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Cryoglobulin-induced RBC agglutination

View larger version (129K): [in this window] [in a new window]   Figure 1. A peripheral smear prepared at room temperature from a patient with acute hepatitis secondary to hepatitis C virus is shown. Her CBC included a hemoglobin of 12.2g/dl, RBC count of 0.78 x 106/ul, hematocrit of 8.4%, MCV of 107.7 fl, MCH of 156 pg and a MCHC of 145g/dl. Extensive RBC agglutination secondary to the presence of Type II cryoglobulins is evident in this low magnification image. The cryoglobulin is composed of polyclonal IgG and monoclonal IgM complexes. The falsely abnormal RBC indicies obtained on the automated hematology analyzer are the result of RBC clumping resulting in a marked decrease in the number of RBCs that are counted.

View larger version (135K): [in this window] [in a new window]   Figure 2. A higher magnification of the previous image is shown.

View larger version (108K): [in this window] [in a new window]   Figure 3. At this higher magnification areas of rouleaux formation are evident in addition to the marked regions of agglutinated RBCs. When the blood sample was heated to 37°C and a repeat CBC was performed, the RBC count was 3.79M/ul, the MCV was 90fl, the MCH was 30.9 pg, and the MCHC was 34.3 g/dl.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections Screening for infectious disease Related Image Bank Image Sets Related ASH Education Book Article Social Bookmarking                   What's this?