Case #274 – April, 2010

A patient from Pakistan was admitted to a medical facility with non-cirrhosit portal hypertension, hepatic vein thrombosis, IVC stenosis and respiratory failure. No eosinophilia was reported at the time patient was admitted, but was present at 7% the next day. A blood smear was made at midnight and stained with Wright-Giemsa. Figure A shows what was observed by the attending pathologist at 1000x magnification. What is your diagnosis? Based on what criteria?

Figure A

The objects in this case were artifacts (fungal elements, possibly Helicosporium sp. or related) and a diagnosis was made of No Parasites Found (NPF). Fungal hyphae and conidia are not uncommon airborne contaminants in the laboratory. If such objects were to alight on a drying blood smear, they could get stained, observed and possibly misinterpreted as parasites. In this case, the objects most-closely resembled a microfilaria. Careful examination of morphologic features, as well as accurate measurements, should be performed to ensure a proper diagnosis.