doi:10.1111/ejh.12292
European Journal of Haematology 93 (359)
CLINICAL PICTURE
Yeast culture in the peripheral blood !
A 65-yr-old man was diagnosed 7 months prior with an adenocarcinoma of the stomach and received chemotherapy through an intravenous catheter. He then presented with a high fever. A blood cell count (withdrawal through the catheter) was performed using two automated analyzers ADVIA 2120 (Siemens, Saint-Denis, France) and Sysmex XT2000i (Sysmex, Villepinte, France). Hemoglobin was 9.1 g/dL with equivalent red blood cell parameters. White blood cell (WBC) counts ranged from 4.14 to 8.84 9 109/L according to the ‘baso’/‘diff’/‘peroxidase’ channels of the counters and platelets from 71 to 101 9 109/L according to impedance/optical counts. On both analyzers, WBC and platelet data were flagged with abnormal dots detected in the WBC distributions. The blood smear revealed a mix of isolated and clumped yeast forms, non-branching pseudohyphae, and budding forms (Fig. 1). A venepuncture under sterile conditions was performed to assess the source of the yeast that were identified as Candida glabrata. The patient declined rapidly. Although dissemination of measurable circulating microorganisms is extremely rare, it should be considered when analyzers report spurious counts along with abnormal platelet or WBC flags. Yeasts pseudohyphae are exceptionally observed, usually in a deep immunocompromised context.
Figure 1 Yeasts and pseudohyphae, blood film, May Grunwald Giemsa, x630.
Correspondence Jean-Francois Lesesve, Laboratory of Hematology, University Hospital from Nancy, 54511 s-Nancy, France. Vandoeuvre-le Tel: 0033 3 83 15 37 57; Fax: 0033 3 83 15 37 89; e-mail: [email protected]
Jean-Francois Lesesve Laboratory of Hematology, University Hospital, F-Nancy, France
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
359
European Journal of Haematology 93 (359)
CLINICAL PICTURE
Yeast culture in the peripheral blood !
A 65-yr-old man was diagnosed 7 months prior with an adenocarcinoma of the stomach and received chemotherapy through an intravenous catheter. He then presented with a high fever. A blood cell count (withdrawal through the catheter) was performed using two automated analyzers ADVIA 2120 (Siemens, Saint-Denis, France) and Sysmex XT2000i (Sysmex, Villepinte, France). Hemoglobin was 9.1 g/dL with equivalent red blood cell parameters. White blood cell (WBC) counts ranged from 4.14 to 8.84 9 109/L according to the ‘baso’/‘diff’/‘peroxidase’ channels of the counters and platelets from 71 to 101 9 109/L according to impedance/optical counts. On both analyzers, WBC and platelet data were flagged with abnormal dots detected in the WBC distributions. The blood smear revealed a mix of isolated and clumped yeast forms, non-branching pseudohyphae, and budding forms (Fig. 1). A venepuncture under sterile conditions was performed to assess the source of the yeast that were identified as Candida glabrata. The patient declined rapidly. Although dissemination of measurable circulating microorganisms is extremely rare, it should be considered when analyzers report spurious counts along with abnormal platelet or WBC flags. Yeasts pseudohyphae are exceptionally observed, usually in a deep immunocompromised context.
Figure 1 Yeasts and pseudohyphae, blood film, May Grunwald Giemsa, x630.
Correspondence Jean-Francois Lesesve, Laboratory of Hematology, University Hospital from Nancy, 54511 s-Nancy, France. Vandoeuvre-le Tel: 0033 3 83 15 37 57; Fax: 0033 3 83 15 37 89; e-mail: [email protected]
Jean-Francois Lesesve Laboratory of Hematology, University Hospital, F-Nancy, France
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
359
