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Gulati G, Uppal G, Gong J. Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution. Ann Lab Med 2022; 42:515-530. [PMID: 35470271 PMCID: PMC9057813 DOI: 10.3343/alm.2022.42.5.515] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/05/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
Automated hematology analyzers generate accurate complete blood counts (CBC) results on nearly all specimens. However, every laboratory encounters, at times, some specimens that yield no or inaccurate result(s) for one or more CBC parameters even when the analyzer is functioning properly and the manufacturer’s instructions are followed to the letter. Inaccurate results, which may adversely affect patient care, are clinically unreliable and require the attention of laboratory professionals. Laboratory professionals must recognize unreliable results, determine the possible cause(s), and be acquainted with the ways to obtain reliable results on such specimens. We present a concise overview of the known causes of unreliable automated CBC results, ways to recognize them, and means commonly utilized to obtain reliable results. Some examples of unreliable automated CBC results are also illustrated. Pertinent analyzer-specific information can be found in the manufacturers’ operating manuals.
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Affiliation(s)
- Gene Gulati
- Division of Hematopathology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Guldeep Uppal
- Division of Hematopathology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerald Gong
- Division of Hematopathology, Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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2
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Aggressive lymphoma, hemophagocytic lymphohistiocytosis, and G6PD crisis: a lytic cocktail. Ann Hematol 2021; 101:219-221. [PMID: 33415426 DOI: 10.1007/s00277-021-04410-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022]
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3
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Dima F, Salvagno GL, Danese E, Veneri D, Lippi G. An unusual case of sodium citrate-dependent artifactual platelet count. Interv Med Appl Sci 2020; 11:193-196. [PMCID: PMC9467333 DOI: 10.1556/1646.11.2019.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022] Open
Abstract
Background Ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia is a rare phenomenon. Spurious pseudothrombocytopenia has also been described in other circumstances, while artifactual platelet count in whole blood samples anticoagulated with sodium citrate is an exceptional occurrence. Case report In this study, we describe the case of a 44-year-old ostensibly healthy woman who attended the local outpatient clinic for routine laboratory testing, including platelet count in EDTA and sodium citrate, for suspected artifactual pseudothrombocytopenia previously identified in another center. The results of hematological testing on both specimens were essentially normal, except for mild anemia. Nevertheless, the platelet number was 425 × 109/L in K2EDTA and 266 × 109/L (293 × 109/L after correcting for sample dilution) in sodium citrate, respectively. Microscopic revision of blood smears revealed the presence of platelet aggregates and satellitism only in the sodium citrate specimen. Conclusion Unlike previous occasional reports of concomitant EDTA- and sodium citrate-dependent pseudothrombocytopenia, we first describe a paradigmatic case of artifactual platelet count attributable to platelet clumping and satellitism, exclusively developing in blood anticoagulated with sodium citrate.
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Affiliation(s)
- Francesco Dima
- 1 Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Gian Luca Salvagno
- 1 Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Elisa Danese
- 1 Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Dino Veneri
- 2 Hematology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- 1 Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
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4
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Peprah S, Ogwang MD, Kerchan P, Reynolds SJ, Tenge CN, Were PA, Kuremu RT, Wekesa WN, Masalu N, Kawira E, Kinyera T, Otim I, Legason ID, Nabalende H, Dhudha H, Mumia M, Ayers LW, Biggar RJ, Bhatia K, Goedert JJ, Mbulaiteye SM. Mean platelet counts are relatively decreased with malaria but relatively increased with endemic Burkitt Lymphoma in Uganda, Tanzania, and Kenya. Br J Haematol 2020; 190:772-782. [PMID: 32395868 DOI: 10.1111/bjh.16700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
Platelet counts are decreased in Plasmodium falciparum malaria, which is aetiologically linked with endemic Burkitt lymphoma (eBL). However, the pattern of platelet counts in eBL cases is unknown. We studied platelet counts in 582 eBL cases and 2 248 controls enrolled in a case-control study in Uganda, Tanzania and Kenya (2010-2016). Mean platelet counts in controls or eBL cases with or without malaria-infection in controls versus eBLcases were compared using Student's t-test. Odds ratios (ORs) and two-sided 95% confidence intervals (95% CIs) were estimated using multiple logistic regression, controlling for age, sex, haemoglobin and white blood cell counts. Platelets were decreased with malaria infection in the controls [263 vs. 339 × 109 platelets/l, P < 0·0001; adjusted OR (aOR) = 3·42, 95% CI: 2·79-4·18] and eBL cases (314 vs. 367 × 109 platelets/l, P-value = 0·002; aOR = 2·36, 95% CI: 1·49-3·73). Unexpectedly, platelets were elevated in eBL cases versus controls in overall analyses (mean: 353 vs. 307 × 109 platelets/l, P < 0·0001; aOR = 1·41; 95% CI: 1·12-1·77), and when restricted to malaria-positive (mean 314 vs. 263 × 109 platelets/l, P < 0·0001; OR = 2·26; 95% CI: 1·56-3·27) or malaria-negative (mean 367 vs. 339 × 109 platelets/l, P < 0·001; OR = 1·46; 95% CI: 1·17-1·83) subjects. Platelets were decreased with malaria infection in controls and eBL cases but elevated with eBL.
