A Complete Blood Count with Differential is performed on the DXH 900 for a patient with severe sepsis & intravascular hemolysis. Due to the high percentage of neutrophils detected, a manual slide review is performed.
Increased band neutrophils are seen, indicating a left shift. A manual differential is performed with the following results: 46% segmented neutrophils, 37% band neutrophils, 12% metamyelocytes, 3% lymphocytes, and 2% monocytes.
The neutrophils also show toxic granulation and vacuolization. In conjunction with the immature granulocytes, these features indicate response to infection.
Evidence of the severe bacteremia can be seen in some neutrophils as phagocytosed bacteria.
The many spherocytes present in the red blood cell morphology indicates intravascular hemolysis. The increase in erythrocyte destruction overloaded the kidneys’ ability to filter out hemoglobin, leading to hemoglobinuria.
Everything in the manual smear review of the patient paints a cohesive picture of their condition: sepsis with hemolysis. When reviewing a smear, it is always helpful to keep the patient in mind instead of a list of results.