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. 2020 Jan;9(1):166-172.
doi: 10.21037/tcr.2019.12.58.

Correction of spurious low platelet counts by optical fluorescence platelet counting of BC-6800 hematology analyzer in EDTA-dependent pseudo thrombocytopenia patients

Yejiang Bao  1   2   3 , Jia Wang  1   2   3 , Anjun Wang  1   2   3 , Jia Bian  1   2   3 , Yuan Jin  1   2   3
Affiliations

Correction of spurious low platelet counts by optical fluorescence platelet counting of BC-6800 hematology analyzer in EDTA-dependent pseudo thrombocytopenia patients

Yejiang Bao et al. Transl Cancer Res. 2020 Jan.

Abstract

Background: To evaluate the dissociation effect of optical fluorescence platelet counting of BC-6800 hematology analyzer on ethylene diamine tetraacetic acid-dependent pseudo thrombocytopenia (EDTA-PTCP) samples.

Methods: Twenty-three finally identified EDTA-PTCP samples were recruited in this study using criteria as follow: (I) impedance platelet counts lower than 100×109/L with instrument "platelet aggregation" flag; (II) existence of platelet clumps in the blood smear; (III) obviously higher platelet counts without "platelet aggregation" flag and no platelet clumps in blood smear after repeating phlebotomy using citrate anticoagulated tubes. The BC-6800 hematology analyzer and the XE-2100 hematology analyzer were used to test 23 EDTA-PTCP samples and 30 controls on both the impedance channel and the reticulocyte channel. The dissociation rate was defined as optical fluorescence platelet counts in the EDTA tubes/impedance platelet counts in citrate tubes ×100%.

Results: BC-6800 analyzer's optical fluorescence platelet counts of EDTA-PTCP samples were significantly higher than impedance platelet counts (t=4.33, P=0.00) and comparable with the platelet counts of re-collected samples in tubes containing citrate anticoagulant. On BC-6800 hematology analyzer, 22 of 23 EDTA-PTCP samples showed a dissociation rate greater than 80%, and the average dissociation rate was 93%. On the XE-2100 hematology analyzer, 1 of the 17 EDTA-PTCP samples showed a dissociation rate greater than 80%, and the average dissociation rate was 56%.

Conclusions: Optical fluorescence platelet counting of BC-6800 Hematology Analyzer is effective for the correction of spurious low platelet counts in EDTA-PTCP patients, and its dissociation effect on EDTA-PTCP samples was independent of fluorescent dye staining.

Keywords: Ethylene diamine tetraacetic acid-dependent pseudo thrombocytopenia (EDTA-PTCP); PLT clumps; dissociation effect; reticulocyte channel.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2019.12.58). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Typical platelet histogram and microscopic pictures of EDTA-PTCP samples. EDTA-PTCP, ethylene diamine tetraacetic acid-dependent pseudo thrombocytopenia.
Figure 2
Figure 2
BC-6800’s optical fluorescence platelet counts of EDTA-PTCP samples in EDTA tubes were comparable with impedance platelet counts of EDTA-PTCP samples in citrate tubes. PLT-I (EDTA), impedance platelet counts of EDTA-PTCP samples in EDTA tubes; PLT-O (EDTA), optical fluorescence platelet counts of EDTA-PTCP samples in EDTA tubes; PLT-I (citrate), impedance platelet counts of EDTA-PTCP samples in citrate tubes; EDTA-PTCP, ethylene diamine tetraacetic acid-dependent pseudo thrombocytopenia.
Figure 3
Figure 3
Comparable results between impedance platelet counting and optical fluorescence platelet counting on normal control samples in EDTA tubes. PLT-I, impedance platelet counts; PLT-O, optical fluorescence platelet counts.
Figure 4
Figure 4
Typical scatter plots in reticulocyte channel of EDTA dependent pseudo thrombocytopenia samples. EDTA, ethylene diamine tetraacetic acid.
Figure 5
Figure 5
No dissociation effect of XE-2100’s optical fluorescence platelet counting on EDTA-PTCP patients. PLT-I (EDTA), impedance platelet counts of EDTA-PTCP samples in EDTA tubes; PLT-O (EDTA), optical fluorescence platelet counts of EDTA-PTCP samples in EDTA tubes; PLT-I (citrate), impedance platelet counts of EDTA-PTCP samples in citrate tubes; EDTA-PTCP, ethylene diamine tetraacetic acid-dependent pseudo thrombocytopenia.
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