Red Cell Morphology Interference in Platelet Indices from Patients with Anemia and Low Mean Corpuscular Volume from the IPS Universitaria, Clínica León XIII
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Jul 15, 2013
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Abstract
Introduction: The microcytosis and poikilocytosis interfere with platelet count in microcytic anemia, which alters the platelet indices determination in hematology analyzers with impedance.
Objective: To evaluate the red cell morphology in blood smears to identify those alterations that interfere with platelet indices results in patients with microcytic anemia. Materials and Methods: Fifty adult patients hospitalized with heterogeneous microcytic anemia were confirmed through automated full blood count. Red cell and platelet morphology was evaluated in blood films obtained through digital puncture.
Results: It was found red cell anisocytosis characterized by 1+ to 2+ of microcytes. There was a correlation between Platelet Distribution Width (PDW) and Mean Platelet Volume (MPV) (p=0,041 and p=0,036 respectively), the small erythrocytes size correlates with MPV and PDW; nevertheless, erythroid morphology doesn’t correlate neither with P-LCR and platelet count. Also, there wasn’t significant difference between erythroid morphology and platelet indices.
Conclusions: Platelet indices interpretation in hematology analyzers with impedance isn’t influenced by microcytosis or poikilocytosis in patients with heterogeneous microcytic anemia that present several clinical conditions.
Keywords
Anemia, mean corpuscular volume, mean platelet volume, anemia, volumen corpuscular medio, volumen plaquetario medio,
References
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Performance evaluation of the Sysmex
XS-1000i automated haematology analyser. Int J Lab Hematol. 2009;31(5):560-6.
2. Gibbins JM, Mahaut-Smith MP. Platelet and megakaryocy. New Jersey: Humana Press; 2004.
3. Levi M. Platelets. Crit Care Med. 2005;33(12 Suppl):S523-5.
4. Borkataky S, Jain R, Gupta R, Singh S, Krishan G, Gupta K, et al. Role of platelet volume indices in the differential diagnosis of thrombocytopenia: a simple and inexpensive method. Hematology. 2009;14(3):182-6.
5. Campuzano Maya G. Semiología del hemograma. Medicina y Laboratorio. 1995;5:161-74.
6. Babu E, Basu D. Platelet large cell ratio in the differential diagnosis of abnormal platelet counts. Indian J Pathol Microbiol. 2004;47(2):202-5.
7. Michelson AD. Platelets. 2nd ed. Philadelphia: Elsevier; 2007. p. 446-84.
8. Aksoy S, Kilickap S, Hayran M, Harputluoglu H, Koca E, Dede D, et al. Platelet size has diagnostic predictive value for bone marrow metastasis in patients with solid tumors. Int J Lab Hematol. 2008;30(3):214-9.
9. Bowles K, Cooke L, Richards E, Baglin T. Platelet size has diagnostic predictive value in patients with thrombocytopenia. Clin Lab Haematol. 2005;27(6):370-3.
10. De Luca G, Santagostino M, Secco G, Cassetti E, Giuliani L, Franchi E, et al. Mean platelet volume and the extent of coronary artery disease: results from a large prospective study. Atherosclerosis. 2009;206(1):292-7.
11. Dymicka-Piekarska V, Kemona H. Thrombopoietin and reticulated platelets as thrombopoietic markers in colorectal cancer. Thromb Res. 2008;122(1):141-3.
12. Diquattro M, Gagliano F, Calabrò G, Tommasi M, Scott C, Mancuso G, et al. Relationships between platelet counts, platelet volumes and reticulated platelets in patients with ITP: evidence for significant platelet count inaccuracies with conventional instrument methods. Int J Lab Hematol. 2009;31(2):199-206.
13. Suljević E, Fazlić M, Corić J, Kiseljaković J. Evaluation of haematology analyzer CELL-DYN 3700 SL. Bosn J Basic Med Sci. 2003;3(2):35-41.
14. Grimaldi E, Del Vecchio L, Scopacasa F, Lo Pardo C, Capone F, Pariante S, et al. Evaluation of the platelet counting by Abbott CELL-DYN SAPPHIRE haematology analyser compared with flow cytometry. Int J Lab Hematol. 2009;31(2):151-60.
