1Haematology Department, Glasgow Royal Infirmary, and 2Haematology Department, Royal Hospital for. Sick Children, Glasgow. Simon J. Harrison1.
British Journal of Haematology, 2001, 113, 2
IMAGES IN HAEMATOLOGY
Erythrophagocytosis
A 3-year-old boy presented with sudden onset of pallor, jaundice and passing dark urine after being taken out into the cold to collect his brother from school. There was a history of a mild febrile illness throughout the previous day. His admission full blood count (FBC) showed a Hb 4´7 g/dl, white cell count (WCC) 18´5 109/l, platelet count 337 109/l, neutrophils 12´6 109/l, mean cell volume (MCV) 76´8 fl with reticulocyte count of 7 109/l (0´4%). The direct antiglobulin test was positive with a C3 coating. The blood film revealed red cell agglutination, microspherocytes and marked erythrophagocytosis by neutrophils and monocytes. Glandular fever screening test (GFST) was negative. The following day, the Hb had fallen to 3´3 g/dl, so he was transfused and started on steroids. A low titre cold agglutinin was identified and a Donath Landsteiner test was strongly positive. We were unable to demonstrate anti-P antibodies on cells or in serum. The patient responded to steroids promptly, and the picture was felt to be in keeping with paroxysmal cold haemoglobinuria. Erythrophagocytosis is common in this condition. 1
Haematology Department, Glasgow Royal Infirmary, and 2Haematology Department, Royal Hospital for Sick Children, Glasgow