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Affiliation(s)
- Sally Peprah
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin D Ogwang
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Patrick Kerchan
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Kuluva Hospital, Arua & African Field Epidemiology Network, Kuluva, Kampala, Uganda
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Constance N Tenge
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Moi University College of Health Sciences, Eldoret, Kenya
| | - Pamela A Were
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Academic Model Providing Access To Healthcare, Eldoret, Kenya
| | - Robert T Kuremu
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Moi University College of Health Sciences, Eldoret, Kenya
| | - Walter N Wekesa
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Moi University College of Health Sciences, Eldoret, Kenya
| | - Nestory Masalu
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Bugando Medical Center, Mwanza, Tanzania
| | - Esther Kawira
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Shirati Health, Education, and Development Foundation, and Shirati Hospital, Shirati, Tanzania
| | - Tobias Kinyera
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Isaac Otim
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Ismail D Legason
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Kuluva Hospital, Arua & African Field Epidemiology Network, Kuluva, Kampala, Uganda
| | - Hadijah Nabalende
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Herry Dhudha
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Shirati Health, Education, and Development Foundation, and Shirati Hospital, Shirati, Tanzania
| | - Mediatrix Mumia
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Academic Model Providing Access To Healthcare, Eldoret, Kenya
| | - Leona W Ayers
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Robert J Biggar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Baccini V, Geneviève F, Jacqmin H, Chatelain B, Girard S, Wuilleme S, Vedrenne A, Guiheneuf E, Toussaint-Hacquard M, Everaere F, Soulard M, Lesesve JF, Bardet V. Platelet Counting: Ugly Traps and Good Advice. Proposals from the French-Speaking Cellular Hematology Group (GFHC). J Clin Med 2020; 9:jcm9030808. [PMID: 32188124 PMCID: PMC7141345 DOI: 10.3390/jcm9030808] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/25/2022] Open
Abstract
Despite the ongoing development of automated hematology analyzers to optimize complete blood count results, platelet count still suffers from pre-analytical or analytical pitfalls, including EDTA-induced pseudothrombocytopenia. Although most of these interferences are widely known, laboratory practices remain highly heterogeneous. In order to harmonize and standardize cellular hematology practices, the French-speaking Cellular Hematology Group (GFHC) wants to focus on interferences that could affect the platelet count and to detail the verification steps with minimal recommendations, taking into account the different technologies employed nowadays. The conclusions of the GFHC presented here met with a "strong professional agreement" and are explained with their rationale to define the course of actions, in case thrombocytopenia or thrombocytosis is detected. They are proposed as minimum recommendations to be used by each specialist in laboratory medicine who remains free to use more restrictive guidelines based on the patient’s condition.
