Pseudoleukocytosis Due to Cryoprotein Crystals

Taft, Edwin G.; Grossman, Jay; Abraham, George N.; Leddy, John P.; Lichtman, Marshall A.

doi:10.1093/ajcp/60.5.669

Cited by 26 publications

(11 citation statements)

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“…Spurious Hb values have been reported in some instances, and several mechanisms are proposed to explain these abnormal findings. In some cases spuriously high Hb values were related to a mechanism similar to that described above for immunoglobulins (Taft et al. , 1973; Cornbleet, 1983) or to the disturbance of light transmittance, whereas in other cases a slight decrease of both Hb measurement and RBC count was related to a flow anomaly (Taft et al.…”

Section: Haemoglobin Rbc Count and Rbc Parametersmentioning

confidence: 88%

“…The presence of cryoglobulin was first reported as causing erroneous WBC counts (Emori, Bluestone & Goldsberg, 1973; Taft et al. , 1973; Haeney, 1976; Gulliani, Hyun & Gabaldon, 1977), but it also leads in many instances to spuriously elevated PLT counts, and at times to altered RBC counts or Hb measurements (cf., see Fohlen‐Walter et al.…”

Section: White Blood Cellsmentioning

confidence: 99%

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Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, haemoglobin, red cell indices and reticulocytes

Zandecki

Geneviève

Gérard

et al. 2007

Int J Lab Hematology

153

133

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S U M M A R YHaematology analysers provide quick and accurate results in most situations. However, spurious results, related either to platelets (part I of this report) or to other parameters from the cell blood count (CBC) may be observed in several instances. Spuriously low white blood cell (WBC) counts may be observed because of agglutination in the presence of ethylenediamine tetra-acetic acid (EDTA). Cryoglobulins, lipids, insufficiently lysed red blood cells (RBC), erythroblasts and platelet aggregates are common situations increasing WBC counts. In most of these instances flagging and/or an abnormal WBC differential scattergram will alert the operator. Several situations lead to abnormal haemoglobin measurement or to abnormal RBC count, including lipids, agglutinins, cryoglobulins and elevated WBC counts. Mean (red) cell volume (MCV) may be also subject to spurious determination, because of agglutinins, excess of glucose or salts and technological considerations. In turn, abnormality related to one measured parameter will lead to abnormal calculated RBC indices: mean cell haemoglobin content (MCHC) is certainly the most important RBC indices to consider, as it is as important as flags generated by the haematology analysers (HA) in alerting the user to a spurious result. In many circumstances, several of the measured parameters from CBC may be altered, and the discovery of a spurious change on one parameter frequently means that the validity of other parameters should be considered. Sensitive flags now allow the identification of several spurious counts, but only the most sophisticated HA have optimal flagging and more simple HA, especially those without a WBC differential scattergram, do not possess the same sensitivity for detecting anomalous results. Reticulocytes are integrated now into the CBC in many HA, and several situations may lead to abnormal counts.

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Section: Haemoglobin Rbc Count and Rbc Parametersmentioning

confidence: 88%

Section: White Blood Cellsmentioning

confidence: 99%

Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, haemoglobin, red cell indices and reticulocytes

Zandecki

Geneviève

Gérard

et al. 2007

Int J Lab Hematology

153

133

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“…Pseudoleukocytosis due to cryoglobulinemia is a welldescribed, but still unfamiliar event (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). There are few records about this phenomenon in the hematologic literature (2,3,11), and it is generally not mentioned in the hematology textbooks.…”

Section: Discussionmentioning

confidence: 99%

“…In automated blood cell counting systems, cryoglobulinemia has been reported to cause spuriously elevated platelet and/or white blood cell (WBC) counts due to temperature-dependent protein precipitates that are falsely interpreted as blood cells at room temperature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Upon heating to 37°C, these blood counts decrease to normal levels as cryoproteins dissolve.…”

mentioning

confidence: 99%

Pseudospontaneous Platelet Aggregation and Spuriously Elevated Blood Cell Counts in Cryoglobulinemia

Büyükaşık

ileri

Haznedaroğlu

et al. 1998

Clin Appl Thromb Hemost

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Cryoglobulinemia has been reported sometimes to cause false elevation in platelet and/or leukocyte counts in automated blood cell counters due to temperature-dependent protein precipitates that are falsely interpreted as blood cells at room temperature. Upon heating to 37°C, these blood counts decrease to normal levels as cryoproteins dissolve. Therefore, cryoglobulins could theoretically lead to erroneous diagnosis of spontaneous platelet aggregation in platelet counting and tur-bidometric methods as platelet count and turbidity of the platelet-rich plasma decrease at 37°C, respectively. Here, the event of pseudospontaneous platelet aggregation is confirmed in two patients with mixed cryoglobulinemia, both had spuriously elevated blood cell counts.

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“…These findings confirm those of other workers who have shown spurious leucocytosis in cryoglobulinaemic patients (Emori et al, 1973). Taft et al (1973) described one patient with a spontaneously crystallizing paraproteinaemia in whom the leucocytosis was due to needle crystals of cryoglobulin appearing when blood was stored at 24°C but did not occur even after refrigeration to 4°C for 6 hours. This appeared to be related to the size and shape of the crystals produced.…”

Section: Discussionmentioning

confidence: 99%

Erroneous values for the total white cell count and ESR in patients with cryoglobulinaemia.

Haeney¹

1976

J Clin Pathol

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SYNOPSIs Temperature dependent fluctuations in the erythrocyte sedimentation rate were noted during the assessment of one patient with symptomatic cryoglobulinaemia. Two patients with this condition were found to have erroneously high leucocyte counts when estimated by the Model S Coulter Counter. The artefact was directly related to the degree of exposure to cold before the estimation was performed and appeared to be due to the formation of microaggregates of cryoglobulin and fibrinogen.Cryoglobulins are cold-precipitable immunoglobulins which redissolve at warm temperatures. These serum proteins have been described in a variety of clinical conditions in man (Ritzman and Levin, 1961), but particularly in individuals with various infections, autoimmune and neoplastic disorders (Mackay et al, 1956;Meltzer et al, 1966;Barnett et al, 1970).In assessing one patient with symptomatic cryoglobulinaemia, fluctuations in the erythrocyte sedimentation rate were noted. In addition, the same patient demonstrated erroneously high leucocyte counts when the Model S Coulter Counter was used but normal values when counting was performed by hand. The variations in ESR and WBC counts were found to be temperature dependent and thus susceptible to environmental conditions. A further patient with symptomatic cryoglobulinaemia also showed similar changes in leucocyte counts.

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Pseudoleukocytosis Due to Cryoprotein Crystals

Cited by 26 publications

References 0 publications

Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, haemoglobin, red cell indices and reticulocytes

Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, haemoglobin, red cell indices and reticulocytes

Pseudospontaneous Platelet Aggregation and Spuriously Elevated Blood Cell Counts in Cryoglobulinemia

Erroneous values for the total white cell count and ESR in patients with cryoglobulinaemia.

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