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Alinity hq

DENGUE HEMORRHAGIC FEVER

Description

This patient presented with absolute and relative neutropenia, relative lymphocytosis and thrombocytopenia. The VAR LYM flag was triggered, and lymphocyte, monocyte and basophil counts were labelled as suspect.

 

Review of the Alinity hq scatterplots revealed a predominant lymphocyte population (cyan) that had an unusual pattern showing 2 subpopulations of cells (IAS vs ALL). The lymphocyte population also extends into the monocyte population (purple) (ALL vs PSS).

 

Peripheral smear review showed a high number of plasmacytoid reactive lymphocytes with irregular nuclei and abundant basophilic cytoplasm. In addition, there was a visible decrease in the number of platelets and occasional presence of large platelets correlating with the CBC result showing thrombocytopenia. Based on the clinical presentation and laboratory findings, the patient was diagnosed as having dengue hemorrhagic fever (DHF).

 

DHF is caused by the dengue virus, which belongs to the Flavivirus family. Humans are infected by the bite of the infective Aedes aegypti mosquito (Gubler). According to the World Health Organization, DHF is defined by fever, hemorrhagic manifestations (such as petechiae/purpura, epistaxis, menorrhagia and gastrointestinal bleeding), thrombocytopenia and evidence of increased vascular permeability (Gubler, CDC). The diagnosis of DHF is based on clinical, epidemiological and laboratory data. Laboratory findings include neutropenia, lymphocytosis and presence of atypical lymphocytes which are seen in up to 73% of dengue infections (Tanaka). In severe cases, DHF patients can experience sudden deterioration of symptoms which is referred to as dengue shock syndrome (DSS) and can be lethal if not managed appropriately.

Numerical ResultsSuspect

 
WBC 4.19 10e3/μL
NEU .689 10e3/μL 16.4 %
LYM 2.91 10e3/μL 69.6 % VAR LYM
MONO .429 10e3/μL 10.2 %
EOS .146 10e3/μL 3.49 %
BASO 0.01 10e3/μL .235 %
IG 0.00 10e3/μL .005 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 5.28 10e6/μL
HGB 14.9 g/dL
HCT 44.1 %
MCV 83.5 fL
MCH 28.2 pg
MCHC 33.8 g/dL
RDW 13.3 %

 
PLT 88.4 10e3/μL
MPV 8.77 fL

 
FIGURE 1. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
The lymphocyte population (cyan) predominates in this scatter plot with an unusual distribution showing 2 sub-populations of cells suggesting the presence of atypical lymphocytes.
FIGURE 2. ALL x PSS (WBC):
Size vs. polarized side scatter plot
There is overlap of the lymphocyte (cyan) and monocyte (purple) population on this scatterplot, suggesting the presence of abnormal cells which resulted in the triggering of the VAR LYM flag.
FIGURE 3A:
Representative image from patient’s smear
Images of patient’s smear shows presence of atypical plasmacytoid lymphocytes (1, 2) with irregular nuclei with abundant basophilic cytoplasm which can be seen in dengue hemorrhagic fever. Occasional large platelet can also be observed (3).
FIGURE 3B:
Representative image from patient’s smear
Images of patient’s smear shows presence of atypical plasmacytoid lymphocytes (1, 2) with irregular nuclei with abundant basophilic cytoplasm which can be seen in dengue hemorrhagic fever. Occasional large platelet can also be observed (3).
FIGURE 3C:
Representative image from patient’s smear
Images of patient’s smear shows presence of atypical plasmacytoid lymphocytes (1, 2) with irregular nuclei with abundant basophilic cytoplasm which can be seen in dengue hemorrhagic fever. Occasional large platelet can also be observed (3).
Alinity hq Casebook. Dengue Hemorrhagic Fever. ADD-00061876-v3 2020. p.56-57

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Alinity h-series is available in select countries, not including the US.