15. Jain S, Kamat D. Evaluation of microcytic anemia. Clin Pediatr (Phila). 2009;48(1):7-13.
16. Aulakh R, Sohi I, Singh T, Kakkar N. Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia. Indian J Pediatr. 2009;76(3):265-8.
17. Huisman A, van Solinge W. [A flow chart for the laboratory diagnosis of anaemia as requested by general practice]. Ned Tijdschr Geneeskd. 2007;151(42):2302-4.
18. Ratomski K, Zak J, Kasprzycka E, Hryniewicz K, Wysocka J. [The estimation of the number of platelets by different methods]. Pol Merkur Lekarski. 2010;28(167):379-86.
19. Dubois-Galopin F, Lamballais F, Rapatel C, Berger M. [XE-2100: platelet clumps or polymorphonuclear neutrophil aggregates, that is the question]. Ann Biol Clin (Paris). 2010;68(4):480-4.
20. Freise K, Schmidt R, Gingerich E, Veng-Pedersen P, Widness J. The effect of anticoagulant, storage temperature and dilution on cord blood hematology parameters over time. Int J Lab Hematol. 2008.
21. Maurer-Spurej E, Pittendreigh C, Yakimec J, DE Badyn M, Chipperfield K. Erroneous automated optical platelet counts in 1-hour post-transfusion blood samples. Int J Lab Hematol. 2008.
22. Swerdlow SC, E. Harris, N. Jaffe, E. Pileri, S. Stein, H. Thiele, J. Vardiman, J. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: International Agency for Research on Cancer; 2008.
23. Freise KJ, Schmidt RL, Gingerich EL, Veng-Pedersen P, Widness JA. The effect of anticoagulant, storage temperature and dilution on cord blood hematology parameters over time. Int J Lab Hematol. 2009;31(5):496-504.
24. Nakul-Aquaronne D, Sudaka-Sammarcelli I, Ferrero-Vacher C, Starck B, Bayle J. Evaluation of the Sysmex Xe-2100 hematology analyzer in hospital use. J Clin Lab Anal. 2003;17(4):113-23.
25. Escobar AG, F. Manual de procedimientos de hematología, laboratorio clínico sede Clínica León XIII. Medellín; 2009.
26. Ernst DB, Callan L, Szamosi R, Tyndall D, McCall L. CLSI, procedures and devices for the collection of diagnostic capillary blood specimenes. 6th ed. Pennsylvania: CLSI, Clinical and Laboratory Standards Institute; 2008.
27. Bain B. Blood cells: a practical guide. 4th ed. Malden, Massachussets: Blackweel Sinergy; 2006.
28. Berrio MC, Jiménez, M. El hemograma: análisis e interpretación con las tres generaciones. Medellín: Universidad de Antioquia; 2003.
29. Campuzano G. Utilidad clínica del extendido de sangre periférica: los eritrocitos. Medicina y Laboratorio. 2008;14:396. Epub 357.
30. Banno S, Ito Y, Tanaka C, Hori T, Fujimoto K, Suzuki T, et al. Quantification of red blood cell fragmentation by the automated hematology analyzer XE-2100 in patients with living donor liver transplantation. Clin Lab Haematol. 2005;27(5):292-6.
31. Orito M, Shibayama M, Yoshida T, Takami A, Asakura H, Fujita S, et al. [Reliability of low platelet counts--comparison of microscopic counts with automated hematology analyzer XE-2100]. Rinsho Byori. 2005;53(9):793-801.
32. Maya GC. Alteraciones del hemograma relacionado con los contadores de células. Medicina y Laboratorio. 2005;11:236-379.
33. Maya GC. Evaluación del paciente con trombocitopenia. Medicina y Laboratorio. 2007;13:409-37.
34. Naina HV, Harris S. Platelet and red blood cell indices in Harris platelet syndrome. Platelets. 2010;21(4):303-6.
35. Soogarun S, Sirimongkolsakul S, Wiwanitkit V, Mahakittikul B, Pradniwat P. Platelet count and platelet parameters in hemoglobin E carriers. Clin Appl Thromb Hemost. 2004;10(3):285-6.
36. Abe Y, Wada H, Tomatsu H, Sakaguchi A, Nishioka J, Yabu Y, et al. A simple technique to determine thrombopoiesis level using immature platelet fraction (IPF). Thromb Res. 2006;118(4):463-9.
