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Granulocytic fragments in sepsis
J S Krauss1, R K Dover, N K Khankhanian
1Department of Pathology, Medical College of Georgia, Augusta 30912.
Summary
Newly identified granulocytic fragments in blood smears are associated with sepsis and acute pancreatitis, appearing before patient death. These fragments may falsely elevate platelet counts and indicate a poor prognosis.
Area of Science:
- Hematology
- Critical Care Medicine
- Pathology
Background:
- Sepsis and acute pancreatitis are critical conditions with significant mortality.
- Accurate diagnostic markers are crucial for timely intervention and prognosis.
- Previous research has explored complement activation in septic shock.
Observation:
- Three patients with sepsis and one with acute pancreatitis/possible sepsis developed granulocytic fragments on blood smears before death.
- Leukerythroblastosis, characterized by nucleated red blood cells (nRBCs) and elevated white blood cell (WBC) counts, was present in all patients.
- Granulocytic fragments were identified via cytochemistry and electron microscopy, correlating with nRBCs in some cases.
Findings:
- Granulocytic fragments were observed in patients with sepsis and acute pancreatitis, but not in leukemoid reactions without erythroblastosis.
- Terminal complement levels were decreased in patients with fragments, consistent with sepsis findings.
- All patients with identified granulocytic fragments died within 32 hours of identification.
Implications:
- Granulocytic fragments may serve as a novel, albeit grim, prognostic indicator in sepsis and related critical conditions.
- The presence of these fragments can lead to inaccurate platelet count estimations, potentially impacting clinical management.
- Recognition of these fragments is important for understanding the pathophysiology of severe systemic inflammation and shock.