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2012 119: 910 doi:10.1182/blood-2011-02-336420

Peripheral hemophagocytosis in malaria infection


Emilie Klein and Emily Ronez

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blood work
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From bloodjournal.hematologylibrary.org by guest on February 5, 2012. For personal use only.

HEMATOLOGY

Peripheral hemophagocytosis in malaria infection

Emilie Klein and Emily Ronez, APHP, Centre Hospitalier Universitaire Lariboisiere, Paris, France

46-year-old with hepatitis C virus chronic infection was A vomiting aftermantrip10 stable HIV and white bloodsignicant physical ndings.seen for unexplained fever, headache, and a to Cameroon. There were no Complete blood count showed marked /L) and normal cell count and hemoglobin. thrombocytopenia (28
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Examination of the peripheral blood smear showed severe Plasmodium falciparum infection (parasitemia 1% and 1 schizont). In addition, there were numerous examples of hemophagocytosis on the peripheral blood smear. The top left panel shows a monocyte with particulate debris, perhaps remnants of the malarial infection. The top right panel shows a red cell engulfed by a monocyte. On the bottom left, the phagocytosed material resembles a platelet, and on the bottom right is a larger, circular, phagocytosed object that may represent an erythroblast nucleus or a giant platelet. Additional laboratory tests included triglycerides 5.29mM, ferritin 897 g/L, and lactic dehydrogenase 278 UI/L, adding support for the hemophagocytic syndrome. After receiving intravenous quinine, he rapidly improved with correction of thrombocytopenia. Hemophagocytic syndrome is a life-threatening disease associated with excessive stimulation of tissue macrophages. It has been noted in lymphoma, infections, or autoimmune diseases. Hemophagocytic syndrome with malaria infection has been described but without the demonstration of hemophagocytosis in the peripheral blood.
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910

BLOOD, 26 JANUARY 2012 VOLUME 119, NUMBER 4

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