2 years 8 month female child was admitted with 5 days history of fever and cough which worsened since a day. On examination she was febrile, there was increase in respiratory rate and bilateral crepitation's on lung auscultation.

Following investigations were done: 

• USG Chest showed bilateral consolidation with RT pleural effusion.
• BACTEC (Peripheral blood)- No growth was seen after 5 days.
• Peripheral blood EDTA sample was run on 5 part cell counter (Beckmen LH 750) for haemogram, there was flagging in WBC region, total WBC count of 11,000/cumm was shown without differential count. RBC and Platelets data was given by the cell counter without any flags. On review of the blood smear (Leishman stain) showed neutrophils agglutination and the counts appeared higher than those given by the machine. The EDTA sample was incubated at 37degree C for 30 minutes and was re-run. The results came without flagging with total count of 17,500 and differential count.
• The post incubation blood smear showed disappearance of agglutination and even distribution of WBCs. This may suggest temperature dependent auto agglutination of the neutrophils. Agglutination of neutrophils is a very rare phenomenon, which can be seen in severe sepsis, mycoplasma infections or viral infections.This may lead to spurious low WBC counts affecting the clinical diagnosis and management.
• The patient was treated with Amoxycillin and Clavulanic acid and FLUVIR antiviral drug for four days. 
• The X ray chest done after 2 days was clear and repeat haemogram after 4 days was normal.

This case highlights the importance of pseudolecopenia resulting from rare phenomenon of neutrophil agglutination. Such false WBC information may mislead the clinical diagnosis.