Dangerous, a battle of "white" and "bacteria" in the blood!

【Foreword】

【Foreword】【Foreword】

The blood of normal people is sterile.

The blood of normal people is sterile.

On the morning of March 6th, a colleague on the evening shift informed him that he had a critically low white blood cell count last night, and he looked at what was abnormal in the blood smear

figure 1

figure 1

Patient information, male, 72 years old, clinical diagnosis: transient ischemic attack

Patient information, male, 72 years old, clinical diagnosis: transient ischemic attack

I remembered that during my training last year, bacteria were found in blood smears with very low white blood cells

figure 2

figure 2

When I switched to the oil microscope, it was incredible, it turned out that the neutrophils engulfed the bacteria! ! ! Figure 3

When I switched to the oil microscope, it was incredible, it turned out that the neutrophils engulfed the bacteria! ! ! Figure 3

image 3

image 3

This.

This.

Figure 4

When browsing to the beginning of the film, it is found that there are small piles of bacteria that exist alone at the beginning of the pushing film, as shown in Figure 5

When browsing to the beginning of the film, it is found that there are small piles of bacteria that exist alone at the beginning of the pushing film, as shown in Figure 5

Figure 5

Figure 5

Seeing this, it was a sure thing for bacteria to invade the bloodstream and multiply, so I hurriedly called the clinic and learned that the patient was admitted to the hospital last night and had a high fever.

Seeing this, it was a sure thing for bacteria to invade the bloodstream and multiply, so I hurriedly called the clinic and learned that the patient was admitted to the hospital last night and had a high fever.

[Case Tracking] [Case Tracking] Checking the electronic medical records, we learned that the patient was admitted to the hospital due to "dizziness, blurred vision, and brown loose stools for 4 days and frequent vomiting for 5 hours".

Image 6

Image 6

【case analysis】

【Case Analysis】【Case Analysis】

0 1

0 1 0 1 1

The patient had severe diarrhea four days ago.

The patient had severe diarrhea four days ago.
Considering that bacteria had already invaded the patient's body at that time, the toxins (possibly enterotoxins) produced caused the patient to have diarrhea and vomiting, and there were no blood culture conditions in the local area.
Diarrhea symptoms were diagnosed and treated, but the bacteria in the blood were not killed, so the condition worsened
.

At the same time, what is strange to me is where is the entrance of the patient's bloodstream infection? After going around in the medical record system, I finally found a clue on the homepage of the admission journal.
It mentioned that the patient had multiple skin injuries on both lower limbs, so it was highly suspected that the bacteria infiltrated through the wound and then invaded the blood
.
Combined with the CT examination of the patient at the time of admission, it was suggested that both lungs were infected, that is, the way of respiratory infection and then invading the bloodstream was not excluded
.

At the same time, what is strange to me is where is the entrance of the patient's bloodstream infection? After going around in the medical record system, I finally found a clue on the homepage of the admission journal.
It mentioned that the patient had multiple skin injuries on both lower limbs, so it was highly suspected that the bacteria infiltrated through the wound and then invaded the blood
.
Combined with the CT examination of the patient at the time of admission, it was suggested that both lungs were infected, that is, the way of respiratory infection and then invading the bloodstream was not excluded
.
0 2 0 2

When I asked my colleagues in microbiology, I learned that the patient's blood culture had been reported to the police for eight hours.
Such a rapid alarm is very rare.
It can be seen how much bacteria are in the blood
.
Colleagues transfected blood plates and smears with Gram stain, which were initially identified as Gram-negative bacilli, as shown in Figure 7
.

When I asked my colleagues in microbiology, I learned that the patient's blood culture had been reported to the police for eight hours.
Such a rapid alarm is very rare.
It can be seen how much bacteria are in the blood
.
Colleagues transfected blood plates and smears with Gram stain, which were initially identified as Gram-negative bacilli, as shown in Figure 7
.

Figure 7

Figure 7

Surprisingly, there are two kinds of bacteria growing on the blood plate after transplantation! In general, bloodstream infections are more common with one type of bacterial infection than with both
.
As shown in Figure 8, the black box is the larger flat bacteria, and the black arrow is the smaller, round bacteria
.
After further isolation and culture and identification of related biochemical reactions, the larger colonies in the black box were Escherichia coli, and the colonies indicated by the black arrows were Klebsiella pneumoniae
.

Surprisingly, there are two kinds of bacteria growing on the blood plate after transplantation! In general, bloodstream infections are more common with one type of bacterial infection than with both
.
As shown in Figure 8, the black box is the larger flat bacteria, and the black arrow is the smaller, round bacteria
.
After further isolation and culture and identification of related biochemical reactions, the larger colonies in the black box were Escherichia coli, and the colonies indicated by the black arrows were Klebsiella pneumoniae
.

