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.
Challenge: You suspect an infection. What type of organisms are most likely?
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2 comments:
howell jolly bodies?
no spleen?
Scar
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.
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