Bacteria And Other Unexpected White Cell Changes

The presence of bacteria in a peripheral smear indicates bacteremia or sepsis, a condition that may have severe consequence to the patient. Blood is a sterile environment such that the presence of gram-positive or -negative bacteria, fungi, etc., is an unwanted event. Bacteria may be seen intracellularly or extracellularly as either cocci or rods. In either case, bacteria must be recognized and the significant medical caretakers must be alerted (Figs. 10.15 and 10.16). Precipitated stain may at times resemble bacteria; therefore, it is important to be positive in your identification of bacteria, as artifacts may be confusing (Fig. 10.17).

Platelet satellitism has been discussed in a case study in a previous chapter. However, it represents a phenomenon that must be recognized as an unexpected event in a peripheral smear. The blood of some patients will react with EDTA, causing platelets to form a ring around neutrophils. This is described as platelet satel-litism (Fig. 10.18). This event will produce a falsely low platelet count and can be corrected only once the patient sample is collected in a sodium citrate tube for an accurate platelet count (Fig. 10.19). An additional peripheral cell change that may occur in segmented neutrophils is pyknosis, or pyknotic changes. This is c |

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