Felty's Syndrome: Granulocyte-Bound Immunoglobulin G and Splenectomy

Abstract

A quantitative antiglobulin consumption technique was used to measure immunoglobulin G (IgG) present on human granulocytes. Granulocytes from 50 normal subjects had < 20 .times. 10-14 g IgG cell. Patients with granulocytopenia due to bone-marrow failure, patients with IgG multiple myeloma, patients with splenomegaly and patients with rheumatoid arthritis without granulocytopenia had granulocyte-bound IgG within the normal range. Four patients with rheumatoid arthritis, splenomegaly and severe granulocytopenia (Felty''s syndrome) had 30-220 .times. 10-14 g granulocyte-bound IgG/cell. One patient underwent splenectomy, after which his granulocyte-bound IgG fell to normal. Seven additional patients with Felty''s syndrome who previously underwent splenectomy had normal levels of granulocyte-bound IgG. Quantification of granulocyte-bound IgG appears to be useful in defining patients with immunologically mediated granulocytopenia. Studies of patients with Felty''s syndrome who undergo splenectomy suggest that the spleen may produce this neutrophile-bound Ig.