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PP402 Topic: AS13–Hematology/Oncology/Stem Cell Transplant/Immunology: PERIPHERAL BLOOD SMEAR REVIEW BY HEMATOLOGISTS IN PEDIATRIC EMERGENCIES AND INTENSIVE CARE

2024; Lippincott Williams & Wilkins; Volume: 25; Issue: 11S Linguagem: Inglês

10.1097/01.pcc.0001085868.76631.b2

1947-3893

Camila Assis, César Vivian Lopes, Cristina Mangia, Carla Goulart, A. Fernandes, A. Carneluti, A. Carneluti, Flávia Castello Branco Vidal, Luci Corrêa, Miguel Ángel Toledo, Roger P. Rossi, Fernando Meneses, K. Lamenza Maciel, Carlos Eduardo Fontoura da Silva, M. Acras, C. Mozzatto, L. Martignoni, C. M. T. Santin, M.A. Rutkoski, Eliandre de Oliveira, José Luís Oliveira, Mariléia Cháves Andrade,

Hematopoietic Stem Cell Transplantation

Aims & Objectives: Microscopic examination of peripheral blood smears (PBS) offers a rapid and straightforward method for detecting blood cell alterations and potential infectious organisms. This approach can expedite sepsis diagnosis, allowing for the prompt initiation of targeted therapy. Methods: Prospective clinical study involving 20 children admitted to the pediatric emergency department and intensive care unit between 2020 and 2024. Hematologists analyzed PBS samples to detect morphological changes in erythrocytes, leukocytes, and platelets. Patients were categorized based on presenting clinical features: a) Isolated thrombocytopenia with or without bleeding symptoms b) Unexplained bruises with normal platelet counts c) Acute febrile illnesses with leukocytosis or leukopenia d) Anemia e) Other clinical presentations Results: Early hematologist-reviewed PBS examination revealed distinct morphological alterations associated with specific clinical presentations: a) Isolated thrombocytopenia: Giant platelets, platelet clumping, or megakaryocytes b) Unexplained bruises: Schistocytes, fragmented erythrocytes, or microangiopathic changes c) Acute febrile illnesses: Leukopenia with neutropenia or lymphopenia, reactive lymphocytes, or Döhle bodies d) Anemia: Poikilocytosis, anisopoikilocytosis, or schistocytes. Red arrows: Segmented neutrophils with dysmorphic features, hypogranulation, pale cytoplasm, and presence of Döhle bodies in the periphery (blue arrows). Döhle bodies are located in the periphery and are associated with bacterial infections and sepsis. The black arrow indicates reactive lymphocytes.Conclusions: Prompt hematologist-reviewed PBS examination stands as a valuable diagnostic tool for pediatric patients presenting with sepsis, particularly in resource-limited settings. Its ability to detect early morphological alterations, including microangiopathy, holds promise for expediting sepsis phenotype diagnosis and guiding early management decisions. Keywords: peripheral blood smear, child, Thrombocytopenia, bacteremia, Sepsis