A 78-years-old lady presented with intermittent fever for 1 month, twitching of the limbs, urinary incontinence and hematuria for 1 day. Laboratory tests showed hemoglobin of 89 g/L, total leukocyte count-21.83 × 109/L with 85% neutrophils. Total bilirubin (53.49 μmol/L) and indirect bilirubin (32.08 μmol/L) were elevated. The peripheral blood smear showed erythrophagocytosis by neutrophil and rare monocytes (Fig. 1a–c) as well as Dohle bodies and vacuolar degeneration within neutrophils (Fig. 1d).
Fig. 1.
a–c Showed the erythrophagocytosis by neutrophil and monocyte on peripheral blood smear; d showed the typical Dohle bodies (red arrow) and vacuolar degeneration within neutrophils showing erythrophagocytosis on smear (Wright–Giemsa stain, 1000 ×) (color figure online)
Direct Coombs test was positive along with antibody free and release tests confirming the presence of autoimmune hemolytic anemia (AIHA). Computerised tomography showed bilateral pleural effusion with mediastinal and axillary lymphadenopathy.
It could be inferred that the preceding infection was the cause of AIHA in this case. Erythrophagocytosis by neutrophils and monocytes is an uncommon phenomenon. It has been documented in some hematological malignancies and hemolytic anemia with parvovirus B19 infection [1]. Erythrophagocytosis is enhanced by inflammation and represents the clearance of RBCs by IgG in AIHA [2]. This case highlights that erythrophagocytosis may be the initial pointer to the diagnosis of AIHA especially in patients with preceding infection.
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Author Lian, Author Guo, and Author Hao declare that they have no conflict of interest.
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Mingwei Guo, Email: guomingwei1994@163.com.
Jihong Hao, Email: haojihong2003@163.com.
References
- 1.Puigví L, Baumann T, Fernández S, Castro P, Pereira A, Merino A. Massive erythrophagocytosis by peripheral monocytes and neutrophils in parvovirus-B19 autoimmune hemolytic anemia. Ann Hematol. 2017;96(5):881–882. doi: 10.1007/s00277-017-2957-2. [DOI] [PubMed] [Google Scholar]
- 2.Richards AL, Hendrickson JE, Zimring JC, Hudson KE. Erythrophagocytosis by plasmacytoid dendritic cells and monocytes is enhanced during inflammation. Transfusion. 2016;56(4):905–916. doi: 10.1111/trf.13497. [DOI] [PubMed] [Google Scholar]