Dr. Felipe Petian, MD
Médecins Sans Frontières
Mediclinic City Hospital
Dubai Healthcare City
Beth P. Bell, MD, MPH
Centers for Disease Control and Prevention (CDC)
Office of Infectious Diseases (OID)
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
1600 Clifton Road Atlanta, GA 30329-4027 USA
Subject: Blood sample CDC-100576-DG
Date: August 5, 2016
Part I: Introduction
Mediclinic City Hospital of Dubai technicians collected specimen tagged with CDC Identification Number CDC-100576-DG. Said specimen was drawn from a subject suspected of carrying a new strain of avian flu. The investigating doctor’s initial hypothesis was that the blood was from person unknown from the country of Yemen. As required when dealing with a highly pathogenic avian influenza (HPAI), test runs and results were coordinated between local resources and the OID center in Atlanta, Georgia, USA.
The specimen was immediately noteworthy in its failure to coagulate. Blood exposed to air typically begins to lose its viscosity within eight to ten minutes. Initial testing indicated the specimen was chemically similar to blood serum, which lacks fibrinogen, the chief clotting agent in whole blood.
Approximately six hours after arriving at the lab, the specimen – by then divided into a number of subsamples for analysis – underwent a dramatic and unexplained morphological modification, transforming itself from a free-flowing liquid to a touch, non-water-soluble compound resembling Teflon.
The possibility exists that the specimen was contaminated prior to arriving at the lab with an unknown substance that led to the reaction. Further analysis is required to identify the change agent.
Unfortunately, the specimen’s sudden desiccation rendered it questionable whether enough DNA could be extracted for genetic matching to a subject. Further attempts to extract DNA from the specimen are continuing at this time.
Part II: Testing
A complete battery of hematological tests were underway on the sample at the time of desiccation. Full or partial tests were run in the following areas:
1. Blood typing (red-blood-cell antigen analysis)
2. Red and white blood cell counts
3. Hemoglobin concentration
4. Sedimentation rate
5. Blood cell structure
6. Characteristics relating to hemoglobin and other plasma proteins
7. Blood chemistry
8. Enzyme activity
The technical report, including copies of the autoanalyzer printouts, complete where available, accompanies this report.
Part III: Anomalies present in specimen
A number of abnormalities and irregularities were observed in the specimen:
A. Clotting factors
As previously mentioned, until the moment of dramatic desiccation the specimen exhibited characteristics similar to blood serum, from which the fibrinogen has been removed to prevent clotting during storage and transfusion. Indeed, no fibrinogen appeared present in the initial battery of tests. There are two possible explanations for the absence of fibrinogen in the sample:
1. The first possibility is that the fibrinogen had been removed in a blood lab. This seems unlikely, since it would mean the blood found did not come from a donor but was spilled from a plasma bag. Or, and even more unlikely scenario, perhaps the subject recently underwent a massive plasma transfusion. Both possibilities seem remote.
2. Another, more likely, explanation is that the absence of fibrinogen resulted from unknown biological actions in the donors who blood was commingled in the specimen. (See below)
A pronounced absence of thrombocytes was observed in the specimen. A typical adult has between 150,000 and 400,000 platelets per cubic millimeter of blood. Fewer than 10,000 platelets per cubic millimeter were present in the specimen. A platelet count of this level is typical indicative of a number of serious pathologies, including leukemia, thrombocytopenia, hemophilia, and Von Willebrand’s disease.
Data and analysis time were insufficient to identify the exact nature of the pathology responsible for the platelet count and other anomalies.
In summary, it appears likely that the individual whose blood was sampled suffered from a pathology that depleted his blood’s fibrinogen and thrombocyte levels. Further implications of such a condition are discussed in more detail below in this report.
B. Red cell malformation
Three types of erythrocytes, or red blood cells, were identified in the specimen:
1. Healthy adult red cells: Biconcave in shape, with no visible structures within the cell membrane, each lacking a nucleus, as is normal in mature erythrocyte cells. These cells measured approximately 7.8 micrometers. Hemoglobin – which transports oxygen in the blood – constituted about a third of each cell, as is typical in a healthy adult.
