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IMAGES

IN HEMATOLOGY

Peripheral smear clues for Bordetella

pertussis

c Soumya Pandey and Neslihan Cetin, University of Arkansas for Medical Sciences

2-month-old girl, who was current on her immunizations and had no prior illness, presented to the emergency department with
a 2-week history of progressive cough and shortness of breath. A chest radiograph revealed bilateral peribronchial thickening.
Complete blood count results revealed a white blood cell count of 38.6 3 109/L (71% lymphocytes, 19% segmented neutrophils,
6% monocytes, 3% bands, and 1% metamyelocytes); hemoglobin level was 10.7 g/dL, and platelet level was 425 3 109/L. Morphologic
examination of the peripheral blood smear revealed numerous mature lymphocytes with scant cytoplasm, condensed chromatin, and
clefted nucleicharacteristic of Bordetella pertussis lymphocytosis. Real-time polymerase chain reaction was positive for B pertussis and
negative for respiratory syncytial virus and inuenza A and B. The patient was treated with azithromycin and prednisolone.
Pertussis has a wide spectrum of presentation, and a high index of suspicion must be maintained. Analyzing culture is the gold
standard for diagnosis; however, polymerase chain reaction is a rapid and more sensitive test. Studies of pertussis in children show
absolute lymphocytosis in .50% of patients, and characteristic small, mature lymphocytes with hyperchromatic, cleaved nuclei may
account for as much as 56% (12%-56%; mean, 31%) of total lymphocytes. This case emphasizes the importance of peripheral blood
smear evaluation as a diagnostic tool until other results become available.
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2013 by The American Society of Hematology

4012

BLOOD, 12 DECEMBER 2013 x VOLUME 122, NUMBER 25

From www.bloodjournal.org by guest on February 17, 2016. For personal use only.

2013 122: 4012

doi:10.1182/blood-2013-05-502724

Peripheral smear clues for Bordetella pertussis

Soumya Pandey and Neslihan Cetin

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