Hematological aspects of colchicine poisoning Free

A 30-year-old woman with no significant medical history presented after 2 days of nonfebrile severe abdominal pain with vomiting and diarrhea. Initial laboratory tests revealed central anemia and thrombocytopenia (hemoglobin 8 g/dL, platelets 50 000/μL) without leukopenia (leukocytes 6400/μL), rhabdomyolysis (creatine kinase >30 000 U/L), severe coagulopathy (prothrombin time = 35.7 seconds), and hemophagocytic lymphohistiocytosis (ferritin >75 000 ng/mL, triglycerides 443 mg/dL, lactate dehydrogenase 3200 U/L) in the absence of hepatic or renal dysfunction. A gut-derived infection was ruled out based on negative blood and stool cultures and a negative procalcitonin test.

Peripheral blood smear analysis showed neutrophils with hyposegmented nuclei and pseudo-Pelger-Huët anomalies (panel A, May-Grünwald stain, original magnification ×100), containing abundant cytoplasmic vacuoles (panel B, May-Grünwald stain, original magnification ×100) and evidence of nuclear karyorrhexis (panel C, May-Grünwald stain, original magnification ×100). Bone marrow aspiration yielded a hypocellular specimen, with similar cytological abnormalities in hematopoietic precursors (panel D, May-Grünwald stain, original magnification ×100) and hemophagocytosis (panel E, May-Grünwald stain, original magnification ×100). Based on these findings, colchicine toxicity was suspected. Subsequent toxicological analysis confirmed colchicine poisoning due to self-administration, concealed by the patient during the initial interview (plasma colchicine level 2.5 ng/mL). This low level is, in this case, due to chronic intoxication, as the drug quickly leaves the bloodstream and accumulates in tissues where it remains toxic.

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