Multilobed neutrophils in a patient with heatstroke and amphetamine use

Heat stroke can cause neutrophils (PMNs) to become multilobed with a grape-like (botyroid) pattern. Panel A shows multilobed PMNs from a patient with heatstroke in the setting of amphetamine use. The white blood cell count was 17,800/microL, and 65 percent of PMNs showed the abnormality. Panel B shows the patient's monocytes, which demonstrate similar changes. Refer to the UpToDate topic on the peripheral blood smear for further information on this and other abnormal neutrophil findings.