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Affiliation(s)
- Véronique Baccini
- Laboratoire d’hématologie, CHU de la Guadeloupe, INSERM UMR S_1134, 97159 Pointe-à-Pitre, France
- Correspondence:
| | - Franck Geneviève
- Fédération Hospitalo-Universitaire ‘Grand Ouest Against Leukemia’ (FHU GOAL), 49033 Angers, France;
| | - Hugues Jacqmin
- Université Catholique de Louvain, CHU UCL Namur, Laboratoire d’hématologie, Namur Thrombosis and Hemostasis Center, 5530 Yvoir, Belgium; (H.J.); (B.C.)
| | - Bernard Chatelain
- Université Catholique de Louvain, CHU UCL Namur, Laboratoire d’hématologie, Namur Thrombosis and Hemostasis Center, 5530 Yvoir, Belgium; (H.J.); (B.C.)
| | - Sandrine Girard
- Hospices Civils de Lyon, Centre de biologie et pathologie Est, Service d’hématologie biologique, 69500 Bron, France;
| | - Soraya Wuilleme
- Laboratoire d’Hématologie, Institut de Biologie, CHU de Nantes; 44093 Nantes CEDEX, France;
| | - Aurélie Vedrenne
- Service de biologie clinique, Hôpital Foch, 92150 Suresnes, France;
| | - Eric Guiheneuf
- Service d’Hématologie Biologique, CHU Amiens-Picardie, 80054 Amiens CEDEX, France;
| | | | | | - Michel Soulard
- Plateau technique d’hématologie, Laboratoire Biogroup, 92300 Levallois-Perret, France;
| | | | - Valérie Bardet
- Service d’Hématologie-Immunologie-Transfusion, CHU Ambroise Paré, INSERM UMR 1184, AP-HP, Université Paris Saclay, 92100 Boulogne-Billancourt, France;
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6
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Bain BJ. Pseudoplatelets and apoptosis in Burkitt lymphoma. Am J Hematol 2019; 94:1168-1169. [PMID: 31342539 DOI: 10.1002/ajh.25586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Barbara J. Bain
- Department of HaematologySt. Mary's Hospital and Centre for Haematology, St. Mary's Hospital campus of Imperial College Faculty of Medicine, St. Mary's Hospital London United Kingdom
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7
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Tantanate C, Khowawisetsut L, Sukapirom K, Pattanapanyasat K. Analytical performance of automated platelet counts and impact on platelet transfusion guidance in patients with acute leukemia. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:160-166. [PMID: 30761915 DOI: 10.1080/00365513.2019.1576100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the performance of automated impedance platelet counts by Beckman Coulter LH780 (PLT-LH), Sysmex XN-3000 (PLT-XNi) and fluorescence method by Sysmex XN-3000 (PLT-F) in patients with acute leukemia. Blood specimens were subjected to platelet measurements by evaluated methods and then compared against the international reference method (IRM). Eighty-two blood specimens were included. Bland-Altman plots of the differences between the evaluated methods and IRM demonstrated mean biases of PLT-LH, PLT-XNi and PLT-F of 9 × 109/L, 11 × 109/L and 2 × 109/L, respectively. For platelet transfusion guidance, all evaluated methods had acceptable accuracy. For platelet transfusion guidance, the sensitivities of PLT-LH, PLT-XNi and PLT-F were 33.3, 25.0 and 83.3%, respectively, at a transfusion threshold of 10 × 109/L, and 73.1, 61.5 and 84.6%, respectively, at transfusion threshold of 20 × 109/L. High blast count was associated with inaccurate PLT-LH and PLT-XNi. In conclusion, the PLT-F demonstrated excellent performance for diagnosis of thrombocytopenia and for platelet transfusion guidance in the evaluated specimens from acute leukemia patients. With respect to clinical relevance, careful blood smear review is necessary in case of high blast counts.
