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[Spurious macrocytosis associated with cold agglutinins: report of two cases]

B Zdziarska1, M Paśnicki

  • 1Kliniki Hematologii Instytutu Chorób Wewnetrznych Pomorskiej Akademii Medycznej.

Insights

Spurious macrocytosis, a false red blood cell size increase, can occur due to cold agglutinins. This phenomenon was observed in patients with lymphoma and Klebsiella pneumoniae pneumonia, affecting automated blood cell counts.

Area of Science:

  • Hematology
  • Clinical Pathology

Background:

  • Automated hematology analyzers are crucial for accurate blood cell counting.
  • Macrocytosis, an increase in red blood cell size, can indicate various medical conditions.
  • Cold agglutinins are antibodies that cause red blood cells to clump at low temperatures.

Observation:

  • Two patients presented with unexpectedly high red blood cell indices (macrocytosis).
  • Both patients had high titers of cold agglutinins in their blood.
  • In vitro microagglutination of erythrocytes was observed.

Findings:

  • Cold agglutinins induced erythrocyte microagglutination, leading to falsely elevated mean corpuscular volume (MCV).
  • This phenomenon mimicked true macrocytosis, causing spurious macrocytosis.
  • The automated blood cell counting results were inaccurate due to this interference.

Implications:

  • Awareness of cold agglutinin interference is critical for accurate diagnosis.
  • Clinicians should consider cold agglutinins when encountering unexplained macrocytosis.
  • Further investigation may be needed to differentiate spurious from true macrocytosis in affected patients.

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