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  Table of Contents    
Year : 2021  |  Volume : 64  |  Issue : 1  |  Page : 223-224
Neutrophilic leukoaggregates––A rare hematological phenomenon

1 Department of Hematopathology, Care Hospitals, Hyderabad, Telangana, India
2 Department of Medical Oncology, Care Hospitals, Hyderabad, Telangana, India
3 Department of Hematology, Care Hospitals, Hyderabad, Telangana, India

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Date of Submission12-Dec-2019
Date of Decision15-Apr-2020
Date of Acceptance08-Jun-2020
Date of Web Publication8-Jan-2021

How to cite this article:
Sampath Kumar K J, Lal S, Kalpati K, Lingutla AK, Aribandi A, Sharma A. Neutrophilic leukoaggregates––A rare hematological phenomenon. Indian J Pathol Microbiol 2021;64:223-4

How to cite this URL:
Sampath Kumar K J, Lal S, Kalpati K, Lingutla AK, Aribandi A, Sharma A. Neutrophilic leukoaggregates––A rare hematological phenomenon. Indian J Pathol Microbiol [serial online] 2021 [cited 2022 Aug 16];64:223-4. Available from: https://www.ijpmonline.org/text.asp?2021/64/1/223/306544

Dear Editor,

Red cell agglutination and platelet agglutinations are well described, but neutrophilic leukoaggregates is uncommon. The exact reason for neutrophilic leukoaggregates is unknown, but this finding can rarely be seen in normal individuals but more commonly seen in infections, autoimmune conditions, lymphoproliferative neoplasms, liver disorders, and alcoholism.[1],[2] Spurious pseudoleukopenia can be seen in samples stored for more than 3 days and also in presence in cold agglutinins. We present here an occurrence of neutrophilic leukoaggregates in a case of 64-year-old male who diagnosed as B-cell nonHodgkin lymphoma.

A 64-year-old gentleman came to our hospital on 2nd December, 2019 for the treatment of B-cell nonHodgkin lymphoma. On history, he had diplopia, ptosis, and retro orbital pain in August 2019. Magnetic resonance imaging (MRI) was done outside, which was normal at that time. On clinical examination, he was found to have left nerve 3rd cranial nerve palsy with no other clinically palpable lymph nodes and organomegaly. He was given high-dose steroids outside the hospital with improvement, which lasted for 10 days. After 10 days there was a recurrence of symptoms. He was started again on Tab. Wysolone 70 mg/day with tapering doses. He noticed right neck swelling without any B symptoms. As there was no improvement on steroids, MRI was repeated, which suggested diffuse annular bulges – posterolateral disc osteophyte complexes at C3–C4 and C5–C6 levels causing mild sac compression and the impingement of bilateral neural foramina. A diffuse annular bulge at C6–C7 level caused mild thecal sac compression. Also found a well-defined nodular lesion in the posterior triangle of the neck on the right side along the posterior margin of sternocleidomastoid muscle – likely lymphnode. Right cervical lymph node biopsy was done, which reported as B-cell nonHodgkin lymphoma. Slides and blocks were reviewed in our hospitals along with bone marrow examination done as part of staging workup. The bone marrow study was normal. But there was an interesting finding of neutrophilic aggregates found on both peripheral blood and marrow slides [Figure 1]. We did a serological study for antibodies, which showed increased levels of IgM antibodies. After reviewing the relevant literature, we are of the opinion that neutrophilic leukoaggregates may be due to antibody-mediated factors.
Figure 1: (a and b): Neutrophilic aggregates 100 X and 400 X magnification respectively

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Neutrophilic leukoaggregate is a rare hematological phenomenon. It is a rare finding in a normal individual. Neutrophilic leukoaggregates may show variation with small aggregates consisting of less than 10 cells neutrophilic clumping or even more than 100 cells. Formyl-methionyl-leucyl-phenylalanine (synthetic chemotactic tripeptide), cytochalasin B, and high levels of extracellular calcium or phosphate enhanced this effect of leukoaggregation.[3] In addition, the calcium ionophore A23187 aggregated the cells. Aggregation induced by the chemotactic factor and calcium ionophore A23187 required extracellular calcium. This neutrophilic leukoaggregates is the result of IgM antibodies that act when ethylenediaminetetraacetic acid (EDTA) is used as an anticoagulant for blood collection.[4] These IgM antibodies are directed against membrane component of leukocytes especially neutrophils. At times these neutrophilic leukoaggregates are time dependant when immediate processing reduces the leukoagglutination.[5] Especially in the suspected cases of IgM paraproteinemia as these neutrophilic leukoaggregates are EDTA dependent, the blood sample should be drawn in either sodium citrate or heparin vacutainer tubers, which will reduce the formation of neutrophilic leukoaggregates.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Vinatier I, Capiod JC, Sassier P, Roussel B, Delobel J.Four cases of spuriously low WBC count due to in vitro leukocyte agglutination: Contribution of the hematology analyzer Coulter STKS in detecting this clinically misleading artefact. PatholBiol (Paris) 1994;42:775-80.  Back to cited text no. 1
Claviez A, Horst HA, Santer R, Suttorp M. Neutrophil aggregates in a 13-year-old girl: A rare hematological phenomenon. Ann Hematol 2003;82:251-3.  Back to cited text no. 2
O'Flaherty JT, Showell HJ, Becker EL, Ward PA. Substances which aggregate neutrophils. Mechanism of action. Am JPathol 1978;92:155-66.  Back to cited text no. 3
Bizzaro N. Granulocyte aggregation is edetic acid and temperature dependent. Arch Pathol Lab Med 1993;117:528-30.  Back to cited text no. 4
Yenson PR, Fleming A, Kaikov Y, Wadsworth LD. Combined neutrophil and erythrocyte agglutination in a 7-year-old boy. J PediatrHematolOncol 2007;29:664-5.  Back to cited text no. 5

Correspondence Address:
K J Sampath Kumar
Consultant Hematopathology, Care Hospitals, Hyderabad, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_957_19

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