{'fraction_non_alphanumeric': 0.043434680922151685, 'fraction_numerical': 0.025726695623120615, 'mean_word_length': 5.3031578947368425, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A case report related to the recognition of granulocyte fragments in peripheral blood and their clinical significance

Dear Editors, In the past decades, three publications encompassing 12 cases have reported granulocytic fragments in the peripheral blood of patients with sepsis.1-3 Granulocytic fragments in the peripheral blood were first described in leukemia and lymphoma.4,5 It could be a morphological clue to identify patients at high risk of death,1,6 as it was later found in patients with fatal sepsis, 1 and none of those with leukemoid reactions.6 It was unable to differentiate granulocytic fragments from platelets by using impedance method of automated cell analyzer, because granulocytic fragments mimic the platelets, leading to spuriously high platelet counts. Fortunately, they are rapidly conformed by the microscopic finding on Wright-Giemsa–stained blood smears. We reported one case of a 63-year-old man with septic shock, hepatomegaly, and multiple organ failure. Granulocytic fragments were identified on his peripheral blood smear using the CellaVision DI60 analyzer (Figure 1E-L). The patient presented with repeated right upper abdominal pain for half a year, aggravated for 3 days. Physical examination showed that the patient had jaundice on systemic skin and scleral, pallid conjunctiva, congestion on the skin of right shoulder, and tenderness and rebound pain in the abdomen. A complete blood count showed white blood cell, 30.93 × 109/L; red blood cell, 3.16 × 1012/L; mean corpuscular volume (MCV), 76.3 fL; mean corpuscular hemoglobin concentration (MCHC), 493 g/L; hemoglobin, 105 g/L; and platelet, 1834 × 109/L. Other laboratory results revealed prothrombin time (PT) 31.4 seconds; activated partial thromboplastin time (APTT) 64.6 seconds; creatinine levels 182.8 μmol/L; the total bilirubin 311.9 μmol/L with 1 μmol/L direct bilirubin; and high-sensitivity C-reactive protein rapidly increased by 44.6 mg/L. However, back to the histogram of blood routine results, platelet histograms were abnormal with the presence of large particles in the platelet window (black arrow in Figure 1A [patient]; Figure 1B, normal sample) and small particles in red blood cell (RBC) window (black arrow in Figure 1C [patient]; Figure 1D, normal sample). A peripheral blood smear showed no blasts, with 91% neutrophils, 6% lymphocytes, 2% monocytes, and 1% eosinophils. As illustrated, granulocytic fragments (Figure 1E-H: black arrows) with fine granules were characteristically evenly distributed within faint basophilic cytoplasm, as well as vacuolated-appearing cytoplasm (Figure 1I: double arrows). It could readily be distinguished from thrombocytes and macrothrombocytes (Figure 1I-J: black arrows), which had more basophilic cytoplasm and irregularly distributed granules, Döhle's bodies (Figure 1K-L: black arrows). The platelet count was derived from a continuous platelet/RBC histogram using impedance method, in which a false increase in platelet counts may