2019‐04‐08

Infection-related Hematology Laboratory

Abnormalities

Ruth F. Padmore, MD, FRCPC, PhD, 
Associate Professor, University of Ottawa
Staff Hematopathologist, The Ottawa Hospital and Eastern Ontario 
Regional Laboratory Association

Disclosures

• CDC: …… “the material is free of

copyright and users are welcome to store
and copy material in the public domain
(please, kindly cite the source)”

Disclosures

ISLH Education Committee 2019

Dr. Joyce Rogers (VP Education)

Dr. Karen Moffat (Co-Chair)
Dr. Anna Merina (Chair)
Dr. Ruth Padmore (Co-Chair)
Dr. Gina Zini
Dr. Qian-Zhang
Kyle Bradly (Vice-Chair)

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Objectives

• To identify microorganisms on the peripheral

blood film
• To identify peripheral blood film morphological
changes which are characteristically
associated with certain infections
• To be mindful of morphological artefacts which
might mimic microorganisms

Morphology of malaria: Plasmodium falciparum

Mature schizont
Mature trophozoite
Release of merozoites
Asexual cycle  to become gametocytes
in human RBC
Release of merozoites
to become new ring forms

Ring form trophozoite Gametocyte

Sexual form:
To mosquito

Plasmodium falciparum

Ring form trophozoites 
with double chromatin 
dots (headphone cells)

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Plasmodium falciparum

Multiple rings in one red blood cell

Plasmodium falciparum

Mature schizonts

Plasmodium falciparum

Maurer’s clefts

CDC Division of Parasitic Diseases https://www.cdc.gov/dpdx/malaria/

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Plasmodium falciparum

Macrogametocytes

Plasmodium falciparum

Microgametocytes

Plasmodium falciparum
Thick film

Mature schizont

Ring form trophozoites
Gametocyte

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Morphology of malaria: Plasmodium vivax

Ameboid trophozoite Mature schizont
with Schüffner's dots* Release of merozoites
to become gametocytes

Asexual cycle  Release of merozoites
in human RBC to become new ring forms

Ring form trophozoite Gametocyte

Sexual form:
To mosquito
*CDC Division of Parasitic Diseases https://www.cdc.gov/dpdx/malaria/

Plasmodium vivax

Ameboid trophozoites

Plasmodium vivax

Ameboid trophozoite

Immature schizont

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Plasmodium vivax

Maturing schizont

Gametocyte

Morphology of malaria: Plasmodium ovale

Maturing trophozoite Mature schizont
with fimbriation  Release of merozoites
to become gametocytes

Asexual cycle  Release of merozoites
in human RBC to become new ring forms

Ring form trophozoite
Gametocyte

Sexual form:
To mosquito

Plasmodium ovale

Ring form trophozoites 
with prominent chromatin dot

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Plasmodium ovale

Morphology of malaria:
Plasmodium malariae

“Daisy head”
mature schizont
Band form
maturing trophozoite*  Release of merozoites
to become gametocytes

Asexual cycle  Release of merozoites
in human RBC to become new ring forms

“Bird’s eye” Gametocyte
ring form trophozoite* Sexual form:
To mosquito
*CDC Division of Parasitic Diseases https://www.cdc.gov/dpdx/malaria/

Plasmodium malariae
Mature schizont releasing
merozoites

Gametocytes with 
reduction in red cell size

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Morphology of malaria:
Plasmodium knowlesi

Mature schizont*
Band form
maturing trophozoite*  Release of merozoites
to become gametocytes

Asexual cycle  Release of merozoites
in human RBC to become new ring forms

Ring form trophozoite* Gametocyte*

Sexual form:
Van Hellemond J et al. Emerg Inf Dis 15(9):1478‐1480; 2009* To mosquito
https://wwwnc.cdc.gov/eid/article/15/9/pdfs/09‐0358.pdf

Thrombocytopenia and
large reactive lymphocyte
with immunoblastic morphology
in malaria infection

