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Case report: immunoglobulin M-mediated, temperature-dependent neutrophil agglutination as a cause of
M E Carr1, J Whitehead, P Carlson
1Coagulation Special Studies Laboratory, Department of Internal Medicine, Medical College of Virginia, Richmond, USA.
Abstract:
The authors report the case of a 77-year-old man in whom intermittent neutropenia developed during a prolonged hospitalization. Laboratory records revealed wide variations in the patient's routine leukocyte counts. Examination of the peripheral smear revealed clumps of 2-3 polymorphonuclear leukocytes throughout the slide and large aggregates (> 50 cells) along the smear edges. Neutrophil clumping also was observed in blood anticoagulated with citrate or heparin. Replacement of patient plasma with saline prevented agglutination. Addition of patient plasma or serum to normal cells induced neutrophil agglutination. Holding the patients blood at 37 degrees C prevented agglutination, which occurred spontaneously and more exuberantly as the temperature was reduced to 22 degrees C. Flow cytometry revealed immunoglobulin M on neutrophil surfaces. Spontaneous agglutination resolved 6 months after resection of the patient's subsequently diagnosed colon cancer. This is the first report of immunoglobulin M-induced neutrophil clumping occurring in the setting of malignancy, and the first reported immunoglobulin M not to require ethylenediaminetetraacetic acid as a cofactor for agglutination.
Insights
A rare case of intermittent neutropenia was linked to immunoglobulin M-induced neutrophil clumping in a hospitalized patient. This condition resolved after colon cancer treatment, highlighting a novel association.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- A 77-year-old male patient experienced intermittent neutropenia during extended hospitalization.
- Routine leukocyte counts showed significant variations.
Observation:
- Peripheral blood smears revealed neutrophil clumping.
- Agglutination occurred in blood anticoagulated with citrate or heparin.
- Patient plasma or serum induced agglutination in normal neutrophils, while saline prevented it.
Findings:
- Neutrophil clumping was temperature-dependent, worsening at lower temperatures (22°C vs. 37°C).
- Flow cytometry identified immunoglobulin M (IgM) on neutrophil surfaces.
- The condition resolved six months post-colon cancer resection.
Implications:
- This is the first report of immunoglobulin M-induced neutrophil clumping associated with malignancy.
- The identified IgM did not require ethylenediaminetetraacetic acid (EDTA) as a cofactor for agglutination, a novel finding.