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Ann Hematol Oncol. 2017; 4(5): 1151.
Erythrophagocytosis by Neutrophils in Paroxysmal Cold Hemoglobinuria
Sampagar A¹, Bartakke S²*, Lukade U³ and Sethuratnam S³
¹Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, India
¹Department of Clinical Hematology, Aditya Birla Memorial Hospital, India
³Department of Pathology, Aditya Birla Memorial Hospital, India
*Corresponding author: Sandip Bartakke, Department of Clinical Hematology, Aditya Birla Memorial Hospital, Pune, India
Received: April 12, 2017; Accepted: April 27, 2017; Published: May 17, 2017
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Paroxysmal Cold Hemoglobinuria (PCH) is the most common cause of acute autoimmune hemolytic anaemia in children [1,2]. The presence of marked erythrophagocytosis by neutrophils is a relatively rare observation on blood smears, but it is a prominent feature of PCH [3-5]. This case highlights the necessity for clinicians to be aware of the importance of erythrophagocytosis in diagnosis of PCH.
A 4-year-old boy presented with 4 days history of fever, jaundice and dark colored urine. On examination, he had pallor and icterus. A complete blood count was remarkable for haemoglobin of 41 gm/l, a white cell count of 27.1 x109/l and a platelet count of 367x109/l. The reticulocyte count was 2%. Serum lactate dehydrogenase was significantly elevated at 4700 U/L. His serum creatinine was 2.0 mg/ dl and urine analysis showed presence of hemoglobin.
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The peripheral blood smear showed occasional spherocytes and neutrophilic leucocytosis. Approximately 22% of neutrophils showed erythrophagocytosis. The direct antiglobulin test was strongly positive with complement and was negative with polyspecific antihuman globulin. The above laboratory results were suggestive of intravascular haemolysis due to cold-reactive autoantibody. The diagnosis of PCH was confirmed by positive Donath- Landsteiner antibody test.
References
- Weerakkody RM, Ranasinghe NN, Sivagnanam FG. A case of paroxysmal cold haemoglobinuria following chickenpox. Ceylon Med J. 2010; 55: 96.
- Mukhopadhyay S, Keating L, Souid AK. Erythrophagocytosis in paroxysmal cold hemoglobinuria. Am J Hematol. 2003; 74: 196-197.
- Chandrashekar V, Soni M. Florid Erythrophagocytosis on the Peripheral Smear. J Lab Physicians. 2012; 4: 59-61.
- Heddle NM. Acute paroxysmal cold hemoglobinuria. Transfus Med Rev. 1989; 3: 219-229.
- Garratty G. Erythrophagocytosis on the peripheral blood smear and paroxysmal cold hemoglobinuria. Transfusion. 2001; 41: 1073-1074.
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