A Sickle Cell Crisis in a Blood Culture Bottle

摘要

A 38-year-old man presented to the emergency departmentfollowing a 2-day history of severe left abdominal painand fever. His symptoms had started while climbing Mt.Fuji, at an altitude of approximately 2,500 m. His medicalhistory was unremarkable. The patient demonstrated tendernessof the left costovertebral angle. Computed tomographyrevealed a splenic infarction, and his HbA1c level was2.7%. However, a microscopic examination of a blood smeardid not reveal the presence of sickle cells. We hypothesizedthat the patient’s erythrocytes might undergo morphologicalchanges in anaerobic blood culture bottles. Each blood culturebottle was injected with 10 mL of blood and cultured at35°C. After 24-hour culture, the morphology of the cells inthe aerobic (Picture 1) and anaerobic (Picture 2) bottles wascompared; sickle cells were observed only in the anaerobicbottles. This change was not observed in cells from healthyindividuals. We used blood culture bottles to diagnose sicklecell trait, which is an original method that has not been reportedbefore. He was discharged after a week. HemoglobinS was detected subsequently, and the diagnosis of sickle celltrait was confirmed.