A hematopathology consult was requested on a 48-year-old male with a history of HIV infection. The CBC results were:

RBC	2.19 x 109/L
Hb	6.7 g/dL
Hct	19.4%
MCV	88 fL
MCH	30.4 pg
MCHC	34.5%

Mild anisocytosis with macrocytes and hypochromic, microcytic red cells; moderate poikilocytosis with few teardrops, ovalocytes and schistocytes.

WBC	0.7 x 109/L
Granulocytes	77.9%
Lymphocytes	12.7%
Monocytes	6.3%
Eosinophils	3.1%

Mild toxic granulocytes, few Dohle bodies and rare budding yeasts in the cytoplasm of neutrophils.

Figure 22.1

Figure 22.2

Platelet count 19 x 109/L

Bone marrow:
Aspirate showed hypo- to normo-cellularity with adequate megakaryocytes. The M:E ratio is 7.7:1

Promyelocytes	2%
Myelocytes	13%
Metamyelocytes/bands	39%
Segmented neutrophils	6%
Eosinophil	6%
Histiocytes	19%
Pronormocytes	1%
Basophilic normoblasts	2%
Polychromatophilic normoblasts	3%
Lymphocytes	10%

Marked erythroid hypoplasia. Marked increase in histiocytes with numerous intracytoplasmic budding yeast.

Figure 22.3

Biopsy sections show hypercellular marrow. The budding yeast was identified as Histoplasma capsulatum. (Reprinted with permission from: "McKenzie SB, Laudicina RJ. Hematologic changes associated with infection." Clinical Laboratory Science, 11(4):239-251. 1998.
Reference: Coyle TE. Hematologic complications of human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Med Clin N Am 1997; 81:449-70.