PathWays Case Study: May 19



pathways051915-3A 67-year-old male, with a past medical history of Hodgkin's lymphoma and splenectomy, was in good health prior to developing myalgias, fevers, diarrhea, and weakness two weeks ago. Skin exam was negative for erythema migrans. He was seen at the urgent care clinic and was treated with antibiotics for possible anaplasmosis. Testing was sent for confirmation. His symptoms worsened (despite completing the course of antibiotics), which prompted a visit to the ER. Based upon his history, a peripheral smear was obtained (see image).

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Dr. Tahir Mehmood

Tahir Mehmood, M.D.
Fellow, Transfusion Medicine
Mayo Clinic




Dr. Justin Kreuter


Justin Kreuter, M.D.
Consultant, Division of Transfusion Medicine
Mayo Clinic
Instructor in Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine


April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.


i like to read about mayo clinic

Another excellent case. Keep it up!

Wonderful challenge this week!!


I like this and such kind of posts pls would u send me any like investigations using my email because I’m lab. technician

Hi Justin, Hope you are doing well. I loved the case! At least my patient did not die;-) Take care! Sertac


Of note, there is a single case report of the use of plasma exchange to treat severe Babesiosis. The rationale is to remove cytokines and/or red cell hemolysis products. Some physicians will do this but this is not the standard of care and will not reduce parasite burden, which are intraerythrocytic. When applied, plasma exchange is in addition to red cell exchange.

The recommendations for red cell exchange in this setting come from the American Society for Apheresis 2013 guidelines. Here is the reference: Schwartz J, Winters JL, Padmanabhan A, Balogun R, Delaney M, Linenberger ML, Szczepiorkowski ZM, Williams M, Wu Y, Shaz BH. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. The Sixth Special Issue. J Clin Apher 2013;28:145-284. Please see page 169 for the discussion of Babesia. The recommendation is based upon C quality evidence (low to very low quality) but is a strong recommendation and consider a primary treatment modality (ASFA category I) in severely affected individuals. The literature is VERY limited concerning red cell exchange.

Sent to my attention by Blood Bank Supervisor

Just had a case confirmed today. Very timely with great smears displaying the morphology of the Babesia.


Thanks for this case. I would like to receive more cases.

Nice case

Love the case studies.

it good way of learning.

Thank you!!!! An ingenious way to educate the public!


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