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Hematophagocytic lymphohistiocytosis (HLH) in a patient with CLL

View larger version (114K): [in this window] [in a new window]   Figure 1. The patient with a known diagnosis of CLL presented with a fever and sudden onset of fatigue. His hemoglobin on this admission was 7.5g/dl. Other laboratory studies included an elevated LDH, an elevated ferritin level, and a decreased haptoglobin. Coombs’ test was negative. His bone marrow aspirate a background lymphocytosis in addition to scattered myeloid elements at all stages of maturation. Of particular interest is the macrophage in the lower center of the image phagocytizing four intermediate erythroid precursors, consistent with hemophagocytic lymphohistiocytosis (HLH).

View larger version (90K): [in this window] [in a new window]   Figure 2. The erythroid precursors appeared to be vacuoles within the macrophage cytoplasm.

View larger version (97K): [in this window] [in a new window]   Figure 3. The distinct vacuolization of the intermediate stage erythroid precursors is best illustrated in this view. Also of note is the large group of late erythroid precursors reflecting an attempt at compensation for the HLH induced hemolysis.

View larger version (108K): [in this window] [in a new window]   Figure 4. In this image numerous late erytroid precursors are present in the cytoplasm of the macrophage.

View larger version (62K): [in this window] [in a new window]   Figure 5. The previous image is shown at higher magnification to better illustrate the hemophagocytosis. The cytoplasmic borders of the erythroid cells in the vacuoles are clearly delineated within the macrophage cytoplasm.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections Histiocytic hyperplasia/proliferation Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Article Social Bookmarking                   What's this?