Thursday, December 3, 2015


Here's a great case! This blood smear is from a patient with massive hemolysis. In fact,the laboratory called because routine chemistries are not working correctly and they cannot cross-match the blood. The patient initially presented with multiple knife wounds in a fight over black tar heroin (he also does skin popping). He had severe pain at the site of the injuries and was admitted to the hospital for monitoring, but over the last 24 hours, has become quite ill. He was transferred to the intensive care unit with tachycardia, fever, and shock. He is developing renal failure. The skin over his injuries has developed a bronze appearance with some red and purple discoloration. The skin is tense and exquisitely tender. There are some bullae present.

Challenge: What's the diagnosis?

1 comment:

Craig Chen said...


This peripheral blood smear shows red blood cell ghosts (black arrows) that represent intravascular lysis of red cells. The other findings incude spherocytes (bue arrows), reticulocytes (red arrows). Ghost cells are seen as a result of lytic enzymes from infection by Clostridial organisms. This patient has gas gangrene sepsis with Clostridium perfringens.

Source: UpToDate.