Case Report Barbara J Bain

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.

18 thoughts on “Case Report Barbara J Bain”

  1. Bacterial sepsis, with severe DIC reflected by the presence of phagocytosed bacteria in the neutrophils, low platelets and very abnormal clotting.

  2. The presence of intracellular bacteria(neutrophil) causes a sepsis
    (bacteraemia) what’s leading to DIC and other organ failure.

  3. I think she was suffering from hemorrhagic adrenalitis caused by Streptococcus pneumoniae infection.

  4. Intracellular cocci present, the upper image shows diplococci (?Neisseria meningitidis). Marked thrombocytopenia and abnormal coag is a result of DIC – endotoxin being a potent cause.

  5. The Haematological profile including coagulation would support a diagnosis of an overwhelming bacterial infection with an associated bacteraemia and DIC. Intracellular bacteria are noted in the neutrophils.

  6. The neutrophil exhibits features of a bacterial infection. Phagocytosed bacteria are visible. The clinical details would suggest septicaemia resulting in DIC.

  7. bacterial inclusions on the white blood cell .Patient had Septicemia that lead to Toxic Shock Syndrome that explains the rash and renal failure and provokes DIC.

  8. Patient with septicemia. Intracellular cocci and toxic vacules.
    DIC is verified by the low platelets, long PT &PTT and low fibrinogen & high D-Dimer.

  9. I would say that this is an infection by Leishmania sp.To confirm the diagnosis should be a sternal puncture.

    1. I also lean towards the leishmaniasis diagnosis. The inclusions do not look bacterial to me…too large of a capsule around the nucleus.

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