Monday, December 17, 2007


An ambulance brings an unconscious woman into your ER, but no one is able to tell you what happened to her. A quick exam shows heart rate 110 bpm, respiratory rate 24, blood pressure 100/60, and temperature 102 F. She appears to be in her thirties and looks very sick. There is a well-healed abdominal scar on the left upper quadrant.

Here's what a blood smear might show (arrow indicates abnormal finding):

Challenge: You suspect an infection. What type of organisms are most likely?

Related Questions:
1. What does the blood smear show?
2. What is the relevance of the scar?

Image shown under fair use.


Alex said...

howell jolly bodies?
no spleen?

Craig said...


Most likely, the patient has sepsis due to encapsulated bacteria (postsplenectomy sepsis with a fulminant and rapidly fatal progression). The blood smear shows Howell-Jolly bodies, round dense red cell inclusions that represent a nuclear remnant from incomplete nuclear expulsion. They indicate asplenia, which is also suggested by the scar. Without a spleen, the patient is unable to opsonize bacteria with macrophages. The patient is vulnerable to encapsulated pathogens such as Streptococcus pneumonia (most common), Neisseria meningitidis, and Hemophilus influenzae.

Source: Wikipedia; University of Virginia Website; UpToDate.