Platelet Satellitism: A Unique Cause of Pseudothrombocytopenia
Platelet satellitism is an unusual cause of pseudothrombocytopenia. In 1963, Macleod and Field first reported this phenomenon [1]. It is a rare in vitro occurrence observed in the blood that is collected in Ethylene Diamine Tetra acetic Acid (EDTA) vacutainer. It dispenses as platelets rosetting...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Liaquat National Hospital and Medical College
2023-04-01
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| Series: | Journal of Liaquat National Hospital |
| Subjects: | |
| Online Access: | https://journals.lnh.edu.pk/jlnh/pdf/38d08914-bd55-4d53-9b75-4a0ca1a6d298.pdf |
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| Summary: | Platelet satellitism is an unusual cause of pseudothrombocytopenia. In 1963, Macleod and Field first reported
this phenomenon [1]. It is a rare in vitro occurrence
observed in the blood that is collected in Ethylene
Diamine Tetra acetic Acid (EDTA) vacutainer. It
dispenses as platelets rosetting around neutrophilic
leucocytes [2]. This culminates in spuriously low platelet
levels on complete blood counts performed on hematology analyzers [3]. The exact mechanism is still unclear.
The pathophysiology evolves around the existence of
IgG autoantibodies against the cryptic domain of the αIIb
β3 integrin of platelets. The rosetting is caused by the
reaction between these antibodies and the Fcγ receptor of
neutrophils. The latency of EDTA unveils this phenomenon. This is usually observed in healthy individuals and
the existence of such autoantibodies is still unclear [4].
Some cases of lymphoma [5] and autoimmune hemolytic
anemia also report such a phenomenon [6]. This
phenomenon is not linked with the dysfunction of platelets or any bleeding.
There are a few reported cases from Pakistan. Hence we
report this unique finding in a 20-year-old male who
came for a routine checkup and underwent a complete
blood count (CBC). The report showed normocytic
normochromic cells with normal total leukocyte count
and differentials. However, the platelet count was 60 x
109/L. Peripheral blood film (Leishman-stained) showed
platelet satellitism in the majority of neutrophils (Fig. 1).
There was no satellitism observed in other cells of the
myeloid series. The erroneous platelet count was deleted
from the report and an explanation was provided along
with the manual estimation of platelet count. Vortex
mixing of the primary EDTA tube sample has been
reported to alleviate pseudothrombocytopenia [7].
Another method used for the correction of pseudothrombocytopenia is the collection of a sample in an S-Monovette ThromboExact tube or sodium citrate tube. The
platelet and white blood cell count obtained from the
citratetube must be multiplied by 1.1 to account for the
different blood-to-anticoagulant ratios in the citrate tube
[8].
Platelet satellistism is an uncommon but clinically
relevant cause of spurious pseudothrombocytopenia.
Awareness among pathologists is of pivotal importance
so that it is not missed. A major limitation of our case is that no corrective action like anticoagulant replacement
from EDTA to Citrate was performed. |
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| ISSN: | 2959-1805 2960-2963 |