Neutrophils Drumsticks and Sessile nodules

One X chromosome of women is inactivated. In nrutrophils this may appear in one of three forms. Drumsticks are nuclear appendages 1.5μ in diameter. They are seen in 0.5-2.6% of neutrophils. The inactivated X chromosome may also appear as sessile nodules or as a condensation under the nuclear membrane. The frequency of drumsticks increases with nuclear segmentation. They may be seen in eosinophils but are uncommon as eosinophils have fewer lobes. Racquet forms have a central clearing and should not be confused with drumsticks. They are not inactivations of X chromosomes. The X chromosome is only inactivated in an individual with more than one chromosome. Drumsticks are not seen in individuals having only one X chromosomes [males (XY), Turner’s syndrome (XO) and testicular feminization (XY)]. Contrary to expectations individuals who are XXX rarely have cells with two drumsticks. They have an increased incidence of sessile nodule. XXX is also characterized by fewer neutrophil segments. Drumsticks in XXX are less common than normal women. The incidence of drumsticks in patients with Klienfelter’s Syndrome (XXY) is lesser than normal women. Shift to left, CML and Down’s syndrome is characterized by a decreased drumstick count. It returns to normal in CML following treatment. Drumsticks are more frequent in women with isochromosome of the long are of X. Patients with megaloblastic anaemia and congenital hypersegmentation have a higher frequency of drumsticks in the peripheral smear.