20 February 2018 (Tuesday) - Platelets...

An interesting case appeared on Facebook today

With this patient we didn’t release the platelet count to the clinician due to the severe platelet clumping as seen in the pics above. This phenomenon is called platelet satellitism and as some correctly identified there is also some platelet phagocytosis occurring in the neutrophils which appear as large vacuoles.
Due to their agranular appearance we considered grey platelet syndrome but we were able to rule this out because when a single platelet was seen it had normal granulation.
We have suggested that they recollect in a citrate tube to see if we can get a more accurate platelet count.
We also vortexed the sample just for interest in an attempt to break up the aggregates and we got a platelet count of 214 but with no accurate platelet count available we were unable to determine how close this was to the real result.
This patient has MGUS and we wonder if this might be playing a part so we have forwarded the film to our consultant haematologist for comment.”

Satellites and phagocytosis…

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