Related Experiment Video
Updated: Aug 8, 2026
Granulocyte-dependent Autoantibody-induced Skin Blistering
Published on: October 12, 2012
[Pseudoleukocytosis in cryoglobulinemia type I]
H H Wöltjen1, E Hansmann, K Bremer
1Abteilung für Hämatologie und Onkologie, Augusta-Kranken-Anstalt Bochum.
Insights
A man
Area of Science:
- Hematology
- Immunology
- Dermatology
Background:
- A 54-year-old man presented with persistent leukocytosis of unknown origin.
- He later developed painful, transient cyanosis in his fingers, suggesting an underlying condition.
Observation:
- Further symptoms included acral hemorrhages after cold exposure.
- Laboratory tests revealed monoclonal IgG-kappa immunoglobulin, a positive antinuclear antibody test, and high cryoglobulin levels (800 mg/dl).
Findings:
- The initial leukocytosis was identified as a pseudoleukocytosis artifact caused by cryoglobulinemia.
- Treatment with chlorambucil, prednisolone, and interferon alpha-2b successfully reduced cryoglobulin levels to 150 mg/dl.
Implications:
- This case highlights the importance of considering cryoglobulinemia in patients with unexplained leukocytosis and acral vascular events.
- Effective management of cryoglobulinemia can prevent recurrence of severe symptoms like cyanosis and hemorrhage.
Abstract:
During routine clinical and laboratory examinations of a symptom-free 54-year-old man a leukocytosis was repeatedly noted, but no cause found. 11 months later a painful spontaneously disappearing cyanosis occurred in two fingers of his right hand. Serum analysis demonstrated monoclonal type IgG-kappa immunoglobulin and an antinuclear antibody titre of 1:160. Skin biopsy suggested scleroderma. 4 months later, after exposure to cold, extensive acral haemorrhages occurred. Serum cryoglobulin concentration in serum was found to be 800 mg/dl. Comparative manual and electronic counts on warm and cooled blood identified the previously diagnosed leukocytosis as a typical artefact associated with cryoglobulinaemia. Treatment with chlorambucil (10-20 mg/d) and prednisolone (25 mg/d), for 14 days every 4 weeks, and finally interferon alpha-2b (5 mill. IU/d) reduced the cryoglobulin concentration to 150 mg/dl. Acral cyanosis and haemorrhages have not recurred since then. No cause of the cryoglobulinaemia has been found.
