Florid Erythrophagocytosis on the Peripheral Smear

Chandrashekar, Vani; Soni, Mamta

doi:10.4103/0974-2727.98679

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…However, there are several case reports of patients with hemolytic conditions such as AIHA in which circulating neutrophils are identified that carry internalized RBCs. [10][11][12][13][14][15][16][17] Nevertheless, this phenomenon has remained unexplained, as it seems highly unlikely that neutrophils capture RBCs in the bloodstream where the shear force is markedly high. Furthermore, it is not known whether neutrophils, under these and other conditions, have a substantial contribution to erythrocyte clearance in humans.…”

Section: Introductionmentioning

confidence: 99%

Human and murine splenic neutrophils are potent phagocytes of IgG-opsonized red blood cells

et al. 2017

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Key Points• In steady state, where no IgGs against RBCs are present, macrophages are the primary phagocytes of RBCs.• In conditions where RBCs are IgGopsonized, neutrophils can have a major effect on RBC clearance.Red blood cell (RBC) clearance is known to occur primarily in the spleen, and is presumed to be executed by red pulp macrophages. Erythrophagocytosis in the spleen takes place as part of the homeostatic turnover of RBCs to remove old RBCs. It can be strongly promoted by immunoglobulin G (IgG) opsonization of RBCs, a condition that can occur as a consequence of autoantibody or alloantibody formation. The purpose of our study was to investigate which phagocytes are involved in IgG-mediated RBC clearance in the human spleen. We developed a highly specific in vitro assay to monitor RBC phagocytosis in total human splenocytes. Surprisingly, we have found that whereas homeostatic clearance of RBCs is primarily a task for splenic macrophages, neutrophils and, to a lesser extent, also monocytes can be a major factor in clearance of IgG-opsonized RBCs. Erythrophagocytosis by neutrophils is strongly dependent on the degree of opsonization of the RBCs. Additionally, the process is enhanced after blocking the "do not eat me" signal CD47 on the opsonized RBCs, which binds signal regulatory protein a, a myeloid inhibitory receptor that restricts phagocytosis. Moreover, RBCs isolated from autoimmune hemolytic anemia patients, opsonized by auto-IgGs, were shown to be readily phagocytosed by neutrophils. Finally, priming of neutrophils by inflammatory mediators such as tumor necrosis factor a and lipopolysaccharide further increases the magnitude of erythrophagocytosis. Collectively, our data suggest that neutrophils contribute significantly to the phagocytosis of antibody-opsonized RBCs, especially under inflammatory conditions. This indicates a hereto unanticipated contribution of neutrophils in RBC phagocytosis, especially under pathological conditions such as alloimmunization or autoimmunization.

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Section: Introductionmentioning

confidence: 99%

Human and murine splenic neutrophils are potent phagocytes of IgG-opsonized red blood cells

et al. 2017

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“…Erythrophagocytosis by neutrophils in peripheral smear though an uncommon finding, is a strong predictor towards the diagnosis of PCH (5). Erythrophagocytosis by neutrophils in peripheral smear has been reported rarely AIHA.…”

Section: Discussionmentioning

confidence: 97%

“…Chandrashekhar et al proposed that the presence of erythrophagocytosis in peripheral smear should alert the pathologist for a diagnosis of PCH. (5). Fadeyi EA reported two cases of PCH occurring in children and emphasized the presence of erythrophagocytosis as an important indicator of PCH (8).…”

Section: Discussionmentioning

confidence: 99%

“…Donath Landsteiner test (DL) is the gold standard diagnostic test. Presence of erythrocyte rosetting mostly by monocytes and massive erythrophagocytosis in peripheral smear has been reported very rarely in PCH (4)(5)(6). Here in we report a rare case of fatal PCH with extensive erythrocyte rosetting by neutrophils and erythrophagocytosis in an adult female.…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil Erythrophagocytosis and Neutrophil Erythrocyte Rosetting in Paroxysmal Cold Haemoglobinuria

Krishnappa¹,

Shankar²,

Kalmood³

et al. 2018

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“…The presence of marked erythrophagocytosis by neutrophils is a relatively rare observation on blood smears, but it is a prominent feature of PCH [3][4][5]. This case highlights the necessity for clinicians to be aware of the importance of erythrophagocytosis in diagnosis of PCH.…”

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confidence: 99%

Erythrophagocytosis by Neutrophils in Paroxysmal Cold Hemoglobinuria

Bartakke¹

2017

Ann Hematol Oncol

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Paroxysmal Cold Hemoglobinuria (PCH) is the most common cause of acute autoimmune hemolytic anaemia in children [1,2]. The presence of marked erythrophagocytosis by neutrophils is a relatively rare observation on blood smears, but it is a prominent feature of PCH [3][4][5]. This case highlights the necessity for clinicians to be aware of the importance of erythrophagocytosis in diagnosis of PCH.A 4-year-old boy presented with 4 days history of fever, jaundice and dark colored urine. On examination, he had pallor and icterus. A complete blood count was remarkable for haemoglobin of 41 gm/l, a white cell count of 27.1 x10 9 /l and a platelet count of 367x10 9 /l. The reticulocyte count was 2%. Serum lactate dehydrogenase was significantly elevated at 4700 U/L. His serum creatinine was 2.0 mg/ dl and urine analysis showed presence of hemoglobin.

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Florid Erythrophagocytosis on the Peripheral Smear

Cited by 9 publications

References 16 publications

Human and murine splenic neutrophils are potent phagocytes of IgG-opsonized red blood cells

Human and murine splenic neutrophils are potent phagocytes of IgG-opsonized red blood cells

Neutrophil Erythrophagocytosis and Neutrophil Erythrocyte Rosetting in Paroxysmal Cold Haemoglobinuria

Erythrophagocytosis by Neutrophils in Paroxysmal Cold Hemoglobinuria

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