13 January 2017 (Friday) - Platelet Phagocytosis

Here's an interesting case which appeared on Facebook this morning:

"this sample was from a 44 year old male from an outpatient setting (sample transport time was 2 to 3 hours from draw site to testing facility). Automated platelet count was 84 x10^3/uL. The majority of the segs seen resembled those in the pictures"

Another such case is seen here: http://www.bloodjournal.org/content/122/9/1543?sso-checked=true

This is a case of EDTA-dependent platelet phagocytosis; it doesn't seem to happen with other anticoagulants. I've heard of EDTA causing cllumping or satellitism but causing neutrophils to engulf platelets is a new one to me. But it illustrates a point: 

The peripheral smear must be carefully reviewed to evaluate any new case of thrombocytopenia. Pseudothrombocytopenia from any cause may lead to extensive and unnecessary workup for thrombocytopenia. Awareness of such phenomena can prevent errors such as delaying surgery, holding medications, or giving unneeded platelet transfusion for purported thrombocytopenia.

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