Medical Analysis

Understanding LE Cells: A Comprehensive Overview of Diagnostic Procedures for Lupus Erythematosus

Introduction – LE Cells

The LE cell test is a specialized diagnostic procedure specifically used to identify LE cells within a patient’s blood sample. Historically, the lupus erythematosus (LE) cell test was the standard method performed to diagnose systemic lupus erythematosus (SLE). However, in modern clinical practice, this test has been largely replaced for diagnostic purposes by more advanced and sensitive antinuclear antibody (ANA) testing. It is important to note that negative findings on an LE cell test are significant, as they effectively exclude a diagnosis of systemic lupus erythematosus (SLE). Conversely, the presence of LE cells is a clinical indicator of lupus.

LE Cells Pathophysiology

An LE cell serves as a telltale sign of an active autoimmune process within the body. The pathophysiology involves autoantibodies that react with diseased cells, resulting in the production of apoptotic bodies. These bodies are subsequently phagocytosed (engulfed) by other neutrophils, a process that becomes a hallmark feature of SLE. Clinically, LE cells can be identified in cytology samples such as pleural or pericardial fluids, within the buffy coat of a blood sample, or in histopathology specimens.

Principle of Test

The following table outlines the mechanism behind the test:

LE Cell Testing – Indications

Medical professionals may order an LE cell test under specific clinical circumstances:

• To evaluate the presence of autoimmune disorders.

• To evaluate for systemic lupus erythematosus (SLE), particularly in patients presenting with common symptoms such as fever, fatigue, skin rash, and joint pains.

• To evaluate for other conditions including rheumatoid arthritis, scleroderma, and chronic active hepatitis.

• As a baseline test before carrying out more specific immunological investigations such as ANA and Anti-ds-DNA testing.

Method of Sample Collection

Proper sample collection is vital for accurate laboratory results:

• Collect 3.0 ml of blood in an EDTA tube (identified by a lavender cap).

• Mix the sample well and utilize the whole blood for further testing.

• Complete the agitation procedure within a maximum of two hours after the collection of the blood sample to avoid cellular degradation.

Transportation of Samples

To maintain the diagnostic validity of the sample, transport should be carefully managed. As far as possible, the sample should be transported refrigerated in a cold pack to preserve the integrity of the cells.

Methods of Detection: The Mechanical Agitation Method

The primary method for identifying these cells is the Mechanical Agitation Method. Because LE cells are not normally seen in peripheral blood, the test induces their formation. In this procedure, 2.0 ml of venous blood is taken in a small glass bulb, and a sufficient quantity of glass beads is added. The mixture is then vigorously shaken for 15-20 minutes to break the leukocytes. The nuclear material, which becomes exposed due to this trauma, is taken up by intact neutrophils through the process of phagocytosis. Under microscopic observation, these appear as homogeneous, round, pinkish-colored bodies surrounded by the compressed lobes of neutrophils. The identification of these structures confirms the presence of LE cells, which are diagnostic of SLE.

Schematic Presentation – Flow Chart

The process can be summarized as follows:

1. Autoantibodies (ANA) combine with nuclear material.

2. Formation of immune complexes occurs (incubate with patient serum ± added nuclei).

3. A neutrophil encounters these complexes and performs phagocytosis.

4. This results in a homogeneous, round LE body inside the neutrophil.

5. This constitutes the classic LE cell morphology.

Interpretation of the Results

The interpretation of the LE cell test is straightforward:

• The normal reference range is a negative test result.

• The LE cell test is considered positive if LE cells comprise approximately 2-30% of the neutrophil cells observed in the smear.

• Positive LE cell tests indicate the presence of SLE.

LE Body & LE Cell

It is useful to distinguish between the two entities: An LE body represents the degraded nuclear material of an injured cell that has been phagocytized by an intact phagocyte. Conversely, an LE cell is a telltale sign of an autoimmune process. It results from the phagocytosis of apoptotic bodies induced by autoantibodies and serves as a hallmark of systemic lupus erythematosus (SLE).

Advantages & Limitations

• Advantages: Historically useful before the advent of advanced immunological testing.

• Limitations: The test is characterized by low sensitivity and specificity. It cannot differentiate among different autoimmune diseases and has been largely replaced by more specific and reliable tests, including ANA, anti-dsDNA, and anti-Sm antibody tests.

For Non-Medicos: A Simple Guide to the LE Cell Test

What is the LE Cell Test?

The LE cell test is an older medical test used to look for signs of a disease called Systemic Lupus Erythematosus (SLE), often just called “lupus.” Lupus is an autoimmune disease, which means the body’s immune system mistakenly attacks its own healthy tissues.

How Does the Test Work?

