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Alinity hq



This case highlights the same patient reviewed in the NRBC and IG case. However, this discussion will focus on the platelet parameters. The patient has significant thrombocytopenia, and a platelet clump flag has rendered the PLT count, mean platelet volume (MPV) and reticulated platelet (%rP) as suspect.


A blood smear review revealed an increased number of large and giant platelets, but platelet clumps were not seen. It is important to note that the platelet clump flag on Alinity hq can also be triggered when large/giant platelets are present. An estimate of the platelet count from the smear concurred with the Alinity hq result of 56 (x10e3/uL).


The increased MPV was in line with the smear findings. When the rate of PLT production is accelerated, PLTs tend to be larger and contain more residual RNA than PLTs produced in steady state conditions. PLTs identified by their larger size and higher RNA content are called reticulated PLTs. Their presence suggests increased megakaryocytopoiesis which is associated with consumptive platelet disorders as well as bone marrow recovery following chemotherapy and other conditions associated with bone marrow aplasia (Mcpherson).

Numerical Results

WBC 27.6 10e3/μL
NEU 23.7 10e3/μL 86.0 % Left Shift
LYM .844 10e3/μL 3.06 %
MONO 1.05 10e3/μL 3.82 %
EOS .111 10e3/μL .401 %
BASO 1.01 10e3/μL .035 %
IG 1.84 10e3/μL 6.69 %
NRBC 1.54 10e3/μL
NR/W 5.58

RBC 2.54 10e6/μL
HGB 7.55 g/dL
HCT 23.2 %
MCV 89.4 fL
MCH 29.1 pg
MCHC 32.6 g/dL
RDW 19.1 %

RETIC 144. 10e3/μL 5.67 %
IRF .624
MCHr 33.2 pg

PLT 55.5 10e3/μL PLT Clump
MPV 11.6 fL
%rP 25.7 %

Reticulocyte/platelet – Size vs. fluorescence plot
Reticulated platelets are enumerated in the reticulocyte channel, and are visible in this scatterplot. Compared with the normal ALL x FL1 (Retic/PLT) plot, the blue (rPLT) events spread further along both axes. This is due to the larger size (ALL) and RNA content (FL1) of the rPLT population.
FIGURE 2. Volume (PLT):
Platelet size distribution histogram
This histogram displays platelet size (x-axis) plotted against platelet number (y-axis). While the curve is log normal, it does not reach baseline until 25-30 fL, indicating an increased number of large/giant platelets. Because the patient is thrombocytopenic, the height of the curve is reduced compared to that expected for a normal individual.
Alinity hq casebook. Large Platelets And Increased Reticulated Platelets. ADD-00061876-v2 2019. p.50-51

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Alinity h-series is available in select countries, not including the US.