From www.bloodjournal.org by guest on September 19, 2019. For personal use only.

work images in hematology

Contamination
Jonathan Bloch and Sabine Blum, Centre Hospitalier Universitaire Vaudois

FS/SS

A 69-year-old white woman was evaluated for progressive
pancytopenia with fatigue and exertion dyspnea without signs of
infection. No organomegaly or signs of sepsis were found. A
bone marrow examination revealed dysplasia in all 3 hemato-
poietic lineages. Flow cytometry was performed, and the
forward-scatter/side-scatter chart revealed numerous dots
corresponding to small-sized elements (panel A, arrow). The analy-
sis of centrifuged bone marrow cells via cytospin (Romanowsky
staining, 1003 objective), which is routinely performed in our lab-
oratory and evaluated before flow cytometry, revealed the presence
of numerous bacteria, sometimes forming small chains (panel B).
Most of these bacteria were extracellular, but some appeared to
be inside neutrophils and monocytes. A sample of the bone marrow
was evaluated by our microbiology department and gram staining
was performed, but the bacteria were absent in their samples. After
complete revision of the flow cytometry process, we discovered
that the RPMI-1640 stock was contaminated; thus, the presence
of bacteria was due to a preanalytical error.
Use of staining to distinguish dead from live bacteria could have
been useful in this case. Clinicians and laboratory workers should
be aware of this possible preanalytical pitfall to avoid exposing
patients to unnecessary and potentially harmful examinations
and treatments.

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DOI 10.1182/blood-2019-01-894451 © 2019 by The American Society of Hematology

1612 blood® 4 APRIL 2019 | VOLUME 133, NUMBER 14

 From www.bloodjournal.org by guest on September 19, 2019. For personal use only.

2019 133: 1612

doi:10.1182/blood-2019-01-894451

Contamination
Jonathan Bloch and Sabine Blum

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