Mortimer S. Greenberg, MD
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To the Editors: The article on the acute lupus hemophagocytic syndrome (1) implies that the mechanism underlying the cytopenias is phagocytosis of the blood cells by macrophages. This in turn raises the question of whether there are antibodies to the blood cells in the plasma, because macrophages have surface receptors for immunoglobulins. Did the authors test these patients for antibodies that react in vitro to erythrocytes (Coombs test), neutrophils, or platelets? Histiocytes with phagocytosed neutrophils have been described in the bone marrow and spleen of patients with autoimmune neutropenia (2) who do have serum antibodies to neutrophils.
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Greenberg MS. The Hemophagocytic Syndrome. Ann Intern Med. ;114:993. doi: 10.7326/0003-4819-114-11-993_1
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Published: Ann Intern Med. 1991;114(11):993.
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