Question 21.1

A blood film taken from a 23-year-old patient 3 months after a motor vehicle accident shows target cells, acanthocytes, Howell-Jolly bodies, basophilic stippling and Pappenheimer bodies.

a)    State the diagnosis.    (10% marks)

b)    State which condition is the patient at risk for.    (10% marks)

c)    List two prevention strategies.    (20% marks)


[Click here to toggle visibility of the answers]

College answer

Not available.


a) In the CICM exam, trauma + blood film abnormalities = splenectomy. Specifically, the features include:

  • Howel-Jolly bodies
  • Anisocytosis
  • Thrombocytosis
  • Acanthocytosis
  • Target cells
  • Pappenheimer bodies
  • Platelet aggregates

b) Sepsis. They are more susceptible to severe infection by encapsulated organisms.

c) Prevention strategies could include:

  • Vaccination
    • Pneumococcal vaccination
    •  Haemophilus influenzae type b conjugate vaccine
    • Meningococcal conjugate vaccine (B, C)
    • Influenza immunization
  • Lifelong prophylactic antibiotics


Cadili, Ali, and Chris de Gara. "Complications of splenectomy." The American journal of medicine 121.5 (2008): 371-375.

Di Sabatino, Antonio, Rita Carsetti, and Gino Roberto Corazza. "Post-splenectomy and hyposplenic states." The Lancet 378.9785 (2011): 86-97.

Davies, John M., et al. "Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: Prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato‐Oncology Task Force." British journal of haematology 155.3 (2011): 308-317.