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Affiliation(s)
- Chaicharoen Tantanate
- a Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Ladawan Khowawisetsut
- b Department of Parasitology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Kasama Sukapirom
- c Department of Research and Development , Siriraj Center of Research Excellence for Microparticle and Exosome in Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Kovit Pattanapanyasat
- c Department of Research and Development , Siriraj Center of Research Excellence for Microparticle and Exosome in Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
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Johnson SM, Dempsey C, Parker C, Mironov A, Bradley H, Saha V. Acute lymphoblastic leukaemia cells produce large extracellular vesicles containing organelles and an active cytoskeleton. J Extracell Vesicles 2017; 6:1294339. [PMID: 28386390 PMCID: PMC5373679 DOI: 10.1080/20013078.2017.1294339] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/26/2016] [Indexed: 02/07/2023] Open
Abstract
Extracellular vesicles have been described in non-paracrine cellular interactions in cancer. We report a similar phenomenon in B-cell precursor (BCP) acute lymphoblastic leukaemia (ALL). Using advanced microscopy and high throughput screening, we further characterise a subset of large vesicles (LEVs) identified in cell lines, murine models of human BCP-ALL and clinical samples. Primary ALL blasts and cell lines released heterogeneous anucleate vesicles <6 micron into extracellular fluids. Larger LEVs were enclosed in continuous membranes, contained intact organelles and demonstrated an organised cytoskeleton. An excess of circulating CD19-positive LEVs were observed in diagnostic samples and isolated from mice engrafted with BCP-ALL primary cells. LEVs exhibited dynamic shape change in vitro and were internalised by other leukaemic cell lines leading to phenotypic transformation analogous to the cell of origin. In patient-derived xenografts, LEVs were released by primary ALL cells into extracellular spaces and internalised by murine mesenchymal cells in vivo. Collectively these data highlight the heterogeneity but accessibility of LEVs in clinical samples and their potential to provide a unique insight into the biology of the cell of origin and to their development as novel biomarkers to aid diagnosis and improve therapeutic outcomes.
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Affiliation(s)
- Suzanne M Johnson
- Children's Cancer Group, Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester , Manchester , UK
| | - Clare Dempsey
- Children's Cancer Group, Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester , Manchester , UK
| | - Catriona Parker
- Children's Cancer Group, Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester , Manchester , UK
| | - Aleksandr Mironov
- Children's Cancer Group, Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester , Manchester , UK
| | - Helen Bradley
- Faculty of Biology, Medicine and Health, CRUK Manchester Institute, University of Manchester , Manchester , UK
| | - Vaskar Saha
- Children's Cancer Group, Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
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9
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Frotscher B, Salignac S, Muller M, Latger-Cannard V, Feugier P, Lesesve JF. Interference of blast cell fragments with automated platelet counting. Int J Lab Hematol 2015; 37:613-9. [DOI: 10.1111/ijlh.12371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- B. Frotscher
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Haemophilia Treatment Centre; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - S. Salignac
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - M. Muller
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Laboratory of Genetics; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - V. Latger-Cannard
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Flow Cytometry Plateform; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - P. Feugier
- Department of Clinical Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - J. F. Lesesve
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Flow Cytometry Plateform; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
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Akinsegun A, Akinola Olusola D, Sarah JO, Olajumoke O, Adewumi A, Majeed O, Anthonia O, Ebele U, Olaitan O, Olanrewaju A, Kingsley A. Mean platelet volume and platelet counts in type 2 diabetes: mellitus on treatment and non-diabetic mellitus controls in Lagos, Nigeria. Pan Afr Med J 2014; 18:42. [PMID: 25368731 PMCID: PMC4215377 DOI: 10.11604/pamj.2014.18.42.3651] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/01/2014] [Indexed: 12/19/2022] Open
Abstract
Introduction The Mean platelet volume and platelet counts are indicators of thrombotic potentials, and risk factors for microvascular complications in diabetics. This study aimed to establish variations in platelet counts and mean platelet volume in type 2 diabetic patients on treatment and non-diabetic controls. Methods This was an unmatched case-control study involving 200 participants consisting of 100 diabetics and 100 non-diabetic controls. Four and half milliliters of blood was collected from diabetics and non diabetic controls into EDTA anticoagulant tubes. Full blood count was performed using the Sysmex KN-21N, (manufactured by Sysmex corporation Kobe, Japan) a three- part auto analyzer able to run 19 parameters per sample including platelet counts and mean platelet volume. Results The mean fasting blood sugar for the diabetics was 147.85±72.54 mg/dl and the controls 95.20±30.10 mg/dl. The mean platelet count for the diabetics was 235.29±76.81*109/L and controls, 211.32±66.44*109/L. The mean platelet volume, for the diabetics was 8.69±0.67 fl and the controls, 8.91±0.80 fl. There was a statistically significant difference in platelet counts of diabetics and healthy controls p =0.038 while none existed between the mean platelet volume in diabetics and healthy controls p = 0.593. Conclusion This study revealed a higher mean platelet count for diabetics on treatment than for non diabetic controls while mean platelet volume was lower in cases than controls. However, both parameters in diabetics on treatment were within the normal reference range for healthy individuals.
