Cold-Induced Pseudoneutropenia in Human Immunodeficiency Virus Infection: First Case Report and Review of Related Articles

Abstract

Cold agglutination of erythrocyte or platelet aggregation in vitro due to cold agglutination are well recognized and extensively studied. Aggregation of leucocyte is a rare hematological phenomenon resulting in a spurious low leucocyte count performed using automated hematology analyzers. Aggregation of leucocyte may relate to malignancy, lymphoproliferative disorders, infection, liver diseases, or autoimmune disorders. It is believed that the mechanism of leucocyte aggregation is mainly related to the use of ethylene diamine tetraacetic acid (EDTA) anticoagulant or is temperature-mediated. Leucoagglutination is associated with either a spurious leucopenia or an underestimation of leucocytosis. This can adversely affect management decisions in terms of unnecessary management of leucopenia or ignoring a leucocytosis that may be indicator of an underlying serious disease. To our knowledge, we report here for the first time the occurrence of pseudoneutropenia due to temperature-mediated, EDTAindependent neutrophil agglutination in adult with human immunodeficiency virus infection.

Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution

“…Clumps of granulocytes ( Fig. 3 ) have occasionally been observed in the blood smears of patients with infection, cirrhosis, autoimmune disorder, uremia, immunosuppression, or various malignancies [ 21 - 26 ]. Clumps of lymphocytes have occasionally been observed in the blood smears of patients with lymphoproliferative disorders [ 21 , 22 ].…”

“…c. Incubate the EDTA-anticoagulated blood specimen at 37°C for 10 min and rerun the analysis [ 20 , 22 , 23 ].…”

“…The MCV, MCH, MCHC, and RDW values do not require correction. The use of alternative anticoagulants, such as acid citrate dextrose and citrate-pyridoxal 5´-phosphate-Tris, to collect blood specimens has also been recommended [ 23 ].…”

“…Clumps of lymphocytes have occasionally been observed in the blood smears of patients with lymphoproliferative disorders [21,22]. The cause of WBC clumping may be multifactorial, including the presence of leukoagglutinins, which may be cold-reactive (at temperatures < 37°C) and/or EDTA-dependent [19,[22][23][24][25][26][27]. To obtain reliable results, one may attempt any or all of the following approaches because none of them yields reliable results in all cases [19][20][21][22][23][24][25][26][27].…”

“…The cause of WBC clumping may be multifactorial, including the presence of leukoagglutinins, which may be cold-reactive (at temperatures < 37°C) and/or EDTA-dependent [19,[22][23][24][25][26][27]. To obtain reliable results, one may attempt any or all of the following approaches because none of them yields reliable results in all cases [19][20][21][22][23][24][25][26][27].…”