Rivera Antonio Sierra, Valdelvira María García, Elia Martínez María A, Martí Ángeles Férez, Benito Goitzane Marcaida
Servicio de Análisis Clínicos Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Servicio de Análisis Clínicos Hospital Universitario Doctor Peset, Valencia, Spain.
Adv Lab Med. 2022 Jul 7;3(3):295-302. doi: 10.1515/almed-2022-0060. eCollection 2022 Oct.
Blue-green, birefractory, poorly-defined, cytoplasmic inclusions in some types of leukocytes are an underdiagnosed finding, which composition and clinical significance is not well understood. Inclusions are only found on peripheral blood smear (PBS).
We report the case of a male with a history of chronic disease (hypertension, obesity, dyslipidemia, and kidney failure) admitted to the emergency room (ER) with shortness of breath, who was later transferred to the intensive care unit (ICU). The patient had a torpid disease course and ultimately died of multiorgan failure, including severe liver failure. When his status exacerbated, these inclusions were observed on PBS in conjunction with liver enzyme abnormalities.
This case confirms that blue-green inclusions on PBS in cases of acute severe liver failure with concurrent lactic acidosis should be immediately reported to the medical team, since it is suggestive of critical status and poor prognosis.
某些类型白细胞中出现的蓝绿色、双折射、边界不清的胞质内包涵体是一种诊断不足的发现，其组成和临床意义尚不清楚。包涵体仅在外周血涂片（PBS）上发现。
我们报告一例有慢性疾病史（高血压、肥胖、血脂异常和肾衰竭）的男性患者，因呼吸困难入住急诊室（ER），随后转入重症监护病房（ICU）。患者病程缓慢，最终死于多器官功能衰竭，包括严重肝衰竭。当他的病情加重时，在PBS上观察到这些包涵体，同时伴有肝酶异常。
该病例证实，急性严重肝衰竭并发乳酸酸中毒患者PBS上出现蓝绿色包涵体应立即报告给医疗团队，因为这提示病情危急且预后不良。
