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Alinity hq

PLATELET CLUMPS

Description

This patient had leukocytosis and neutrophilia with increased immature granulocytes (IG). The morphological flag Left Shift was triggered. Smear review showed an increase in band neutrophils, which correlated with the Left Shift flag. A few myelocytes and metamyelocytes were also seen on the smear, which confirmed the automated IG count.

 

A normocytic normochromic anemia was also present. A platelet clump flag resulted in an invalidated platelet count and associated parameters. A moderate number of variably sized platelet clumps were seen in the body as well as peripheral edges of the smear.

 

In this case, the platelet count is normal. However, it is not reportable as it does not include platelets that are clumped. Platelet clumping is an in-vitro phenomenon and a common cause of pseudothrombocytopenia (Zandecki). When not properly identified, platelet clumping and falsely low platelet counts can lead to unnecessary diagnostic tests, inappropriate treatment decisions and misdiagnosis (Zandecki).

Numerical ResultsInvalid Data

 
WBC 25.3 10e3/μL
NEU 22.0 10e3/μL 87.0 % Left Shift
LYM .991 10e3/μL 3.91 %
MONO 1.62 10e3/μL 6.39 %
EOS 0.02 10e3/μL 0.08 %
BASO .039 10e3/μL .153 %
IG 0.62 10e3/μL 2.45 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 2.80 10e6/μL
HGB 8.10 g/dL
HCT 24.7 %
MCV 86.7 fL
MCH 28.4 pg
MCHC 32.8 g/dL
RDW 13.5 %

 
RETIC 58.4 10e3/μL 2.09 %
IRF .492
MCHr 28.7 pg

 
PLT 231.X 10e3/μL PLT Clump
MPV 5.68X fL
%rP 6.33X %

 
FIGURE 1. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
Platelet clumps appear as gray events on this scatterplot. The clumps seem to overlap with the lymphocyte population (cyan) on this scatterplot; however, as demonstrated in the FL1 x ALL plot (refer to Figure 2, Leukocytosis with Left Shift and Immature Granulocytes (IG), and Macrocytosis case), they are separated from WBC in the FL1 channel.
FIGURE 2. ALL x PSS (WBC):
Size vs. polarized side scatter plot
This scatterplot shows a characteristic pattern that is specific to platelet clumps (gray). The positioning of the platelet clump and lymphocyte populations (cyan) along the ALL axis suggests that their size is similar. However, using polarized side scatter, the two populations are separated along the y-axis.
FIGURE 3. FL1 x ALL (WBC):
Size vs. fluorescence plot
Platelet clumps (gray) are differentiated from WBC in this scatterplot. Platelet clumps vary in size as shown along the y-axis, and some clumps are about the same size as WBC. In the fluorescence channel (FL1), the nucleic acid dye enables the separation of WBC from platelet clumps, therefore no interference with the WBC count or differential occurs.
Alinity hq casebook. Platelet Clumps. ADD-00061876-v2 2019. p.48-49

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