From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
bloodwork ®
IMAGES
IN HEMATOLOGY
Massive hemolysis and erythrophagocytosis in severe sepsis
c Arend-Jan Meinders and Ineke Dijkstra, St. Antonius Hospital
A
61-year-old female patient with an uneventful medical history was admitted to the emergency department because of icterus and abdominal discomfort. Upon arrival, she was hemodynamically stable. No laboratory tests could be performed because of a massive hemolysis (panel A), so the decision was made to perform a direct blood smear, which showed 2 species of bacteria and erythrophagocytosis (panels B and C). The patient deteriorated acutely and was admitted to the intensive care unit, where she was intubated and started on massive inotropes and broad-spectrum antibiotics, under the hypothesis that she was in septic shock. Repeated blood samples showed severe hemolysis with no possibility of chemical or hematologic testing. The patient died within 1 hour as a result of overwhelming sepsis. Postmortem blood cultures showed Clostridium perfringens and Escherichia coli bacteremia. The autopsy revealed an infected hematoma in the liver hilum as the source of the sepsis. Clostridium septicemia is known for its massive hemolysis and poor prognosis. This case shows that a direct blood smear can be a fast and relevant test to diagnose severely ill patients.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org. © 2014 by The American Society of Hematology BLOOD, 7 AUGUST 2014 x VOLUME 124, NUMBER 6
841
From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
2014 124: 841 doi:10.1182/blood-2014-04-565663
Massive hemolysis and erythrophagocytosis in severe sepsis Arend-Jan Meinders and Ineke Dijkstra
Updated information and services can be found at: http://www.bloodjournal.org/content/124/6/841.full.html Articles on similar topics can be found in the following Blood collections BloodWork (465 articles) Clinical Trials and Observations (4385 articles) Free Research Articles (4041 articles) Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.
bloodwork ®
IMAGES
IN HEMATOLOGY
Massive hemolysis and erythrophagocytosis in severe sepsis
c Arend-Jan Meinders and Ineke Dijkstra, St. Antonius Hospital
A
61-year-old female patient with an uneventful medical history was admitted to the emergency department because of icterus and abdominal discomfort. Upon arrival, she was hemodynamically stable. No laboratory tests could be performed because of a massive hemolysis (panel A), so the decision was made to perform a direct blood smear, which showed 2 species of bacteria and erythrophagocytosis (panels B and C). The patient deteriorated acutely and was admitted to the intensive care unit, where she was intubated and started on massive inotropes and broad-spectrum antibiotics, under the hypothesis that she was in septic shock. Repeated blood samples showed severe hemolysis with no possibility of chemical or hematologic testing. The patient died within 1 hour as a result of overwhelming sepsis. Postmortem blood cultures showed Clostridium perfringens and Escherichia coli bacteremia. The autopsy revealed an infected hematoma in the liver hilum as the source of the sepsis. Clostridium septicemia is known for its massive hemolysis and poor prognosis. This case shows that a direct blood smear can be a fast and relevant test to diagnose severely ill patients.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org. © 2014 by The American Society of Hematology BLOOD, 7 AUGUST 2014 x VOLUME 124, NUMBER 6
841
From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
2014 124: 841 doi:10.1182/blood-2014-04-565663
Massive hemolysis and erythrophagocytosis in severe sepsis Arend-Jan Meinders and Ineke Dijkstra
Updated information and services can be found at: http://www.bloodjournal.org/content/124/6/841.full.html Articles on similar topics can be found in the following Blood collections BloodWork (465 articles) Clinical Trials and Observations (4385 articles) Free Research Articles (4041 articles) Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.
