present for the sex to be determined as female.1 It is possible that the neutrophil in question was infused as part of a blood transfusion from a female blood donor, but we believe that this explanation is highly unlikely, given the short half-life of transfused neutrophils (about seven hours).3 Drumsticks may be seen in male patients with Klinefelter's syndrome.3 Our patient, however, had no clinical evidence of this syndrome.

Brian Schapiro, M.D.
Philip Daoust, M.D.
New England Medical Center, Boston, MA 02111

3 References

1. 1

   Davidson WM, Smith DR. A morphological sex difference in the polymorphonuclear neutrophil leucocytes. BMJ 1954;2:6-7
   CrossRef | Web of Science | Medline

2. 2

   Sandoz atlas of haematology. 2nd rev. ed. Basel, Switzerland: Sandoz, 1973:Plate 18.
   

3. 3

   Lee GR, Bithell TC, Foerster J, Athens JW, Lukens JN. Wintrobe's clinical hematology. 9th ed. Philadelphia: Lea & Febiger, 1993.