A Normal Absolute Neutrophils Count in Bacterial Infection: A Precaution Step Needed

Hafizuddin Mohamed Fauzi, Redzuan Abdullah


The rare condition of neutrophils agglutination in-vitro may give inaccurate neutrophils count. We reported a case of a 71-year-old female admitted with a diagnosis of extended-spectrum beta-lactamase (ESBL) Escherichia Coli (E.coli) septicaemia secondary to the left lower limb cellulitis. Despite underlying infection, total white blood cell count (TWBC) and absolute neutrophil count remained in a normal range. An accidental finding of full blood picture (FBP) using K2 ethylenediaminetetraacetic acid (EDTA) tube presented numerous neutrophils agglutination. Further tests were carried out using citrated and heparinised tubes and tested at room temperature, 4 C, and 37 ͦC. The findings showed a significant reduction in neutrophils agglutination in both citrated and heparinised tubes, including when tested at room temperature (RT) and 4 ͦC. Surprisingly, at 37 ͦC, no neutrophil agglutination was observed. This indicates that temperature-dependent anti-neutrophil IgM antibody may be found in the patient's serum that reacted with the EDTA anticoagulant. In conclusion, white blood cells (WBC) agglutination has been associated with malignancy, sepsis, liver disease, and autoimmune disease. Thus, a baseline FBP is recommended, especially in these categories of patients to optimise their clinical management


neutrophil count, neutrophil agglutination, full blood picture

Full Text:



Glasser L. Pseudo-neutropenia secondary to leukoagglutination. Am J Hematol. 2005;80:147.

(2) Dagan Yang, MS, Xichao Guo, BS, Yu Chen, MD, Genyun Xu, BS. Leukocyte Aggregation In Vitro as a Cause of Pseudoleukopenia. Lab medicine. Feb 2008; 39:2.

(3) Preethi Paul, Naveen Kakkar. Neutrophil Aggregates in a Young Female With Sepsis. Lab medicine. March 2009; 40:3

(4) Urbach J, Rogowski O, Branski D. Leukocyte aggregation-related pseudoleukopenia in pediatrics: A sporadic event or a systematic error? PediatrInfect Dis J. 2005;24:717–720.

(5) Lesesve JF, Haristoy X, Lecompte T. EDTA-dependent leukoagglutination. Clin Lab Haematol. 2002;24:67–69.

Copyright (c) 2020 Journal of Biomedical and Clinical Sciences (JBCS)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Journal of Biomedical and Clinical Sciences (JBCS) publishes original research articles, short review, short communication, case reports, quiz and letter to editor that covering the areas of fundamental aspects of biomedical and clinical sciences, from pre-clinical towards translational research and their applications in medicine, dentistry and healthcare management. JBCS aims to provide a platform for basic science and clinical researchers to communicate and share their research findings to the advancement of technologies in biomedical and clinical sciences by providing maximum access to scholarly communication.

Flag Counter           


                                              Copyright © 2016 AMDI Publisher, Universiti Sains Malaysia.
Disclaimer : This website has been updated to the best of our knowledge to be accurate. However, Universiti Sains Malaysia shall not be liable for any loss or damage caused by the usage of any information obtained from this web site.
                                            Best viewed: Mozilla Firefox 4.0 & Google Chrome at 1024 × 768 resolution.