Diagnosic Dilemma No. 14 

Contributor: Emeritus Professor John Goldsmid, University of Tasmania

This patient, a woman in Tasmania, presented with anaemia. She had had a splenectomy some time previously and a blood slide was sent to the laboratory for examination. The Giemsa stained blood film revealed numerous small round bodies as seen in Fig. 14.1

Image 1
Fig. 14.1 - Giemsa stained blood film

The laboratory queried the possibility of malaria although the patient had no history of overseas travel.
With a history of splenectomy, the possibility of Babesia was also mooted, although the bodies were very small and did not morphologically resemble these protozoa.
There was no history of tick bite.

What is your diagnosis?


No definitive diagnosis was arrived at and the patient made an uneventful recovery

The morphology of the bodies suggested any one of the following:
Pappenheimer bodies
Babesia sp
Ehrlichia sp
Anaplasma sp
Haemobartonella sp

Although the bodies did not have the morphological appearance of Babesia, serum was sent to a reference laboratory in the UK and they sent an urgent report saying that the serum was positive for Babesia and that the patient should receive immediate appropriate treatment.
By this time the patient had improved so no further action was taken and the patient made an uneventful recovery. The identity of the bodies seen in the blood film remained unconfirmed.


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