Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 44

 

Home  | About Us | Editors | Search | Ahead Of Print | Current Issue | Archives | Submit Article | Instructions | Subscribe | Contacts | Login 
     


 
 
Table of Contents
LETTER TO THE EDITOR
Year : 2012  |  Volume : 2  |  Issue : 3  |  Page : 190

Thrombocytopenia and edges of the smear - keep your eyes peeled


1 Department of Emergency and Critical Care Medicine, Sri Gokulam hospital and Research Institute, Salem, India
2 Department of Neurosciences, Sri Gokulam hospital and Research Institute, Salem, India
3 Srinivas Institute Of Medical Sciences and Research Centre, Mangalore, India
4 Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, India

Date of Web Publication12-Sep-2012

Correspondence Address:
S SenthilKumaran
Department of Accident, Emergency and Critical Care Medicine, Sri Gokulam hospital and Research institute, Salem, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.100939

Rights and Permissions

How to cite this article:
SenthilKumaran S, Balamurugan N, Menezes RG, Thirumalaikolundusubramanian P. Thrombocytopenia and edges of the smear - keep your eyes peeled. Int J Crit Illn Inj Sci 2012;2:190

How to cite this URL:
SenthilKumaran S, Balamurugan N, Menezes RG, Thirumalaikolundusubramanian P. Thrombocytopenia and edges of the smear - keep your eyes peeled. Int J Crit Illn Inj Sci [serial online] 2012 [cited 2019 Aug 17];2:190. Available from: http://www.ijciis.org/text.asp?2012/2/3/190/100939

Sir,

The reports of thrombocytopenia elicit a knee jerk to the practitioners and make them search for a cause. Rarely analytical error has been considered. We present one such report, emphasizing the importance of examining the terminal edge of a smear. The widespread use of automated hematology analyzer has replaced the traditional manual method because of rapid, cost effective and dependable results. However, spurious results are observed at times due to agglutination of platelets in the smear prepared from the blood sample collected with an anticoagulant ethylenediamine tetra-acetic acid (EDTA). [1] Usually analyzer will turn on the signals to alert the technician, during extreme results. We had noted thrombocytopenia in a healthy middle-aged male without any co- morbidities during the routine health check up for whom any alarming signs were present. Careful inspection of the blood smear revealed massive platelet clumps exclusively found at the edges of the smear. A repeat smear of the same patient made from heparinized blood sample revealed a normal platelet count and distribution. EDTA-induced pseudothrombocytopenia is aggravated, as evident from the illusionary microscopic findings of massive clump exclusively noticed at the lateral edges of the smear [Figure 1]. Bowen et al, [2] had reported that large clumps in the feather edge of the smear were missed in the routine slide review. Lombarts et al, [3] had emphasized to examine the edges of the smear since the clumps may migrate to the edges. This report including picture is presented in order to create awareness among physicians and laboratory personnel to exclude the possibility of pseudothrombocytopenia and thereby avoid inappropriate diagnostics and decisions.
Figure 1: Peripheral smear shows large platelet clumps exclusively found at the edges of the smear. Only very few single platelets were seen in the actual examination field of the smear

Click here to view


 
   References Top

1.Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: A review, part I: Platelets. Int J Lab Hematol 2007;29:4-20.  Back to cited text no. 1
[PUBMED]    
2.Bowen KL, Procopio N, Wystepek E, Glazier J, Mattson JC. Platelet clumps, nucleated red cells, and leukocyte counts: A comparison between the Abbott CELL-DYN® 4000 and Coulter® STKS. Lab Hematol 1998;4:7-16.  Back to cited text no. 2
    
3.Lombartsa JPF, Zijlstra JJ, Peters RH, Thomasson CG, Franck PF. Accurate platelet counting in an insidious case of pseudothrombocytopenia. Clin Chem Lab Med 1999;37:1063-6.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed1967    
    Printed78    
    Emailed0    
    PDF Downloaded62    
    Comments [Add]    

Recommend this journal