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Neutrophil Aggregates


This 78 year old patient was hospitalized at the Intensive Care Unit with sepsis. As this sample gave an IG/BAND flag, a blood smear was made and examined. The microscopist noted that the neutrophils tended to form small groups and when she investigated the feather end of the smear she observed large clusters of neutrophils. It was concluded that this was a case of neutrophil aggregation. This is an in vitro artefact, often caused by EDTA-dependent antibodies to neutrophils.


In the SIZE/COMPLEXITY, 90º / WBC 10º and 90º /WBC 0º plots, neutrophils are not only located in the normal position, but there is an additional cluster, presumably consisting of two or more aggregated neutrophils. As the aggregated neutrophils are counted as single neutrophils, the total WBC and neutrophil count might be underestimated.

Numerical Results

WBC 15.9 10e3/μL
NEU 11.84 74.63 %  IG/BAND
BLST .002 .010 %
MONe 1.10 6.95 %
EOS .118 .743 %
BASO .038 .241 %
LYM 2.767 17.469 %

RBC 5.70 10e6/μL
HGB 17.1 g/dL
HCT 49.7 %
MCV 87.2 fL
MCH 30.1 pg
MCHC 34.5 g/dL
RDW 11.4 %

PLT 241. 10e3/μL
MPV 9.18 fL

CELL-DYN Ruby Casebook. Neutrophil Aggregates. 2018. ADD-00005070. p.47
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