Leukocytic fragments in blood smears

We retrospectively reviewed blood smears from patients with septic shock and/or disseminated intravascular coagulation (DIC) in order to determine whether the appearance of leukocytic fragments on blood smears has any clinical significance. Leukocytic fragments were seen in six of twelve cases with septic shock but in none of three cases of DIC without sepsis. All six cases with leukocytic fragments also showed fragmented erythrocytes. The fact that five of these six cases died and that four were dead within two days after the leukocytic fragments were noted may indicate that this appearance heralds a severe and terminal condition of sepsis. Although the exact reason for the appearance of these fragments is unclear, it seems to be related either to mechanical shearing through microangiopathic fibrin strands, which may also cause erythrocytic fragments, or to a complex alteration in the cell membrane due to bacteria, endotoxin, or other factors. We would like to stress that the presence of leukocytic fragments on blood smears provides an important clue to the patient's prognosis.