Clinical Case 10 - Babesia divergens
Patient demography: Female aged 72
Diagnosis: Presented at accident and emergency department with 3 days history of feeling generally unwell, abdominal pain, febrile, nausea and dark urine now feeling very unwell.
Other information: Unremarkable medical history, spleen intact.
Analyzer: Yumizen H2500/H1500
Case provided by: North Devon Healthcare NHS Trust Barnstaple, Devon, England
FBC results plus flagging/graphical indicators: A coagulation screen was also requested and after centrifugation the serum was found to be markedly hemolyzed, a reticulocyte was subsequently performed, with the reticulocyte percentage being raised.
The samples were retaken with the subsequent results showing a decrease in the platelet count and an increase in red cell parameters. At this stage, the patient was exceedingly poor.
Together with the LMNE plot being abnormal and the suspicion of active intravascular hemolysis (low platelets, was that approx. 20% of the red cells contained small ring trophozoite hemolyzed sample, increased retics) a blood film was examined.
The blood film showed thrombocytopenia, echinocytes. Mild neutrophil left shift but with heavy granulation, the most striking features (1) with some red cells containing up to 6 parasites. A field stain blood film was examined (2) and Maltese Cross forms were seen and recognized as being characteristic of babesiosis (3). The patient was transferred to a specialized hospital, babesia divergens was confirmed by PCR and the patient made a full recovery due in no small part to the prompt diagnosis by the vigilant on-call Biomedical Scientist.
