Cryoglobulinemia Diagnosed by Peripheral Smear Examination: Value of a Basic Underestimated Test.

A 58-year-old female with a history of vasculitis presented to the hospital with sudden onset hemoptysis, ulceration over bilateral lower limbs, and low-grade intermittent fever. Computed tomographic scan of chest revealed pulmonary hemorrhage. Investigations showed a hemoglobin of 5.8 g/dL, pseudoleukocytosis (46 (cid:1) 10 3 / μ L), and platelet count of 483 (cid:1) 10 3 / μ L. Examination of the Leishman-stained peripheral smear showed blue background with grossly visible agglutinates ( ► Fig. 1A ) and a normal total white blood cell count. Pseudoleukocytosis could have been the result of counting of precipitated cryoglobulin deposits as leukocytes by the automated cell counter. 1 Basophilic to faint amorphous globular and granular the background the neutrophils pre-cipitates. Qualitative determination of was