37. Kabutomori O, Kanakura Y, Iwatani Y. Increase in platelet-large cell ratio in chronic myeloid leukemia. Leuk Res. 2001;25(10):873.
38. Butkiewicz A, Kemona H, Dymicka-Piekarska V, Matowicka-Karna J, Radziwon P, Lipska A. Platelet count, mean platelet volume and thrombocytopoietic indices in healthy women and men. Thromb Res. 2006;118(2):199-204.
39. Jackson S, Carter J. Platelet volume: laboratory measurement and clinical application. Blood Rev. 1993;7(2):104-13.
40. Cakal B, Akoz AG, Ustundag Y, Yalinkilic M, Ulker A, Ankarali H. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci. 2009;54(4):842-7.
41. Di Mario A, Garzia M, Leone F, Arcangeli A, Pagano L, Zini G. Immature platelet fraction (IPF) in hospitalized patients with neutrophilia and suspected bacterial infection. J Infect. 2009;59(3):201-6.
42. Tozkoparan E, Deniz O, Ucar E, Bilgic H, Ekiz K. Changes in platelet count and indices in pulmonary tuberculosis. Clin Chem Lab Med. 2007;45(8):1009-13.
43. Khandekar M, Khurana A, Deshmukh S, Kakrani A, Katdare A, Inamdar A. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006;59(2):146-9.
44. Grove E, Hvas A, Kristensen S. Immature platelets in patients with acute coronary syndromes. Thromb Haemost. 2009;101(1):151-6.
45. Muscari A, Puddu G, Cenni A, Silvestri M, Giuzio R, Rosati M, et al. Mean platelet volume (MPV) increase during acute non-lacunar ischemic strokes. Thromb Res. 2009;123(4):587-91.
46. Agarwal N, Prchal JT. Anemia of chronic disease (anemia of inflammation). Acta Haematol. 2009;122(2-3):103-8.
47. Cembrowski GS, Smith B, Tung D. Rationale for using insensitive quality control rules for today’s hematology analyzers. Int J Lab Hematol. 2010;32(6 Pt 2):606-15.
48. Jiang H, Zeng TT, Huang JB, Mao ZG, Zeng SG. [Clinical application of review criteria for complete blood analysis]. Zhonghua Yi Xue Za Zhi. 2010;90(22):1522-5.
49. Kim SY, Kim JE, Kim HK, Han KS, Toh CH. Accuracy of platelet counting by automated hematologic analyzers in acute leukemia and disseminated intravascular coagulation: potential effects of platelet activation. Am J Clin Pathol. 2010;134(4):634-47.
Performance evaluation of the Sysmex
XS-1000i automated haematology analyser. Int J Lab Hematol. 2009;31(5):560-6.
2. Gibbins JM, Mahaut-Smith MP. Platelet and megakaryocy. New Jersey: Humana Press; 2004.
3. Levi M. Platelets. Crit Care Med. 2005;33(12 Suppl):S523-5.
4. Borkataky S, Jain R, Gupta R, Singh S, Krishan G, Gupta K, et al. Role of platelet volume indices in the differential diagnosis of thrombocytopenia: a simple and inexpensive method. Hematology. 2009;14(3):182-6.
5. Campuzano Maya G. Semiología del hemograma. Medicina y Laboratorio. 1995;5:161-74.
6. Babu E, Basu D. Platelet large cell ratio in the differential diagnosis of abnormal platelet counts. Indian J Pathol Microbiol. 2004;47(2):202-5.
7. Michelson AD. Platelets. 2nd ed. Philadelphia: Elsevier; 2007. p. 446-84.
8. Aksoy S, Kilickap S, Hayran M, Harputluoglu H, Koca E, Dede D, et al. Platelet size has diagnostic predictive value for bone marrow metastasis in patients with solid tumors. Int J Lab Hematol. 2008;30(3):214-9.
9. Bowles K, Cooke L, Richards E, Baglin T. Platelet size has diagnostic predictive value in patients with thrombocytopenia. Clin Lab Haematol. 2005;27(6):370-3.
