PMC7803163_01
Graphs showing the variation of the mean count of each bone marrow lineage as a function of time. (a) Mean white blood cell count (x1000 cells/muL) over time. Leukocytosis was noted since admission with no significant drop in white blood cell count observed during hospitalization. (b) Variation of mean hemoglobin level (g/dL) over time with acute drop in hemoglobin level observed within 3 days of admission. (c) Variation of mean platelet count (x1000 platelets/muL) over time showing a significant decrease of platelet count within 3 days of admission.
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Her laboratory studies revealed worsening thrombocytopenia (Figure 1), hyponatremia, and acute kidney injury.
Bone marrow biopsy specimen. Immunopathology reveals positive staining for CD163, indicating moderately increased number of macrophages, some of them with hemophagocytosis.
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After her death, the hemopathology report of the bone marrow aspirate showed cellular bone marrow (20 to 40%) with trilineage maturing hematopoiesis with the presence of hemophagocytosis and decreased iron stores (Figures 2 and 3). 5 out of 8 criteria for the diagnosis of HLH have therefore been met.
Microscopic analysis of a peripheral smear specimen with hematoxylin and eosin staining revealing the presence of macrophages with hemophagocytosis.
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After her death, the hemopathology report of the bone marrow aspirate showed cellular bone marrow (20 to 40%) with trilineage maturing hematopoiesis with the presence of hemophagocytosis and decreased iron stores (Figures 2 and 3). 5 out of 8 criteria for the diagnosis of HLH have therefore been met.