Normally, you don’t find “LE cells” in healthy blood. During this test, a lab technician takes a blood sample and shakes it with glass beads to purposely damage some of the cells. In people with lupus, the blood contains special proteins called “autoantibodies.” These proteins attach to the damaged cell parts. White blood cells (called neutrophils) then “eat” these damaged parts. When a white blood cell has swallowed these damaged bits, it is called an “LE cell.” A technician looks under a microscope to find these cells.

Why Do Doctors Use It?

Doctors might use this test to help figure out why a patient has symptoms like unexplained fevers, constant tiredness, skin rashes, or painful joints. While it was once the main way to diagnose lupus, doctors today usually prefer newer, more accurate tests like the ANA test. If the LE cell test comes back negative, it is a very strong sign that the person does not have lupus.

Key Points for Patients

• Preparation: Your doctor will collect a small amount of blood in a special tube.

• Speed: It is important for the lab to process the blood quickly (usually within two hours) so the cells don’t break down naturally.

• Modern Context: Because this test is not as precise as newer blood tests, don’t be surprised if your doctor prioritizes other tests like ANA or DNA antibody tests for a more accurate diagnosis.

References:

• Hargraves, M. M., Richmond, H., & Morton, R. (1948). Presentation of two bone marrow elements: the “tart” cell and the “LE” cell. Proceedings of the Staff Meetings of the Mayo Clinic, 23, 25–28.
• Heitzman, R. (1948). The LE cell. JAMA, 138(10), 728–733.
• Sundberg, R. D., & Lick, N. B. (1949). LE cells in the blood in acute disseminated lupus erythematosus. Journal of Investigative Dermatology, 12, 83–84.
• Haserick, J. R., Lewis, L. A., & Bortz, D. W. (1950). Blood factor in acute disseminated lupus erythematosus. The American Journal of the Medical Sciences, 219(6), 660–663.
• Zimmer, F. E., & Hargraves, M. M. (1952). The effect of blood coagulation on LE cell formation. Proceedings of the Staff Meetings of the Mayo Clinic, 27, 424–430.
• Miescher, P., & Fauconnet, M. (1954). Absorption of the LE cell factor by isolated nuclei. Experientia, 10(6), 252–254.
• Koffler, D., Agnello, V., & Winchester, R. (1971). The occurrence of “LE” cells in systemic lupus erythematosus. Journal of Clinical Investigation, 50, 1702–1709.
• Tan, E. M., Cohen, A. S., Fries, J. F., et al. (1982). The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis & Rheumatism, 25, 1271–1277.
• Pisetsky, D. S. (1989). Immune complexes in rheumatic disease: a review. Clinical Immunology and Immunopathology, 53, 439–449.
• Lahita, R. G. (1992). Systemic Lupus Erythematosus. Churchill Livingstone.
• Hepburn, A. L. (2001). The LE cell. Rheumatology, 40(7), 826–827. https://doi.org/10.1093/rheumatology/40.7.826
• Ameer, M. A., Chaudhry, H., Mushtaq, J., et al. (2022). An overview of systemic lupus erythematosus (SLE) pathogenesis, classification, and management. Cureus, 14(10), e30330. https://doi.org/10.7759/cureus.30330 Cited by: 587
• Atmanto, K. A. A., Muhadi, D., & Arif, M. (2022). Lupus erythematosus cell test Magath and Winkle method: A diagnostic test for systemic lupus erythematosus. International Journal of Scientific Advances, 3(3), 386–390. https://doi.org/10.51542/ijscia.v3i3.15
• Parodis, I. (2026). Old and new autoantibodies in systemic lupus erythematosus. Expert Review of Clinical Immunology, 22(3), 265–278. https://doi.org/10.1080/1744666X.2026.2625964

FAQ’s:

• What are LE cells?
  They are neutrophils that have engulfed damaged nuclear material, signaling an active autoimmune process.

• What is the LE test?
  A diagnostic procedure specifically used to identify LE cells in a patient’s blood sample.

• Does LE test diagnose lupus?
  It was historically used for this, but has been replaced by more advanced ANA testing.

• What does positive indicate?
  A positive LE cell test is a clinical indicator of systemic lupus erythematosus (SLE).

• What is the normal range?
  The normal reference range for the LE cell test is a negative test result.

• How is blood collected?
  Collect 3.0 ml of blood in an EDTA lavender-capped tube and process within two hours.

• Why use glass beads?
  They are used in the mechanical agitation method to damage cells and induce phagocytosis.

• What triggers LE cell formation?
  Autoantibodies react with nuclear antigens, creating damaged material which neutrophils then ingest.

• Can LE test detect arthritis?
  Yes, it is used to evaluate conditions like rheumatoid arthritis, scleroderma, and chronic active hepatitis.

• Are results highly specific?
  No, the test has low sensitivity and specificity compared to modern immunological testing methods.