#00063402

A 21-year-old, apparently healthy male presented to our center which is a remote hospital in the North East of India, with fever, dark red urine and breathlessness. On examination, he was found to have tachycardia, tachypnea with oxygen saturation (SpO2) of 78%. Peripheral smear examination showed raised number of nucleated red blood cells (NRBCs) along with changes in Red Blood cell morphology suggestive of a hemolytic blood picture.  Manual estimation of the enzyme Glucose-6-Phosphate Dehydrogenase (G-6-PD), Heinz Body preparation with a supra-vital stain confirmed G-6-PD deficiency. The presence of nucleated RBC in the peripheral blood smear is known. Some dyserythropoeisis is seen in Bone marrow. Here in this case there is a spillage of cells showing budding of nuclear material similar to eryptosis.

Magnification 100x showing eryptosis and nucleated RBCs.