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Year : 2018  |  Volume : 9  |  Issue : 3  |  Page : 108-109

Pseudoeosinophilia associated with malaria infection determined in the white blood cell scattergram


Department of Pharmacy and Clinical Laboratory, Clinical Laboratory Division, University Hospital, University of São Paulo, Sao Paulo, SP, Brazil

Date of Web Publication31-Oct-2018

Correspondence Address:
Prof. Ricardo Ambrósio Fock
Department of Pharmacy and Clinical Laboratory, Clinical Laboratory Division, University Hospital, University of São Paulo. Avenida Lineu Prestes, 2565. Sao Paulo, SP
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_20_18

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How to cite this article:
de Noronha TR, Fock RA. Pseudoeosinophilia associated with malaria infection determined in the white blood cell scattergram. J Appl Hematol 2018;9:108-9

How to cite this URL:
de Noronha TR, Fock RA. Pseudoeosinophilia associated with malaria infection determined in the white blood cell scattergram. J Appl Hematol [serial online] 2018 [cited 2018 Dec 14];9:108-9. Available from: http://www.jahjournal.org/text.asp?2018/9/3/108/244535

A 29-year-old female patient sought medical attention complaining of fever. Complete blood cell count (CBC) was performed, and Plasmodium vivax was detected. CBC was made in the Sysmex XT-2000i hematology analyzer and revealed erroneously high eosinophil counts and abnormal white blood cell (WBC) scattergram [Figure 1]. Malaria parasites digest hemoglobin and detoxify free haem by converting it into a stable, birefringent crystal known as hemozoin.[1] During malaria schizont rupture, hemozoin is released from infected red cells and is subsequently phagocytized by host WBCs. The XT-2000i analyzer differentiates eosinophils from neutrophils based on side light scattering differences. Considering that hemozoin is a birefringent crystal, hemozoin-containing neutrophils show considerable side light scattering and hemozoin-containing neutrophils are incorrectly classified as eosinophils, which is the cause of pseudoeosinophilia.[2]
Figure 1: (a) 0 day complete blood cell count normal differential and normal white blood cell. (b) 5 days complete blood cell pseudoeosinophilia and abnormal white blood cell (arrow). (c) 9 days complete blood cell count normal differential and normal white blood cell. (d) 11 days complete blood cell count pseudoeosinophilia and abnormal white blood cell (arrow). Trophozoite and Schizont: May-Grünwald stain, magnification: ×1000. DIFF = Differential, LYMPH = Lymphocytes, MONO = Monocytes, NEUT = Neutrophils, EO = Eosinophils, Auto = Automatic count. Parasitemia was determined by counting the number of parasites per 100 white blood cell s in blood smear and converted to the number of parasites per microliter of blood

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This report included four CBCs of the same patient (0, 5, 9, and 11 days). Two CBCs showed erroneously high eosinophil counts and atypical eosinophils distribution in the WBCs scattergram [Figure 1]b and [Figure 1]d which was due to the presence of hemozoin-containing neutrophils. However, decreasing the parasitemia can be observed reduction in the erroneous automated count of eosinophils. In conclusion, in the presence of pseudoeosinophilia and abnormal scattergram, manual blood smear analysis should be performed.[3]

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  References Top

1.
Krekora M, Zych-Krekora K, Słodki M, Grzesiak M, Respondek-Liberska M. The course of pregnancy and delivery in a patient with malaria. Ginekol Pol 2017;88:574-5.  Back to cited text no. 1
    
2.
Huh J, Jung J, Yoon H, Chung W. Pseudoeosinophilia associated with malaria infection determined in the sysmex XE-2100 hematology analyzer. Ann Hematol 2005;84:400-2.  Back to cited text no. 2
    
3.
Huh HJ, Oh GY, Huh JW, Chae SL. Malaria detection with the sysmex XE-2100 hematology analyzer using pseudoeosinophilia and abnormal WBC scattergram. Ann Hematol 2008;87:755-9.  Back to cited text no. 3
    


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