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» LymeNet Flash » Questions and Discussion » Medical Questions » How reliable are blood smears?

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Author Topic: How reliable are blood smears?
Spiritwalk
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Just curious as I've had one done and the doc said it appears I have a coinfection, but he wasn't sure which one.

My red blood cells have little black splotches/specks on and around them.

The medical assistant said it was babesia. When I spoke to my LLMD, he said he wasn't sure if it was babesia or bartenella or another coinfection.

I asked him if he was certain and if it meant it had to have come from a tick, he said, "yeah a tick or a mosquito."

Just curious if others have had experiences with red blood smears. Thanks.

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S13
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Babesia has some distinct features by which it can be identified. Dr. S has some info on it:
www.personalconsult.com/free/BabesiaLabGuide.pdf

Bartonella is difficult to distinguish from other blood bacteria, so i dont see a blood smear as a diagnostic tool for bart.

Dont just assume its either bartonella or babesia when you see bacteria clinging to rbc's on a giemsa blood smear. Bacteremia can just as well come from bacterial leakage from the intestine.

(Editing out doctor's last name per LN rules - Robin)

[ 08-17-2015, 08:36 PM: Message edited by: Robin123 ]

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Spiritwalk
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Spiritwalk
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That is a picture of my blood smear. What do you guys think?
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TNT
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This is just my opinion with what I initially thought when I saw your pic, and after viewing the material that S13 posted above.

Please remember that I am not a pathologist.

I would say that all those stained pathogens look like bartonella. But, of course, the two stained platelets are not bartonella.

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Spiritwalk
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What do you mean TNT?
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TNT
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What I meant, was, the small, stained organisms you see on and in the red blood cells appear to me to be bartonella.

Though, the more I look at Dr S's pdf, I am starting to think your pathogens are protozoan (probably babesia)(based on the slight clearing around them).

But the two larger stained (lavender colored) objects in the plasma between the red blood cells are platelets.

(editing out doctor name per Lymenet rules)

[ 10-01-2015, 01:30 AM: Message edited by: Robin123 ]

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TNT
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The title of your thread is "How reliable are blood smears?"

VERY RELIABLE! But, it takes a trained pathologist to really know what they are looking at.

But, be assured, your smear is abnormal (pathogenic)!!

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Spiritwalk
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TNT,

Thanks. Could it be something other than a tick-borne coinfection?

My joints (especially my back) are really causing a lot of pain. The LLMD believes I have Lyme (did not have 5 bands), but he didn't sound sure about the blood smear coinfection. I had never heard of bacteria leakage that S13 above referred to.

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TNT
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If you look at the pdf at the above link that S13 posted, you will see the Dr. gives a pretty good description for reading smears.

I would say you definitely have a tick-borne pathogen in your blood. My opinion (now changed), is that it resembles babesia.

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TNT
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Most people don't get just Lyme, or just Babesia, or just any other infection when they get bitten. Usually there are multiple infections carried by a tick that gets passed on to the victim.

So, if you have babesia, you most likely have Lyme, and possibly, bartonella, too, although your posted pic doesn't appear to show it (bart).

If your Western Blot had any Lyme-specific bands (even if not a total of 5 bands), you are positive for Lyme disease just like your doc said.

What S13 is referring to is leaky gut. Most chronic Lyme patients will have some degree of mucosal-wall breakdown on the inner lining of the intestines because of long term ABX usage, or from the pathogens themselves. This allows the normal GI flora to pass into the blood stream in small numbers. What he is saying is that it may be possible for a blood smear to show these organisms. These would be normally-friendly things like E. coli bacteria, etc.

But, I'm not sure if they would show up ON the RBCs like bart or babs do. I would tend to think they would only be seen in the plasma if a stain would happen to pick up a solitary organism or two.

So, I personally think you can be relatively certain that what you see in your pic is not from leaky gut, but that you do, in fact, have a tick-borne coinfection.

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Spiritwalk
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I'm pretty sure I have leaky-gut too as I am intolerant to just about every food. I have an extremely limited diet. But when I eat the foods I have more popping in my joints. Some foods do now wreck my stomach too like salads and beans (which I used to be able to eat regularly). I'm intolerant to all dairy, gluten, eggs, many vegetables, red meat (as far as I can tell), rice and other foods.

So you answered my question. I was curious if the blood smear could be showing bacteria from leaky-gut instead of a tick-borne coinfection.

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S13
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In my opinion it can, so i wouldnt dismiss the option of gut bacteria showing up on your giemsa stain just yet.

I think you need to realize that a lot of what we see under the microscope is guesswork. Its like what this guy says in his blog:
http://lymemd.blogspot.nl/2013/09/blood-smear-of-blos-from-our-office-lab.html
They are mystery bugs. No more, no less.

Even the document i posted earlier has a lot of assumptions and is based on the opinion of just one doctor. He admitted later that some of what was shown in this document could actually be protomyxzoa instead of babesia. So yet another mysterybug...


If foods like vegetables (especially fiber and prebiotic foods like onions, garlic, leeks, beans etc) cause trouble then its probably because its feeding bad bugs in your gut. Dysbiosis is what you have then.

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