Tuesday, December 29, 2015

Q:  Triad of 
  • thrombocytopenia, 
  • a left-shifted granulocytic series on smear, and 
  •  an immunoblast count exceeding 10 percent of the total lymphoid series
is diagnostic of which disease?

Answer:  Hantavirus cardiopulmonary syndrome (HCPS)

If HCPS is strongly suspected and if above triad is found in a patient, it calls for a prompt response, probably insertion of ECMO device. HCPS is unique in the sense that symptoms of noncardiogenic pulmonary edema and hemodynamic collapse happens abruptly. Interestingly, symptoms resolve as quickly as the onset. Usual time period of hemodynamic instability lasts between 24 to 48 hours and proper and preemptive hemodynamic support can be life saving in literal sense.


Koster F, Foucar K, Hjelle B, et al. Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review. Am J Clin Pathol 2001; 116:665.  

Hallin GW, Simpson SQ, Crowell RE, et al. Cardiopulmonary manifestations of hantavirus pulmonary syndrome. Crit Care Med 1996; 24:252.

Crowley MR, Katz RW, Kessler R, et al. Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. Crit Care Med 1998; 26:409.

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