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IMAGES IN HEMATOLOGY
Plasmodium falciparum in trephine biopsy
Sanjeev Kumar Gupta, Deepali Jain,* and Tejinder Singh
Case HistoryA 22-year-old male presented with a 15 days history of
febrile illness with hepatosplenomegaly and pancytopenia.On the basis of clinical presentation and findings, a Hairycell leukemia variant, Kala azar, and Tropical splenomegalywere considered as possible diagnosis; hemogram andbone marrow examination were performed.Hemogram findings were as follows: Hb, 4.5 g%; Total
Leukocyte Count (TLC), 1.730 � 103/mL; Platelet count,
41,000/mL; RBC count, 1 � 106/mL; MCV, 83.8 fl; MCH,31.1 pg; MCHC, 37.2 g/dL; RDW, 15.7%; ESR, 72 mm infirst hour.Peripheral blood smear examination showed 31% poly-
morphs, 66% lymphocytes, 2% monocytes, and 1% eosino-phil. RBC morphology showed normocytic normochromicerythrocytes with occasional macrocytes. Platelets werereduced on smear. In addition, there were numerous game-tocytes of Plasmodium falciparum seen parasitizing 1% ofRBCs. No ring forms were seen.Bone marrow aspiration and trephine biopsy revealed
normocellular marrow particles along with numerousgametocytes of Plasmodium falciparum studded withhemozoin pigment (Images. 1–3). No hairy cell infiltrate,blasts, or other hemoparasites were noted in bone marrowexamination.On the basis of overall findings, a diagnosis of Plasmo-
dium falciparum parasitemia was made and the patientreceived injectable Artemisinin for 5 days. The patientimproved clinically and hematologically (smear negative forparasite) and was discharged after a week.
Figure 1. Trephine biopsy shows many P. falciparum gametocytes with normocellu-lar marrow spaces. Hematoxylin and eosin 3600.
Figure 2. Aspirate smear showing a megakaryocyte with P. falciparum gameto-cytes (white arrows) in cytoplasm. Giemsa 31,000.
Figure 3. Gametocytes of P. falciparum studded with hemozoin pigment parasit-izing the sinusoidal endothelial cell (black arrow) and lying freely between hemato-poietic cells. Hematoxylin and eosin 31,000.
Department of Pathology, Maulana Azad Medical College, New Delhi,India
Deepali Jain, Department of Pathology, Maulana Azad Medical College,New Delhi, India. E-mail: [email protected]
Received for publication 9 December 2006; Accepted 2 February 2007
Am. J. Hematol. 83:602, 2008.
Published online 19 June 2007 in Wiley InterScience (www.interscience.wiley.com).DOI: 10.1002/ajh.20931
VVC 2007 Wiley-Liss, Inc.
American Journal of Hematology 602 http://www3.interscience.wiley.com/cgi-bin/jhome/35105
