Misidentification of Candida parapsilosis as Large Platelets in an Automated Blood Analyzer

Do Hoon Kim; Jung Sook Ha; Nam Hee Ryoo; Dong Suk Jeon; Jae Ryong Kim; Young Rok Do; Ki Young Kwon

doi:10.5145/KJCM.2009.12.3.138

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Kim, Ha, Ryoo, Jeon, Kim, Do, and Kwon: Misidentification of Candida parapsilosis as Large Platelets in an Automated Blood Analyzer

Original Article

Korean J Clin Microbiol 2009;12(3):138-140.

Published online: 22 September 2009

DOI: https://doi.org/10.5145/KJCM.2009.12.3.138

Misidentification of Candida parapsilosis as Large Platelets in an Automated Blood Analyzer

Do Hoon Kim, Jung Sook Ha, Nam Hee Ryoo, Dong Suk Jeon, Jae Ryong Kim, Young Rok Do¹, Ki Young Kwon¹

Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea

¹Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

Correspondence: Nam Hee Ryoo, Department of Laboratory Medicine, Keimyung University School of Medicine, 194, Dongsan-dong, Jung-gu, Daegu 700-712, Korea. (Tel) 82-53-250-7950, (Fax) 82-53-250-7275, (E-mail) nhryoo@dsmc.or.kr

Received 21 April 200920 May 2009 Accepted 20 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We experienced a case in which yeasts in blood sample from a patient with cervical cancer with hepatic metastasis and multiple intraperitoneal cysts interfered with platelet morphology flag in automated blood analyzer. The peripheral blood smear was performed to confirm the flag and revealed intracellular and extracellular yeasts, which were subsequently identified as Candida parapsilosis by blood culture.

Keywords: Candida parapsilosis, Peripheral blood smear, Automated blood analyzer, Large platelet

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Fig. 1.

Phagocytized yeasts within neutrophils (Wright stain, ×1,000).

Fig. 2.

Multiple budding yeast cells observed on peripheral blood smear (Wright stain, ×1,000).

Table 1.

Sequential laboratory findings of this patient

Dec 16	Dec 23^∗	Dec 29	Jan 5	Jan 14^∗	Jan 21^†	Jan 28^∗	Jan 29	Feb 4	Feb 6
WBC count (×10³/μL) 10.7	9.9	8.5	14.4	12.8	15.4	6.0	6.2		7.4
Neutrophil (%) 61	70	74	80	94	80	62	68		79
Hemoglobin (g/dL) 12.7 Platelet count (×10³/μL) 248	7.7 289	9.4 300	7.5 321	8.8 285	6.9 59	5.2 56	8.3 86		6.8 39
CRP (mg/dL)			15.4	15.0	14.0				18.2
Blood culture			NG	CPA	CPA	CPA		NG
AF culture				CPA	CPA	NG		PAE

^∗ Date of a transfusion of packed red cells;

^† Date of detection of Candidemia by peripheral blood smear. Abbreviations: CRP, C-reactive protein; NG, no growth after 5 days; CPA, Candida parapsilosis; PAE, Pseudomonas aeruginosa; AF, ascitic fluid.

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