A 35 year old immigrant from Sudan presents with fever. Images from a Giemsa-stained thin blood film are shown. Diagnosis? (CLICK ON IMAGES TO ENLARGE)
I wonder whether the tiny intraerythrocytic inclusions may be bacterial, like Bartonella. B. bacilliformis is the only one that's supposed to show up on peripheral smear, but no epi hx to fit. Is patient immunocompetent? Could be dog or non-human strain in HIV patient?
I think they look like Howell-Jolly bodies and a RBC that has not extruded its nucleus. Perhaps the patient is asplenic? There seems to be a good number of echinocytes as well which could support this guess.
Howell jolly bodies inside cell-little dots and some little dots-platelets outside the cell. Third photo from top possibly an early trophozoite stage of (malaria)Plasmodium spp.-large stained nucleate in one of the rbc?
Smears like this are confusing. Howell Jolly bodies and small dots that look like Pappenheimer bodies.Where is the spleen? PCR for malaria and babesia might help.
It's not Plasmodium, it's not Babesia, what's left?
ReplyDeleteArtifact
Howell-Jolly bodies
ReplyDeleteI wonder whether the tiny intraerythrocytic inclusions may be bacterial, like Bartonella. B. bacilliformis is the only one that's supposed to show up on peripheral smear, but no epi hx to fit. Is patient immunocompetent? Could be dog or non-human strain in HIV patient?
ReplyDeleteI think they look like Howell-Jolly bodies and a RBC that has not extruded its nucleus. Perhaps the patient is asplenic? There seems to be a good number of echinocytes as well which could support this guess.
ReplyDeleteHowell jolly bodies inside cell-little dots and some little dots-platelets outside the cell.
ReplyDeleteThird photo from top possibly an early trophozoite stage of (malaria)Plasmodium spp.-large
stained nucleate in one of the rbc?
Smears like this are confusing. Howell Jolly bodies and small dots that look like Pappenheimer bodies.Where is the spleen? PCR for malaria and babesia might help.
ReplyDelete4th photo down. Said 3rd photo erroneously. Howell Jolly bodies may indicate megaloblastic or hemolytic anemia.
ReplyDeleteplasmodium ovale
ReplyDeleteSome of the red blood cells look elongated. Could be Sickle cell anemia.
ReplyDelete