Monocyte adhesion with platelet satellitism and phagocytosis in Hodgkin lymphoma.

Abstract

Platelet satellitism is an in vitro phenomenon usually involving neutrophils and occasionally followed by phagocytosis of platelets. It is quite uncommon for lineages other than neutrophils, to be involved. Here, we report the occurrence of monocyte-monocyte adhesion, satellitism and phagocytosis of platelets by monocytes without neutrophils being involved. The patient was a 37-year-old man with β-thalassemia heterozygosity and stage IVB Hodgkin lymphoma. His blood count showed: white cell count 10.2 × 109/L; monocyte count 1.3 × 109/L; hemoglobin concentration 75 g/L; mean cell volume 73 fL; and platelet count 174 × 109/L. His blood film confirmed monocytosis and showed monocytes that were adherent to each other, satellitism of platelets around monocytes, and phagocytosis of platelets (Images). In addition, there was microcytosis and hypochromia (attributable to β-thalassemia) and increased rouleaux formation. Other blood tests showed evidence of a marked inflammatory response with C-reactive protein of 253 mg/L (normal range 0-10), serum ferritin of 1306 μg/L (22-322), reduced serum iron, transferrin at the lower limit of normal and reduced serum albumin of 22 g/L (35-50). The patient responded well to treatment and on follow-up, when he was clinically well, the phenomenon was no longer present. We postulate that the abnormalities observed were part of the marked inflammatory response to Hodgkin lymphoma. None.