Erythrophagocytosis by neutrophils--a rare morphological phenomenon resulting in acquired haemolytic anaemia?

Erythrophagocytosis by neutrophils is a rare morphological phenomenon described in patients with clonal malignancies of haematopoiesis with myelodysplasia and in some haemolytic conditions including paroxysmal cold haemoglobinuria, haemolysis caused by snake-bite, sickle cell anaemia and other defects of red cells. We describe a female patient who presented with acquired haemolytic anaemia. Erythrophagocytosis was found in around 35% of neutrophils of the peripheral blood. A similar picture was seen in the bone marrow, but with additional erythrophagocytosis by macrophages. These two processes were considered as the main causes of anaemia, but the first one seemed to be predominant. Malignancies, autoimmunisation disorders and infections were excluded. Immunosuppressive therapy with corticosteroids was implemented, but had to be stopped because of side effects. Long-term normalization of peripheral blood morphology was achieved after splenectomy. Splenectomy may be considered a therapeutic option for patients with diagnosed neutrophil erythrophagocytic hyperactivity. Therapy with corticosteroids is also possible, but the long-term effects remain unknown.