Desde hacía unos años el avance de nuestra sociedad parecía estar viento en popa. Los datos del desarrollo económico se iban recuperando poco a poco tras el jarro de agua fría que dejó la anterior crisis. Y así, fuera de la previsión del mejor analista financiero, y de repente, irrumpe en la marcha normal de la rutina del mundo una crisis sanitaria sin precedentes desde hacía varias generaciones. El motor económico del progreso queda relegado a un segundo plano, eclipsado por la salud, que es ahora el viento de proa que impone una zona muerta en la inercia del avance mundial.

Figure 1. Set of kidney stones of the same patient (a), examined individually according to their appearance (b, c and d). Typical calcium oxalate monohydrate kidney stone (e). Several kidney stones of 388.5 mg corresponding to the same patient (a). Depending on their appearance three kidney stones are distinguised: the first is brown, smooth, rounded surface and hard fracture consistency (b). The second is light brown, smooth, rounded surface and hard fracture consistency (c). The third is grayish, with a rough surface, and intermediate hardness (d).

Kidney stones belong to a 54-year-old patient with surgical history of multiple renal lithiasis, who presents an episode of left obstructive uropathy with infection due to a new event of lithiasis. She required a double J stent placement.

Figure 1. Smear of peripheral blood with severe Rouleaux and a plasmatic cell in the center of the image.

This study reports the case of a 67 year old male patient who went to the emergency department with a three week low back pain wich did not yield with conventional analgesia. The most relevant data of basic biochemistry and blood count tests performed upon patient’s arrival are present in Table 1.

Figure. Appearance of the liquid before centrifugation (A), after centrifugation (B) and sparkling supernatant (C and D).

A 53-year-old patient with a diagnosis of stage IIIC high-grade serous carcinoma of the ovary, admitted to surgery for peritoneal carcinomatosis secondary to it, for biopsy and treatment of hyperthermic intraperitoneal chemotherapy (HIPEC).

In the course of the intervention, a large amount of milky-looking ascitic fluid is found, which is evacuated to a total of 4.9 liters. When in doubt about the origin and composition of the same, they send the sample for analysis to the laboratory.

Figure 1. An image of a peripheral blood smear is presented, stained with fast panoptic, of a 92 years old patient with essential thrombocythemia (ET), JAK2 positive, diagnosed in 2008 with a score in the Dynamic International Prognosis Score System (DIPSS) of 5 (high risk).

The patient goes to the emergency with a clinical profile of tiredness, dizziness, fatigue, and abdominal pain. In the analytical highlights the presence of normochromic normocytic anemia, with thrombopenia, neutrophilic leukocytosis and a significant increase in LDH values (Hemoglobin: 8,5 g/dL, MCV: 88,8 fL, MCH: 26,3 pg, platelets: 34.000/mm³, leukocytes: 103.300/mm³, neutrophils: 71.160/mm³, LDH: 855 UI/L). Studying the blood smear showed dysplastic neutrophils with segmentation and hypodesgranulation abnormalities; 61% of medium-sized blasts, with a nucleus that may have an unclear nucleolus and sometimes a kidney-shape configuration, moderate-sparse cytoplasm, without Auer canes and myeloperoxidase positive in 2-3% of blasts. In addition, marked anisopoiquilocitosis and anisochromia were observed.

Figure. Atypical crystals of calcium oxalate monohydrate in urine caused by ethylene glycol poisoning.

A 52-year-old female is admitted to intensive care unit (ICU) after being found on her floor's home, she presents decreased level of consciousness. Her blood profile performed at admission shows a severe metabolic acidosis with pH <7 and lactic acid >20_mmol/L. Crystals of calcium oxalate monohydrate are observed in the urine sediment. Osmolal gap is determined (88 mOsm/kg), so that treatment with intravenous ethanol and hemodialysis is initiated. Sample is sent to an outside laboratory to determinate levels of methanol, ethylene glycol and salicylates; ethylene glycol was positive with 2,68 g/L.