Hyperthermia associated morphological changes in white blood cells
Hyperthermia associated morphological changes in white blood cells
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DOI：
10.1111/ijlh.13480
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发表时间：
2021-02-03
影响因子：
3
通讯作者：
Chan, Ching Bill
中科院分区：
文献类型：
--
作者：
Li, Ting Hon Stanford;Wong, Man Sin;Chan, Ching Bill
入院时体温41℃，血压153/97 mm Hg，脉搏163次/min，呼吸24次/min。格拉斯哥昏迷评分为3分。无神经学征象提示抗精神病药恶性综合征或血清素综合征。当时城市环境温度31℃，相对湿度82%。患者出现横纹肌溶解（肌酸激酶148 830 IU/L）、急性肝损害（胆红素117 μmol/L，谷丙转氨酶[ALT] 1708 IU/L，天冬氨酸转氨酶[AST] 1019 IU/L）、凝血功能障碍（凝血酶原时间[PT] 65.4秒，活化部分凝血活酶时间[APTT] 44.8秒）、急性肾功能衰竭（肌酐392 μmol/L）、重度乳酸酸中毒（pH 6.79，乳酸7.7 mmol/L）。全血细胞计数：血红蛋白148 g/L，白细胞31.6× 109/L，血小板352× 109/L。患者血小板计数1 d后下降，入院第5天降至最低点21× 109/L，入院第14天恢复正常。入院时外周血涂片显示白细胞，形态怪异。中性粒细胞呈葡萄样核，类似一串葡萄。核片段数量增加，通常为6个或更多，呈放射状排列，精致的染色质丝连接着中间的片段[图1A， B]。一些核类似于轮辐状的外观。淋巴细胞出现核芽殖或分裂[图1C]。单核细胞中也可见大裂核
On admission, his body temperature was 41℃, with blood pressure 153/97 mm Hg, pulse 163/min and respirations 24/min. His Glasgow Coma score was 3. There were no neurological signs suggestive of neuroleptic malignant syndrome or serotonin syndrome. The ambient temperature in the city at that time was 31 C with relative humidity 82%. The patient developed rhabdomyolysis (creatine kinase 148 830 IU/L), acute liver damage (bilirubin 117 μmol/L, alanine aminotransferase [ALT] 1708 IU/L, aspartate aminotransferase [AST] 1019 IU/L), coagulopathy (prothrombin time [PT] 65.4 seconds, activated partial thromboplastin time [APTT] 44.8 seconds), acute renal failure (creatinine 392 μmol/L) and severe lactic acidosis (pH 6.79, lactate 7.7 mmol/L). His complete blood count showed haemoglobin 148 g/L, white cell count 31.6× 109/L and platelet count 352× 109/L. The patient's platelet count declined 1 day later, with a nadir of 21× 109/L on day 5 of admission, and returned to normal on day 14 of admission.Peripheral blood smear on admission revealed white cells with bizarre morphology. Neutrophils showed botryoid nuclei, which resembled a bunch of grapes. There were increased numbers of nuclear segments, usually six or more, being radially arranged with delicate chromatin filaments connecting the segments centrally [Figure 1A, B]. Some of the nuclei resembled a spoke-wheel appearance. Lymphocytes showed nuclear budding or lobation [Figure 1C]. Hyperlobated nuclei were also seen in monocytes