10. De Luca G, Santagostino M, Secco G, Cassetti E, Giuliani L, Franchi E, et al. Mean platelet volume and the extent of coronary artery disease: results from a large prospective study. Atherosclerosis. 2009;206(1):292-7.
11. Dymicka-Piekarska V, Kemona H. Thrombopoietin and reticulated platelets as thrombopoietic markers in colorectal cancer. Thromb Res. 2008;122(1):141-3.
12. Diquattro M, Gagliano F, Calabrò G, Tommasi M, Scott C, Mancuso G, et al. Relationships between platelet counts, platelet volumes and reticulated platelets in patients with ITP: evidence for significant platelet count inaccuracies with conventional instrument methods. Int J Lab Hematol. 2009;31(2):199-206.
13. Suljević E, Fazlić M, Corić J, Kiseljaković J. Evaluation of haematology analyzer CELL-DYN 3700 SL. Bosn J Basic Med Sci. 2003;3(2):35-41.
14. Grimaldi E, Del Vecchio L, Scopacasa F, Lo Pardo C, Capone F, Pariante S, et al. Evaluation of the platelet counting by Abbott CELL-DYN SAPPHIRE haematology analyser compared with flow cytometry. Int J Lab Hematol. 2009;31(2):151-60.
15. Jain S, Kamat D. Evaluation of microcytic anemia. Clin Pediatr (Phila). 2009;48(1):7-13.
16. Aulakh R, Sohi I, Singh T, Kakkar N. Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia. Indian J Pediatr. 2009;76(3):265-8.
17. Huisman A, van Solinge W. [A flow chart for the laboratory diagnosis of anaemia as requested by general practice]. Ned Tijdschr Geneeskd. 2007;151(42):2302-4.
18. Ratomski K, Zak J, Kasprzycka E, Hryniewicz K, Wysocka J. [The estimation of the number of platelets by different methods]. Pol Merkur Lekarski. 2010;28(167):379-86.
19. Dubois-Galopin F, Lamballais F, Rapatel C, Berger M. [XE-2100: platelet clumps or polymorphonuclear neutrophil aggregates, that is the question]. Ann Biol Clin (Paris). 2010;68(4):480-4.
20. Freise K, Schmidt R, Gingerich E, Veng-Pedersen P, Widness J. The effect of anticoagulant, storage temperature and dilution on cord blood hematology parameters over time. Int J Lab Hematol. 2008.
21. Maurer-Spurej E, Pittendreigh C, Yakimec J, DE Badyn M, Chipperfield K. Erroneous automated optical platelet counts in 1-hour post-transfusion blood samples. Int J Lab Hematol. 2008.
22. Swerdlow SC, E. Harris, N. Jaffe, E. Pileri, S. Stein, H. Thiele, J. Vardiman, J. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: International Agency for Research on Cancer; 2008.
23. Freise KJ, Schmidt RL, Gingerich EL, Veng-Pedersen P, Widness JA. The effect of anticoagulant, storage temperature and dilution on cord blood hematology parameters over time. Int J Lab Hematol. 2009;31(5):496-504.
24. Nakul-Aquaronne D, Sudaka-Sammarcelli I, Ferrero-Vacher C, Starck B, Bayle J. Evaluation of the Sysmex Xe-2100 hematology analyzer in hospital use. J Clin Lab Anal. 2003;17(4):113-23.
25. Escobar AG, F. Manual de procedimientos de hematología, laboratorio clínico sede Clínica León XIII. Medellín; 2009.
26. Ernst DB, Callan L, Szamosi R, Tyndall D, McCall L. CLSI, procedures and devices for the collection of diagnostic capillary blood specimenes. 6th ed. Pennsylvania: CLSI, Clinical and Laboratory Standards Institute; 2008.
27. Bain B. Blood cells: a practical guide. 4th ed. Malden, Massachussets: Blackweel Sinergy; 2006.
28. Berrio MC, Jiménez, M. El hemograma: análisis e interpretación con las tres generaciones. Medellín: Universidad de Antioquia; 2003.
29. Campuzano G. Utilidad clínica del extendido de sangre periférica: los eritrocitos. Medicina y Laboratorio. 2008;14:396. Epub 357.
30. Banno S, Ito Y, Tanaka C, Hori T, Fujimoto K, Suzuki T, et al. Quantification of red blood cell fragmentation by the automated hematology analyzer XE-2100 in patients with living donor liver transplantation. Clin Lab Haematol. 2005;27(5):292-6.
