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Войти в исследования Laboratory medicine · 2025
Blue-green inclusions in neutrophils and monocytes as a sign of imminent death: an unexpected finding in the peripheral blood smears.
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Sierra-Rivera Antonio, Elia-Martínez María Asunción, Comes-Raga Ana, Hernández-Hernández Carmen, Ferriz-Vivancos Jorge, Férez-Martí Ángeles
Аннотация
INTRODUCTION: Blue-green, refractile, and irregularly contoured inclusions found in the cytoplasm of some leukocytes are a rare and underdiagnosed finding. They have been a subject of discussion among professionals regarding their composition and clinical significance. These inclusions are strongly associated with ischemic liver injury in a multitude of clinical contexts.
METHODS: Patients admitted between March 2021 and March 2022 were included in this study. Medical records, laboratory results, and progression were reviewed in all patients where the presence of these inclusions in peripheral blood smears observed under the optical microscope was reported.
RESULTS: The etiologies of the various liver failures that triggered the appearance of these inclusions were highly varied. Alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase levels were highest in these patients. Lactic acidosis was another consistent feature associated with the inclusions. The mortality rate was 84.6%.
DISCUSSION: Peripheral blood smear is the only procedure that results in detection of these inclusions. Therefore, the clinical laboratory professional must be aware of the existence of these inclusions and consider notifying the responsible emergency physicians. In contrast, emergency physicians must also be aware of the severity of this finding and take it into account in the overall clinical assessment of critically ill patients.
METHODS: Patients admitted between March 2021 and March 2022 were included in this study. Medical records, laboratory results, and progression were reviewed in all patients where the presence of these inclusions in peripheral blood smears observed under the optical microscope was reported.
RESULTS: The etiologies of the various liver failures that triggered the appearance of these inclusions were highly varied. Alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase levels were highest in these patients. Lactic acidosis was another consistent feature associated with the inclusions. The mortality rate was 84.6%.
DISCUSSION: Peripheral blood smear is the only procedure that results in detection of these inclusions. Therefore, the clinical laboratory professional must be aware of the existence of these inclusions and consider notifying the responsible emergency physicians. In contrast, emergency physicians must also be aware of the severity of this finding and take it into account in the overall clinical assessment of critically ill patients.