Figure 8

Figure 8 0 3 0 3

The patient's white blood cells were extremely low.
Usually, many teachers would simply scan the field of view with a simple low-power microscope when examining blood smears.
When they found that the number of white blood cells was indeed rare, they reported that the microscopic examination report had been completed.
This is an inadvisable method
.

The patient's white blood cells were extremely low.
Usually, many teachers would simply scan the field of view with a simple low-power microscope when examining blood smears.
When they found that the number of white blood cells was indeed rare, they reported that the microscopic examination report had been completed.
This is an inadvisable method
.

For low-white blood smears, we can search for cells under low magnification, and try to dig out abnormally shaped cells (such as large, low plasma, lightly stained primitive cells, or strangely shaped cells) under low magnification as much as possible.
cells) and then transferred to the oil microscope for confirmation, so that valuable abnormal cells can be found faster in a shorter time
.

For low-white blood smears, we can search for cells under low magnification, and try to dig out abnormally shaped cells (such as large, low plasma, lightly stained primitive cells, or strangely shaped cells) under low magnification as much as possible.
cells) and then transferred to the oil microscope for confirmation, so that valuable abnormal cells can be found faster in a shorter time
.

Of course, concentrated production can also be performed.
The blood routine samples can be centrifuged at a low speed, the upper plasma layer can be sucked off, and the buffy coat layer (ie, nucleated red blood cells and white blood cell layer) can be taken for production, but it should be noted that a small amount of white blood should be taken when producing.
Membrane layer, thin push, slow push to avoid cell stacking
.

Of course, concentrated production can also be performed.
The blood routine samples can be centrifuged at a low speed, the upper plasma layer can be sucked off, and the buffy coat layer (ie, nucleated red blood cells and white blood cell layer) can be taken for production, but it should be noted that a small amount of white blood should be taken when producing.
Membrane layer, thin push, slow push to avoid cell stacking
.
0 4 0 4

Through this low white blood cell case, I have also more realized the importance of cell morphology and the urgency of improving the morphological discrimination ability of evening shift workers, providing a more accurate direction for clinical diagnosis and treatment, especially when encountering M3 and TTP , can be described as a race against death to grab time
.

Through this low white blood cell case, I have also more realized the importance of cell morphology and the urgency of improving the morphological discrimination ability of evening shift workers, providing a more accurate direction for clinical diagnosis and treatment, especially when encountering M3 and TTP , can be described as a race against death to grab time
.
【Summary】【Summary】

The function of neutrophils is to move to the focal area under the action of chemokines when pathogenic microorganisms invade in the body, and digest the pathogenic microorganisms through phagocytosis and intracellular lysozyme release proteolytic enzymes.
, especially in the case of extremely low blood leukocytes, in addition to considering the possibility of blood diseases, it is also necessary to carefully check whether there are bacteria, especially leukocytes that have phagocytosed bacteria
.
If it is not easy to find bacteria at the end of the film and the tail of the body, you can turn your attention to the beginning of the film.
Due to the initial pushing of the film, the blood tends to be more concentrated, the amount of cells is larger, and it is easier to find bacteria
.

The function of neutrophils is to move to the focal area under the action of chemokines when pathogenic microorganisms invade in the body, and digest the pathogenic microorganisms through phagocytosis and intracellular lysozyme release proteolytic enzymes.
, especially in the case of extremely low blood leukocytes, in addition to considering the possibility of blood diseases, it is also necessary to carefully check whether there are bacteria, especially leukocytes that have phagocytosed bacteria
.
If it is not easy to find bacteria at the end of the film and the tail of the body, you can turn your attention to the beginning of the film.
Due to the initial pushing of the film, the blood tends to be more concentrated, the amount of cells is larger, and it is easier to find bacteria
.

Finally, if you want to train Jinjing Huoyan to find abnormal cells in a low-power field of view, in addition to paying attention to the role of cell morphology, you need to continue to learn and persevere.
cold
.
"

Finally, if you want to train Jinjing Huoyan to find abnormal cells in a low-power field of view, in addition to paying attention to the role of cell morphology, you need to continue to learn and persevere.
cold
.
"

【references】

【references】

[1] Liu Yunde, Lou Yongliang.
Clinical Microbiology Testing Technology [M].
Beijing: People's Health Publishing House, 2015: 363-367

[1] Liu Yunde, Lou Yongliang.
Clinical Microbiology Testing Technology [M].
Beijing: People's Health Publishing House, 2015: 363-367

[2] Chen Dongke, Sun Changgui.
Practical clinical microbiology test and atlas [M].
Beijing: People's Health Publishing House, 2011: 317-323, 327-333

[2] Chen Dongke, Sun Changgui.
Practical clinical microbiology test and atlas [M].
Beijing: People's Health Publishing House, 2011: 317-323, 327-333

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