Pseudo-neutropenia is a rare phenomenon and has no physiologic consequences, 1-7 however, it may lead to multiple unnecessary tests if not recognized.8 A 20-year-old woman with no significant past medical history presented to her primary care physician with symptoms of an upper respiratory tract infection. Complete blood count (CBC) performed the same day revealed a white blood cell (WBC) count of 3.7×109/L with a differential of 53% neutrophils, 30% lymphocytes, 17% monocytes and less than 1% eosinophils and basophils; hemoglobin of 12.6 g/mL and platelet count of 168×109/L. The patient completed a course of azithromycin with resolution of her symptoms. Two weeks after the first CBC, a repeat CBC was obtained to monitor her WBC. This second test revealed a WBC count of 3.6×109/L with no changes in the other parameters. The patient was referred to a hematologist for further evaluation of her apparent neutropenia.