The manual differential performed on the blood smear supported the analyzer results. It did show a very slight shift to the left in the neutrophils. The most revealing finding was the inclusion bodies seen in the neutrophils. Images of such inclusion are seen on the right.
These inclusions are very suggestive of the morulae seen in tick-borne infections caused by the bacterium Anaplasma phagocytophilum, which causes human granulocytic anaplasmosis (HGA).
Because of the smear results, an indirect immunofluorescence antibody (IFA) test was ordered and revealed a high titer of anti-IgG antibodies to Anaplasma phagocytophilum. A PCR test was performed on the original sample and was also positive.
