The diagnosis was meningococcal septicaemia. In the top image it is clear that the organisms are diplococci. A punch biopsy of the skin showed leucocytoclastic vasculitis, microthrombi and Gram-negative cocci. There was dermal haemorrhage. Blood cultures and antigen tests for meningococcus were negative but PCR was positive for meningococcus group C.

To see more images of neutrophils containing meningococci, including a Gram stain, see a case published by Professor Bain and Dr James Uprichard, Consultant Haematologist, St George’s Hospital, London: Uprichard J and Bain BJ (2008) A young woman with sudden onset of a severe coagulation abnormality. Am J Hematol, 83, 672.

The blood film can be very important in the rapid confirmation of suspected meningococcal septicaemia.

Thank you Barbara Bain for sharing these cases with us!

This week’s blog editor recently played a huge part at the 2012 CellaVision Users’ Meeting when sharing her impressive knowledge in blood cell morphology with her peers. In this case report, Professor Barbara J Bain of Imperial College, UK introduces you to a sick young woman.

Here are the patient details:

A 27-year-old woman presented to an accident and emergency department with fever and feeling unwell. She developed a ‘rash’ and later that day was noted to be bleeding from cannulae sites. FBC showed WBC 4.3 x 10⁹/l, Hb 161 g/l, MCV 88 fl and platelet count 35 x 10⁹/l. She was given a platelet transfusion and intravenous fluids. A later blood count was: WBC 1.5 x 10⁹/l, neutrophils 0.9 x 10⁹/l, Hb 78 g/l, and platelet count 35 x 10⁹/l. Her blood would not clot (PT, aPTT infinite, fibrinogen not detected, D-dimer 76,700). She had renal failure and an albumin less than 15 g/l. The changes in the blood count following resuscitation show how haemoconcentrated she had been at presentation.

What can you see in different cell images and what do you think about the woman’s condition?

Click on the cell images to enlarge them.