#00065461

A 21 year old male patient, known case of sickle cell anaemia (HbSS) presented with fever, chills and rigor along with fatique and weakness since 3 days. On general examination the body temperature was 104^oF with pulse rate of 116/min. A complete blood count revealed a hemoglobin of 6.5 g %, total leukocyte count of 3900/cumm with differential counts of (65% polymorphs, 32% lymphocytes, 2% monocyte, 1% eosinophil) and platelet count was 20,000/cumm.

General blood picture showed marked anisopoikilocytosis displaying few sickle cells(encircled) and malaria parasite (P. Vivax) in schizont stage comprising of merozoites along with brown pigments marked by arrow. (Leishman stain 100x)

Learning points

1.     Patient of sickle cell anaemia are not always protected against malaria.

2.     A careful examination of peripheral blood smear on oil immersion view is recommended  to reduce the chances of missing out malarial parasites even in case of Sickle cell Disease.

3.     Patient with dual disease may have dreaded complications and a fatal disease course.