Early detection of unusual cryoglobulinemia from automated cell counts and blood films

Cryoglobulins are circulating immunoglobulins characterized by reversible cold-induced precipitation. The process of serum cryoprecipitation, performed at 4 °C, takes three to seven days, which leads to delays in obtaining cryoglobulinemia lab-results. Here, we report two cases of cryoglobulinemia, each with distinct cryoglobulin-induced features that were identifiable through automated hemocytometry and blood smear analysis. The blood smear showed neutrophilic inclusions and amorphous extra-cellular material, and the automated hematology analyzer displayed abnormal scatterplots. All these unique features positively correlated with the duration the blood sample was kept at room temperature prior to analysis. These hemocytometric abnormalities may serve as early indicators for the diagnosis of cryoglobulinemia, potentially aiding the detection of this condition.