Babesiosis

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Babesiosis Babesiosis

https://www.cdc.gov/dpdx/babesiosis/index.html Recent Case of Babesiosis

Babesiosis

Extracellular ring forms

Trypanosoma brucei rhodesiense

acute (African) sleeping sickness

Undulating membrane

Flagellum

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Trypanosoma cruzi
Chagas’s disease

Microfilaria: Loa loa

Microfilaria: Mansonella perstans

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Histoplasmosis: Histoplasma capsulatum

Disseminated histoplasmosis diagnosed by peripheral blood
film in a patient with chronic lymphocytic leukaemia. Zhaodong Xu, Greg 
German, Peter Jessamine, Janis Bormanis, Antonio Giulivi and Ruth Padmore
bjh images in haematology, British Journal of Haematology, 2013, 162, 572

Ehrlichia and Anaplasmosis

MMWR May 13, 2016
“All material in the MMWR Series is in the public domain and may be used and reprinted 
without permission; citation as to source, however, is appreciated.”

Tick borne relapsing fever: (Borrelia species)

Spirochetes

Image from CDC
https://www.cdc.gov/relapsing‐fever/clinicians/

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Spherocytic hemolysis due 
to Clostridium perfringens

https://www.islh.org/ISLH‐Education/cases.php

Lymphocytosis due to 
Bordetella pertussis

Lymphocytosis due to 
Bordetella pertussis

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Lymphocytosis due to 
infectious mononucleosis
with apoptotic lymphocyte

Question 1.

What type of infection is

shown on this
peripheral blood film
photomicrograph?
(choose the best answer)
a)Tick-borne relapsing
fever
b)Chagas disease
c) Malaria infection
d)African sleeping
sickness
e)Microfilaria

Question 1.

What type of infection is

shown on this
peripheral blood film
photomicrograph?
(choose the best answer)
a)Tick-borne relapsing
fever
b)Chagas disease
c) Malaria infection
d)African sleeping
sickness
e)Microfilaria

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Question 2.

What does this photomicrograph

show? (choose the best
answer)
a)Plasmodium ovale gametocyte
and ring forms
b)Plasmodium ovale gametocyte
and water artefact
c) Plasmodium falciparum
gametocyte and ring forms
d)Plasmodium falciparum
gametocyte and water artefact

Question 2.

What does this photomicrograph

show? (choose the best
answer)
a)Plasmodium ovale gametocyte
and ring forms
b)Plasmodium ovale gametocyte
and water artefact
c) Plasmodium falciparum
gametocyte and ring forms
d)Plasmodium falciparum
gametocyte and water artefact

Question 3.

What does this

photomicrograph show?
(choose the best answer)
a)1 = Babesiosis 1   
2 = Platelet
b)1 = Platelet
2 = Babesiosis 2 
c) 1 = Plasmodium ring form
2 = Platelet
d)1 = Platelet
2 = Plasmodium ring form

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Question 3.

What does this

photomicrograph show?
(choose the best answer)
a)1 = Babesiosis 1   
2 = Platelet
b)1 = Platelet
2 = Babesiosis 2 
c) 1 = Plasmodium ring form
2 = Platelet
d)1 = Platelet
2 = Plasmodium ring form

Question 4.
What does this 1.
photomicrograph show?
(choose the best answer)
a)1 = Ehrlichia
2 = Babesiosis
b)1 = Platelet clumps
2 = Babesiosis
2.
c) 1 = Ehrlichia
2 = Plasmodium falciparum
d)1 = Platelet clumps
2 = Plasmodium falciparum

Question 4.
What does this 1.
photomicrograph show?
(choose the best answer)
a)1 = Ehrlichia
2 = Babesiosis
b)1 = Platelet clumps
2.
2 = Babesiosis
c) 1 = Ehrlichia
2 = Plasmodium falciparum
d)1 = Platelet clumps
2 = Plasmodium falciparum

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Questions ?

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