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Case Report: “Flowers” in the blood: A novel paired erythrocyte arrangement found in CFS patient


Senior Member
“Flowers” in the blood: A novel paired erythrocyte arrangement in a patient with chronic fatigue syndrome following infectious mononucleosis

Carrie E Burdzinski


"A 28-year-old caucasian female presented with chronic fatigue persisting for nine months following infectious mononucleosis. Laboratory evaluation excluded classic causes of fatigue. Peripheral blood smear examination revealed numerous pairs of unusual nondiscocytic c-shaped erythrocytes, coupled in perpendicular crosses resembling four-petalled flowers. the presence of the erythrocyte pairs abated with the patient’s recovery from chronic fatigue syndrome over a 24-month period. this erythrocyte arrangement has not been reported elsewhere in medical literature.

Conclusion: A novel erythrocyte “flower” formation was identified in a patient with chronic fatigue syndrome. the presence of this arrangement paralleled the course of the illness and was no longer observed upon recovery. the physiological relevance of the structure remains a subject for future research. several hypotheses are suggested, including enhanced membrane deformability resulting from elevated catecholamine levels, and immune-mediated agglutination, possibly stemming from viral infection."
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Hoarder of biscuits
As a licensed medical technologist I've never seen anything like this in a book or examining a slide of blood under the microscope. I can't say why they used the pin-prick method to obtain the blood sample - there is no anticoagulant involved with this and sometimes platelets will clump and cause other things around them to clump as well. It'd be interesting to see if the same results happened with the typical blood sample taken from a vein into a tube containing the anti-coagulant EDTA.

There are times when novel blood cells appear that don't match textbook examples. For instance in leukemia, most of the time the cells look like the textbook examples, but occasionally they can't be matched to anything, but they're clearly abnormal. At that point the tech can notify the referring hematologist that his patient has very unusual cells, essentially saying, "He's your patient, you can call these cells whatever you want." This is AFTER all other avenues of discovery have been exhausted to determine what they are. That involves having several techs review the slide, having a pathologist and/or hematologist review it.

I'm very surprised by this discovery. Thanks for posting.