A case report is presented of a woman, aged 49, with persistent neutropenia, increased erythrocyte sedimentation rate, a pathologic serum protein fraction migrating at the same rate as γ-globulin representing about 30 per cent of the total protein, and with undue fatigue as the only symptom.
Normal leukocytes, especially neutrophils, were agglutinated by a factor contained in the patient’s serum and bound to the pathologic γ-globulin fraction and active even in a dilution of at least 1:120.
The neutropenia may be explained by the formation, in the patient, of antibodies intravascularly agglutinating her own neutrophile leukocytes, which were then eliminated from the circulating blood. The appearance of the bone marrow did not argue against such an assumption.
It has not been possible to demonstrate any definite causal factor of the disease. As far as the neutrophile leukocytes are concerned, the disease is analogous with idiopathic immunohemolytic anemia and idiopathic immunothrombocytopenia.
No leukocyte agglutination could be demonstrated in sera from two other patients with granulocytopenia or in sera from a number of patients with various diseases and associated increased γ-globulin.