Sultan Sadia, Irfan Syed Muhammad
Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Acta Med Iran. 2017 Jun;55(6):408-410.
Leukopenia secondary to leukocytic agglutination is caused by an ethylene diamine tetra acetic acid (EDTA) which may appear in both benign and malignant states. Ethylene diamine tetra acetic acid induced platelets clumping in peripheral blood has been well established, but invitro leukocytic aggregation is very rarest hematological finding. Pseudo-leukopenia resulting from leukoagglutinins has been reported in the cirrhotic state, infections, autoimmune disorders, uremia, in immunosuppressed state or in various malignancies. Though the condition seems to be benign but very important to be detected as these artifactual findings lead to unnecessary investigations and remarkably changed the overall management plan. Here we report the case of a young patient with this rare finding who was admitted to our hospital with progressive labor pains. The analysis of ethylene diaminetetraacetic acid (EDTA), anticoagulated blood was done on automated hematology analyzer reveals leukopenia. The peripheral smear examination revealed multiple aggregates of leukocytes. On repeat sampling in citrate anticoagulant, the complete blood count showed total leukocytic count of 16.5x109/L with absolute neutrophilic count of 11.5x109/L. This is a rare case of spurious leukopenia secondary to in-vitro leukocytic agglutination provoked by EDTA anticoagulant.
白细胞凝集继发的白细胞减少是由乙二胺四乙酸（EDTA）引起的，它可出现在良性和恶性状态。乙二胺四乙酸诱导外周血中血小板聚集已得到充分证实，但体外白细胞聚集是极为罕见的血液学发现。由白细胞凝集素导致的假性白细胞减少已在肝硬化状态、感染、自身免疫性疾病、尿毒症、免疫抑制状态或各种恶性肿瘤中被报道。尽管这种情况看似良性，但因其这些人为假象会导致不必要的检查并显著改变整体治疗方案，所以检测出来非常重要。在此，我们报告一例有这一罕见发现的年轻患者，该患者因进行性宫缩痛入院。对乙二胺四乙酸（EDTA）抗凝血液在自动血液分析仪上进行分析显示白细胞减少。外周血涂片检查发现多个白细胞聚集体。在使用枸橼酸盐抗凝剂再次采样时，全血细胞计数显示白细胞总数为16.5×10⁹/L，中性粒细胞绝对计数为11.5×10⁹/L。这是一例由EDTA抗凝剂引发体外白细胞凝集继发的假性白细胞减少的罕见病例。
