A Case of Coombs Negative Hemolytic Anemia with Rosette Formation of Autologous Red Cells around Neutrophils, and with Erythrophagocytosis by Neutrophils

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  • 好中球に特異的に自己赤血球によるロゼット形成及び赤血球貪食像が観察されたクームス陰性溶血性貧血の1例
  • コウチュウキュウ ニ トクイテキ ニ ジコ セッケッキュウ ニ ヨル ロゼット ケイセイ オヨビ セッケッキュウドンショクゾウ ガ カンサツ サレタ クームス インセイ ヨウケツセイ ヒンケツ ノ 1レイ

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A 37-year-old female of acquired hemolytic anemia with negative Coombs test was reported. She was admitted to our hospital on September 2, 1977, with the symptoms of anemia which had occurred in the first trimester of her first pregnancy.<br>She was markedly anemic and jaundiced. Peripheral blood examination revealed RBC 109×104/mm3, Hb 3.5g/dl and reticulocyte 14.6%. The sternal marrow showed a marked erythroid hyperplasia.<br>Although a diagnosis of autoimmune hemolytic anemia was suspected, repeated Coombs tests were negative. In the peripheral blood film, rosette formation of autologous red cells around neutrophils and erythrophagocytosis by neutrophils were detected. These rosette formation and erythrophagocytosis were never found in lymphocytes, nor in monocytes. The same phenomenon was observed in the peripheral blood smear of the male infant who was delivered on November 2, 1977.<br>The rosette formation was found in 70 to 90% of neutrophils when blood was incubated for 2 hours, and not affected by anticoagulants and temperature of the incubation. On the other hand, erythrophagocytosis was more frequently detected in heparinized blood film than in EDTA-anticoagulated blood smear, especially when incubated at 25°C.<br>From study of transmission electron microscopy, this rosette resembled Fc rosette of lymphocyte. The relationship between rosette formation, erythrophagocytosis and hemolytic anemia was discussed.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 20 (1), 40-48, 1979

    The Japanese Society of Hematology

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