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Affiliation(s)
- Akinbami Akinsegun
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Ikeja, Nigeria
| | - Dada Akinola Olusola
- Department of Medicine, Lagos State University, College of Medicine, Ikeja, Nigeria
| | - John-Olabode Sarah
- Department of Haematology, Ben Carson School of Medicine, Babcock University, Ilisan-Remo, Ogun State, Nigeria
| | - Oshinaike Olajumoke
- Department of Medicine, Lagos State University, College of Medicine, Ikeja, Nigeria
| | - Adediran Adewumi
- Department of Haematology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idiaraba, Nigeria
| | | | - Ogbera Anthonia
- Department of Medicine, Lagos State University, College of Medicine, Ikeja, Nigeria
| | - Uche Ebele
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Ikeja, Nigeria
| | - Okunoye Olaitan
- Department of Medicine, University of PortHarcourt, River State, Nigeria
| | - Arogundade Olanrewaju
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Ikeja, Nigeria
| | - Aile Kingsley
- Department of Haematology and Blood Transfusion, Lagos State University, Teaching Hospital, Ikeja, Nigeria
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Pan LL, Chen CM, Huang WT, Sun CK. Enhanced Accuracy of Optical Platelet Counts in Microcytic Anemia. Lab Med 2014; 45:32-6. [DOI: 10.1309/lm7qpuldm5ihbo3l] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Abstract
Platelet counting is a daily basic hematological analysis of crucial interest in many clinical situations. Historical manual techniques (phase-contrast microscopy) have been replaced by automated techniques (impedance or optical analyzers) more rapid and precise. More recently, flow cytometry techniques using labeled monoclonal antibodies have been proposed as reference techniques. Nevertheless, pre-analytical and analytical variables should be respected to obtain reliable results and avoid validation pitfalls.
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Affiliation(s)
- Sylvain Salignac
- Hematology Department and Grand East Competence Center on Inherited Platelet Disorders, CHU Nancy, Nancy, France
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Kim SY, Kim JE, Kim HK, Han KS, Toh CH. Accuracy of platelet counting by automated hematologic analyzers in acute leukemia and disseminated intravascular coagulation: potential effects of platelet activation. Am J Clin Pathol 2010; 134:634-47. [PMID: 20855645 DOI: 10.1309/ajcp88jylrcsrxpp] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Platelet counting in patients with acute leukemia or disseminated intravascular coagulation (DIC) may have a risk for erroneous counts owing to the presence of nonplatelet particles or platelet activation. We evaluated automated platelet counting methods using the Abbott Cell-Dyn Sapphire (Abbott Diagnostics, Santa Clara, CA), Sysmex XE-2100 (Sysmex, Kobe, Japan), ADVIA 2120 (Siemens Diagnostics, Tarrytown, NY), and Beckman Coulter LH 750 (Beckman Coulter, Miami, FL) compared with the international reference method (IRM). Automated platelet counting methods were inaccurate compared with the IRM, without evidence of interfering nonplatelet particles. It is interesting that platelet activation markers were associated with DIC severity and erroneous platelet counting, suggesting that platelet activation is a potential source of inaccuracy. Furthermore, the artifactual in vitro platelet activation induced a high degree of intermethod variation in platelet counts. The inaccuracy of automated platelet counts increased the risk for misdiagnosis of DIC. More attention needs to be given to the accuracy of platelet counts, especially in clinical conditions with florid platelet activation.
