Subjects:
BloodWork, Free Research Articles, Red Cells, Iron, and Erythropoiesis
Topics:
extracorporeal membrane oxygenation, sepsis, stress
An 18-year-old man with no past medical history presented to an outside hospital with acute respiratory distress syndrome complicating a previously undiagnosed interstitial lung disease. While awaiting transplant at our institution, his course was complicated by numerous infections and right-sided heart failure requiring extracorporeal membrane oxygenation. In the week prior to his expiry, the patient had sepsis which was culture positive for multidrug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis. Hematopathologist slide review noted bacterial rods, neutrophil inclusions, and hypo- and hyperlobated neutrophils (panel A; original magnification ×1000 [oil immersion], Wright-Giemsa stain, for both panels). Marked leukoerythroblastosis was present with erythroid dyspoiesis consisting primarily of erythroid nuclear abnormalities (panel B). Corresponding blood count demonstrated hemoglobin of 10.1 g/dL, platelets of 9 × 109/L, white cell count of 25.20 × 109/L with 91% neutrophils, and nucleated red cells representing 35% of nucleated cells. / Despite continued antibiotic therapy, the patient died shortly afterward. Hemolysis, both a known cause of stress dyspoiesis and a known complication of both sepsis and extracorporeal membrane oxygenation, was present as evidenced by decreased haptoglobin (<10 mg/dL) and increased plasma hemoglobin (up to 7.49 g/L). Other potential causes of dyspoiesis (medication, toxin, artifact) were not identified in the current case. This case highlights the level of stress dyspoiesis that may be seen in reactive situations.
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An 18-year-old man with no past medical history presented to an outside hospital with acute respiratory distress syndrome complicating a previously undiagnosed interstitial lung disease. While awaiting transplant at our institution, his course was complicated by numerous infections and right-sided heart failure requiring extracorporeal membrane oxygenation. In the week prior to his expiry, the patient had sepsis which was culture positive for multidrug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis. Hematopathologist slide review noted bacterial rods, neutrophil inclusions, and hypo- and hyperlobated neutrophils (panel A; original magnification ×1000 [oil immersion], Wright-Giemsa stain, for both panels). Marked leukoerythroblastosis was present with erythroid dyspoiesis consisting primarily of erythroid nuclear abnormalities (panel B). Corresponding blood count demonstrated hemoglobin of 10.1 g/dL, platelets of 9 × 109/L, white cell count of 25.20 × 109/L with 91% neutrophils, and nucleated red cells representing 35% of nucleated cells.

Despite continued antibiotic therapy, the patient died shortly afterward. Hemolysis, both a known cause of stress dyspoiesis and a known complication of both sepsis and extracorporeal membrane oxygenation, was present as evidenced by decreased haptoglobin (<10 mg/dL) and increased plasma hemoglobin (up to 7.49 g/L). Other potential causes of dyspoiesis (medication, toxin, artifact) were not identified in the current case. This case highlights the level of stress dyspoiesis that may be seen in reactive situations.

An 18-year-old man with no past medical history presented to an outside hospital with acute respiratory distress syndrome complicating a previously undiagnosed interstitial lung disease. While awaiting transplant at our institution, his course was complicated by numerous infections and right-sided heart failure requiring extracorporeal membrane oxygenation. In the week prior to his expiry, the patient had sepsis which was culture positive for multidrug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis. Hematopathologist slide review noted bacterial rods, neutrophil inclusions, and hypo- and hyperlobated neutrophils (panel A; original magnification ×1000 [oil immersion], Wright-Giemsa stain, for both panels). Marked leukoerythroblastosis was present with erythroid dyspoiesis consisting primarily of erythroid nuclear abnormalities (panel B). Corresponding blood count demonstrated hemoglobin of 10.1 g/dL, platelets of 9 × 109/L, white cell count of 25.20 × 109/L with 91% neutrophils, and nucleated red cells representing 35% of nucleated cells. / Despite continued antibiotic therapy, the patient died shortly afterward. Hemolysis, both a known cause of stress dyspoiesis and a known complication of both sepsis and extracorporeal membrane oxygenation, was present as evidenced by decreased haptoglobin (<10 mg/dL) and increased plasma hemoglobin (up to 7.49 g/L). Other potential causes of dyspoiesis (medication, toxin, artifact) were not identified in the current case. This case highlights the level of stress dyspoiesis that may be seen in reactive situations.
View largeDownload PPT

An 18-year-old man with no past medical history presented to an outside hospital with acute respiratory distress syndrome complicating a previously undiagnosed interstitial lung disease. While awaiting transplant at our institution, his course was complicated by numerous infections and right-sided heart failure requiring extracorporeal membrane oxygenation. In the week prior to his expiry, the patient had sepsis which was culture positive for multidrug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis. Hematopathologist slide review noted bacterial rods, neutrophil inclusions, and hypo- and hyperlobated neutrophils (panel A; original magnification ×1000 [oil immersion], Wright-Giemsa stain, for both panels). Marked leukoerythroblastosis was present with erythroid dyspoiesis consisting primarily of erythroid nuclear abnormalities (panel B). Corresponding blood count demonstrated hemoglobin of 10.1 g/dL, platelets of 9 × 109/L, white cell count of 25.20 × 109/L with 91% neutrophils, and nucleated red cells representing 35% of nucleated cells.

Despite continued antibiotic therapy, the patient died shortly afterward. Hemolysis, both a known cause of stress dyspoiesis and a known complication of both sepsis and extracorporeal membrane oxygenation, was present as evidenced by decreased haptoglobin (<10 mg/dL) and increased plasma hemoglobin (up to 7.49 g/L). Other potential causes of dyspoiesis (medication, toxin, artifact) were not identified in the current case. This case highlights the level of stress dyspoiesis that may be seen in reactive situations.

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© 2016 by The American Society of Hematology
2016
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