2. Diseased red cells: These erythrocytes were approximately the size of the healthy cells, but exhibited an abnormal elongating similar to that present in sickle-cell anemia. The abnormal cells resembled the “ghost” cells that dying red cells become after they lose their hemoglobin. Each of these cells contained a nucleus that appeared to be densely packed with genetic information. Since healthy red cells lose their nuclei as they mature, the presence of DNA in the nuclei of the diseased erythrocytes indications an unexplained abnormality in the donor’s capacity to produced healthy red blood cells. Additionally, these abnormal cells displayed an anomaly that is unmentioned in the medical literature. These DNA-rich “ghost” cells displayed a bluish tint, due, preliminary test results indicated, to the unexplained presence of hemocyanin. (See further discussion of hemocyanin below.)
3. Hybrid cells: These cells appear to be the result of an unknown biological action – potentially result from action of a retrovirus – in which abnormal erythrocytes inject the healthy red blood cells with foreign genetic information, resulting in the formation of a “super” erythrocyte. These mutant cells were larger than the typical normal red blood cell, measuring approximately 10 micrometers in diameter. Preliminary evidence indicated that the hemoglobin in the hybrid cells had superior oxygen-transport capabilities. A hemoglobin molecule contains four iron atoms, each binding with one oxygen molecule as the blood passed through the lungs. Subsequent tests – incomplete at the time the blood desiccated – indicated the hemoglobin in the hybrid red blood cells had a much higher affinity for oxygen than the normal cells, each molecule of hybrid hemoglobin capable of bonding with either oxygen molecules. These “super” erythrocytes, however, appeared to be extremely short-lived. The cell membrane of the hybrids was abnormally thing, perhaps due to the stretching required to contain the greater cell volume. This additional stress to the cell membrane seemed to make the hybrid cells especially prone to hemolysis – the rupture of cells, resulting in the hemoglobin dissolving into the plasma medium. A high percentage of the hybrid cells observed in the specimen evidenced premature coagulate necrosis and other morphological characteristics associated with cell death.
C. Blood Typing
A portion of the specimen was put in a centrifuge to separate the red blood cells from the plasma. Additionally, this action separated the healthy cells from the diseased and the hybrid cells. The division of red blood cells made it possible to identify the blood group among three distinct sets of cells. This, in turn, led to the discovery that the sample of blood was not from one but two distinct donors. Furthermore, blood grouping tests indicated that the hybrid cells were apparently formed from the healthy cells of Donor A after undergoing a retro-virus like action instigated by the diseased cells of Donor B.
Blood cells are broken into four major groups according to the antigen molecules attached to the cells. These common types are A, B, AB, and O. The healthy cells tested to be type A. The damaged cells possessed the antigen properties of group B. The hybrid cells proved to be type AB.
Although the blood group of the hybrid cells could indicate the presence of a third donor, it is my opinion, based upon the other available test data indicating the action of the B-type cells against the A-type cells, that the AB hybrid cells are a result of the reaction, heretofore unobserved in the medical literature, of the B cells against the A cells.
This hypothesis is strengthened by the consideration that the homicide victim had type A blood. Further evidence supporting this hypothesis is found in the fact that the AB cells had a very weak antigen reaction – so weak that the blood group was only able to be identified using the lab’s most sensitive equipment. Although confirmation requires further testing, it appears that the antigens in the AB cells are so mild that the specimen could be transfused into virtually any recipient without provoking the adverse reaction common to mismatched transfusions.
D. Other anomalies observed in the specimen
Other unusual pathologies among the diseased cells in the specimen were observed:
1. The low density of red cells in the B donor was indicative of severe polycythemia.
2. A blue pigment known as hemocyanin, noted above, was isolated in the damaged cells. This pigment, which is blue because of its copper content, has not been observed before in the hemoglobin of human specimens. (Human blood gets its distinctive red coloration from its iron content.) Hemocyanin is typically found in crustaceans and other invertebrates with “open” blood systems, and is not especially efficient at transporting oxygen. The presence of hemocyanin in the unhealthy cells remains unexplained, and has never before been noted in medical literature.
3. High protein count. The plasma in the sample was remarkable for its protein content. Instead of the usual 6% to 8% protein found in mammalian blood, the aggregate sample was 75% water and 25% protein.
4. Abnormal pH. The pH of healthy blood is acidic. The sample, however, was a flat neutral balance between acidic and alkaline, at 7.000
5. Elevated globulin. Globulins are plasma proteins that fight disease and toxins. Globulins were present in radically elevated levels in the specimen, indicating either the presence of a massive, potentially lethal infection or a pathology such as leukemia. It is possible that, given the unique structure of the hybrid red cells, Donor B possesses other undescribed physiological advances, including an extraordinary immune system, as evidenced by the globulin level.
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