This week’s case features a patient currently in the Intensive Care Unit (ICU) suffering from acute liver failure. The laboratory data and the resulting blood film provide a sobering look at the systemic impact of hepatic collapse.

The clinical context:

The patient’s FBC reveals a somewhat complex picture:

• Hb: 67 g/L
• PLT: 41 x 10⁹/L
• WBC: 8.1 x 10⁹/L

While reviewing the blood film, the biomedical scientist noticed abnormalities in the red cells, but also interestingly some inclusions with the neutrophils.

The challenge:

• What are the inclusions within the neutrophils called? They are sometimes referred to by a particularly ominous nickname.
• In the context of liver failure, what does the presence of these inclusions signify for the patient’s prognosis?
• Aside from the neutrophil findings, what red cell features can you see on the film?

Feel free to follow along on LinkedIn or on Twitter (X).