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Abstract
Myeloproliferative disorders and the serum hyperviscosity syndrome can rapidly manifest with emergent presentations. Hyperviscosity occurs from pathologic elevations of either the cellular or acellular (protein) fractions of the circulating blood. Classic hyperviscosity syndrome presents with the triad of bleeding diathesis, visual disturbances, and focal neurologic signs. Emergency medicine providers should be aware of these conditions and be prepared to rapidly initiate supportive and early definitive management, including plasma exchange and apharesis. Early consultation with a hematologist is essential to managing these complex patients.
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Adams BD, Baker R, Lopez JA, Spencer S. Myeloproliferative Disorders and the Hyperviscosity Syndrome. Emerg Med Clin North Am 2009; 27:459-76. [DOI: 10.1016/j.emc.2009.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
The four main procedures for platelet counting are: manual phase contrast microscopy, impedance, optical light scatter/fluorescence and flow cytometry. Early methods to enumerate platelets were inaccurate and irreproducible. The manual count is still recognized as the gold standard or reference method, and until very recently the calibration of platelet counts by the manufacturers of automated cell counters and quality control material was performed by this method. However, it is time-consuming and results in high levels of imprecision. The introduction of automated full blood counters using impedance technology resulted in a dramatic improvement in precision. However, impedance counts still have limitations as cell size analysis cannot discriminate platelets from other similar-sized particles. More recently, light scatter or fluorescence methods have been introduced for automated platelet counting, but there are still occasional cases where an accurate platelet count remains a challenge. Thus, there has been interest in the development of an improved reference procedure to enable optimization of automated platelet counting. This method utilizes monoclonal antibodies to platelet cell surface antigens conjugated to a suitable fluorophore. This permits the possible implementation of a new reference method to calibrate cell counters, assign values to calibrators, and to obtain a direct platelet count on a variety of pathological samples. In future, analysers may introduce additional platelet parameters; a reliable method to quantify immature or reticulated platelets would be useful.
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Affiliation(s)
- C Briggs
- Department of Haematology, University College London Hospitals, London, UK
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Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. ACTA ACUST UNITED AC 2007; 29:4-20. [PMID: 17224004 DOI: 10.1111/j.1365-2257.2006.00870.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The widespread use of haematology analysers (HA) has led to a major improvement of cellular haematology, because of quick and accurate results found in most instances. However, in several situations, spurious results are observed. Inadequate blood samples, situations induced by the anticoagulant(s) used, peculiar changes related to the pathology in the patient, and technical considerations about performances of the various HA must be considered. Spurious thrombocytopenia occurs in several circumstances related to the presence of ethylenediamine tetra-acetic acid (EDTA) used as the anticoagulant. Mechanism of EDTA-dependent platelet (PLT) agglutination is related to circulating (auto)antibodies directed against normally hidden epitope(s) in the glycoprotein alpha IIb/beta IIIa complex from PLT membrane exposed only in the presence of EDTA. Other spuriously low PLT counts may be related to EDTA, including PLT rosetting around white blood cells (WBC; satellitism) and PLT-WBC aggregates, but mechanisms responsible for those latter phenomena are less well known. Spurious increase of PLT count may be related to several situations, including fragmented red blood cells, cytoplasmic fragments of nucleated cells, cryoglobulins, bacteria or fungi, and lipids. Flags generated in several of these situations alert the operator on possible abnormal findings and may identify the problem. Analysing only PLT parameters is not sufficient: in many situations the WBC differential scattergram is of crucial help for flagging. Flags generated depend on the software version on the HA used, the performance in detecting the same anomalies may differ according to which analyser is used, even those from the same manufacturer. Operators must be aware of the characteristics of their analyser and be able to recognize and circumvent anomalous results.
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Affiliation(s)
- M Zandecki
- Haematology Laboratory, University Hospital of Angers, Angers, France.
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Affiliation(s)
- Barbara J Bain
- Department of Haematology, St. Mary's Hospital, London, United Kingdom.
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