31. Orito M, Shibayama M, Yoshida T, Takami A, Asakura H, Fujita S, et al. [Reliability of low platelet counts--comparison of microscopic counts with automated hematology analyzer XE-2100]. Rinsho Byori. 2005;53(9):793-801.
32. Maya GC. Alteraciones del hemograma relacionado con los contadores de células. Medicina y Laboratorio. 2005;11:236-379.
33. Maya GC. Evaluación del paciente con trombocitopenia. Medicina y Laboratorio. 2007;13:409-37.
34. Naina HV, Harris S. Platelet and red blood cell indices in Harris platelet syndrome. Platelets. 2010;21(4):303-6.
35. Soogarun S, Sirimongkolsakul S, Wiwanitkit V, Mahakittikul B, Pradniwat P. Platelet count and platelet parameters in hemoglobin E carriers. Clin Appl Thromb Hemost. 2004;10(3):285-6.
36. Abe Y, Wada H, Tomatsu H, Sakaguchi A, Nishioka J, Yabu Y, et al. A simple technique to determine thrombopoiesis level using immature platelet fraction (IPF). Thromb Res. 2006;118(4):463-9.
37. Kabutomori O, Kanakura Y, Iwatani Y. Increase in platelet-large cell ratio in chronic myeloid leukemia. Leuk Res. 2001;25(10):873.
38. Butkiewicz A, Kemona H, Dymicka-Piekarska V, Matowicka-Karna J, Radziwon P, Lipska A. Platelet count, mean platelet volume and thrombocytopoietic indices in healthy women and men. Thromb Res. 2006;118(2):199-204.
39. Jackson S, Carter J. Platelet volume: laboratory measurement and clinical application. Blood Rev. 1993;7(2):104-13.
40. Cakal B, Akoz AG, Ustundag Y, Yalinkilic M, Ulker A, Ankarali H. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci. 2009;54(4):842-7.
41. Di Mario A, Garzia M, Leone F, Arcangeli A, Pagano L, Zini G. Immature platelet fraction (IPF) in hospitalized patients with neutrophilia and suspected bacterial infection. J Infect. 2009;59(3):201-6.
42. Tozkoparan E, Deniz O, Ucar E, Bilgic H, Ekiz K. Changes in platelet count and indices in pulmonary tuberculosis. Clin Chem Lab Med. 2007;45(8):1009-13.
43. Khandekar M, Khurana A, Deshmukh S, Kakrani A, Katdare A, Inamdar A. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol. 2006;59(2):146-9.
44. Grove E, Hvas A, Kristensen S. Immature platelets in patients with acute coronary syndromes. Thromb Haemost. 2009;101(1):151-6.
45. Muscari A, Puddu G, Cenni A, Silvestri M, Giuzio R, Rosati M, et al. Mean platelet volume (MPV) increase during acute non-lacunar ischemic strokes. Thromb Res. 2009;123(4):587-91.
46. Agarwal N, Prchal JT. Anemia of chronic disease (anemia of inflammation). Acta Haematol. 2009;122(2-3):103-8.
47. Cembrowski GS, Smith B, Tung D. Rationale for using insensitive quality control rules for today’s hematology analyzers. Int J Lab Hematol. 2010;32(6 Pt 2):606-15.
48. Jiang H, Zeng TT, Huang JB, Mao ZG, Zeng SG. [Clinical application of review criteria for complete blood analysis]. Zhonghua Yi Xue Za Zhi. 2010;90(22):1522-5.
49. Kim SY, Kim JE, Kim HK, Han KS, Toh CH. Accuracy of platelet counting by automated hematologic analyzers in acute leukemia and disseminated intravascular coagulation: potential effects of platelet activation. Am J Clin Pathol. 2010;134(4):634-47.
How to Cite
Jaramillo Arbeláez, P. E., & Acevedo Toro, P. A. (2013). Red Cell Morphology Interference in Platelet Indices from Patients with Anemia and Low Mean Corpuscular Volume from the IPS Universitaria, Clínica León XIII. Universitas Medica, 54(4), 443–460. https://doi.org/10.11144/Javeriana.umed54-4.iame
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