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Case Reports
. 2019 Oct 16;3(4):517-522.
doi: 10.1016/j.mayocpiqo.2019.07.001. eCollection 2019 Dec.

Post-Transfusion Hemophagocytosis Without Hemophagocytic Lymphohistiocytosis

Eric McGinnis  1 , Nadia Medvedev  1   2 , Mikhyla J Richards  3   4 , Luke Y C Chen  2   4 , Michelle P Wong  1   3
Affiliations
Case Reports

Post-Transfusion Hemophagocytosis Without Hemophagocytic Lymphohistiocytosis

Eric McGinnis et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Hemophagocytosis refers to ingestion of hematopoietic elements or mature blood cells by another cell, typically by cells conventionally associated with phagocytic capacity. Although the finding of hemophagocytosis as a prominent feature in a patient's bone marrow might prompt consideration of a hemophagocytic syndrome (HPS) such as hemophagocytic lymphohistiocytosis (HLH) in a clinician's or pathologist's differential diagnosis, this morphologic feature can be nonspecific in the absence of other clinical and laboratory features of pathologic immune activation, which is the sine qua non of HPS/HLH. We describe three patients whose clinical presentations included transfusion-dependent anemia and whose bone marrow aspirates showed unexpectedly brisk hemophagocytosis of mature red blood cells. Despite striking morphologic hemophagocytosis, no patient met criteria for diagnosis of an HPS. Transfusion-associated hemophagocytosis and hyperferritinemia must be carefully distinguished from HLH through clinical and laboratory assessment. Biomarkers of pathologic immune activation are important diagnostic aids.

Keywords: HLH, hemophagocytic lymphohistiocytosis; HPS, hemophagocytic syndrome; RBC, red blood cell; sIL2R, soluble interleukin-2 receptor.

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Figures

Figure 1
Figure 1
Bone marrow aspirate, May Grünwald-Giemsa stain. Prominent hemophagocytosis of mature red blood cells identified in case 1. Original magnification ×60 (A) and ×100 (B-C).
Figure 2
Figure 2
Bone marrow aspirate, May Grünwald-Giemsa stain. Prominent hemophagocytosis of mature red blood cells identified in case 2. Original magnification ×100 (A-C).
Figure 3
Figure 3
Bone marrow aspirate, May Grünwald-Giemsa stain. Prominent hemophagocytosis of mature red blood cells identified in case 3. Original magnification ×100x (A-C).
See this image and copyright information in PMC

References

    1. Ravindran A., Sankaran J., Shi M., et al. Characteristics and outcome of direct antiglobulin test-negative hemolytic anemia: a case series. Blood. 2016;128(22):2451.
    1. Al Zaki A.A., Mann S.L., Carruthers M.N., Slack G.W., Chen L.Y.C. A young woman with steroid-responsive, IgG4-positive plasma cell-enriched cystic lymphangioma and chylous ascites. Clin Case Rep. 2018;6(6):1098–1100. - PMC - PubMed
    1. Ramos J., Lorsbach R. Hemophagocytosis by neoplastic plasma cells in multiple myeloma. Blood. 2014;123(11):1634. - PubMed
    1. Molad Y., Stark P., Prokocimer M., Joshua H., Pinkhas J., Sidi Y. Hemophagocytosis by small cell lung carcinoma. Am J Hematol. 1991;36(2):154–156. - PubMed
    1. Goel S., Polski J.M., Imran H. Sensitivity and specificity of bone marrow hemophagocytosis in hemophagocytic lymphohistiocytosis. Ann Clin Lab Sci. 2012;42(1):21–25. - PubMed

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