Overestimation of Automated Platelet Counts by Blast Fragments in Acute Hypercellular Leukemias: A Retrospective Study Comparing Impedance, Optical (PLT-O), Fluorescent (PLT-F), and CD41/CD61 Flow Cytometry Methods

IF 2.2 4区医学 Q3 HEMATOLOGY

International Journal of Laboratory Hematology Pub Date : 2025-04-01 DOI:10.1111/ijlh.14464

Victor Bobée, Romain Ravel-Chapuis, Maïssa Souissi, Catherine Boutet, Dany Bigot, Cédric Paquin, Jorel Gruchet, Virginie Barbay, Vincent Camus, Elsa Bera, Sylvie Daliphard

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引用次数: 0

Abstract

Introduction

Acute leukemias with hyperleukocytosis (> 100 × 10⁹/L) can produce cytoplasmic blast fragments that interfere with platelet counts, notably in impedance-based methods, potentially masking severe thrombocytopenia and increasing hemorrhagic risk. While fluorescent platelet counting (PLT-F) is promoted as platelet-specific, its accuracy in the presence of blast fragments remains uncertain.

Methods

This retrospective study analyzed 269 blood samples from 87 patients with hypercellular acute leukemia. Blast fragments were identified on blood smears. Platelet counts by impedance were compared to optical (PLT-O) and fluorescent (PLT-F) methods when available. Flow cytometry (FC) quantification by CD41+/CD61+ staining was performed in selected cases.

Results

Blast fragments were observed in 26% of cases, predominantly in AML-M5 and AML-M1 subtypes. In the absence of blast fragments, PLT-I, PLT-O, and PLT-F showed comparable results. However, in samples with blast fragments, PLT-I frequently overestimated platelet counts compared to PLT-O and PLT-F. PLT-F counts were closer to FC quantification but still overestimated platelet numbers in 6 of 16 samples with FC results, particularly in cases of severe leukocytosis. Notably, PLT-F failed to trigger abnormal scattergram flags in all but one of the discrepant cases. PLT-O provided results comparable to PLT-F in most cases with blast fragments but also demonstrated limitations in select cases.

Conclusion

PLT-O and PLT-F methods both have limitations in hypercellular acute leukemias with blast fragments. FC remains the most reliable approach when blast fragments are present. Routine blood smear evaluations are essential for detecting interferences and ensuring accurate thrombocytopenia assessment in these high-risk patients.

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急性高细胞白血病中爆炸片段对自动血小板计数的高估：比较阻抗法、光学法（PLT-O）、荧光法（PLT-F）和 CD41/CD61 流式细胞计数法的回顾性研究。

急性白血病伴高白细胞血症（> 100 × 109/L）可产生干扰血小板计数的细胞质母细胞片段，特别是在基于阻抗的方法中，可能掩盖严重的血小板减少和增加出血风险。虽然荧光血小板计数（PLT-F）被认为是血小板特异性的，但其在爆炸碎片存在时的准确性仍不确定。方法：回顾性分析87例高细胞急性白血病患者269份血样。在血液涂片上发现了爆炸碎片。阻抗法血小板计数与光学法（PLT-O）和荧光法（PLT-F）进行比较。选择病例行CD41+/CD61+染色流式细胞术（FC）定量。结果：在26%的病例中观察到爆炸碎片，主要是AML-M5和AML-M1亚型。在没有爆炸碎片的情况下，PLT-I、PLT-O和PLT-F的结果相当。然而，在具有爆炸碎片的样本中，与PLT-O和PLT-F相比，PLT-I经常高估血小板计数。PLT-F计数更接近FC定量，但在16例FC结果样本中仍有6例高估了血小板数量，特别是在严重白细胞增多的情况下。值得注意的是，PLT-F在除一个差异病例外的所有病例中都未能触发异常散点图标志。在大多数爆炸碎片病例中，PLT-O提供的结果与PLT-F相当，但在某些病例中也显示出局限性。结论：PLT-O和PLT-F方法在高细胞急性白血病伴母细胞碎片中均有局限性。当爆炸碎片存在时，FC仍然是最可靠的方法。常规血涂片评估是必不可少的检测干扰和确保准确的血小板减少评估这些高危患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Laboratory Hematology 医学-血液学

CiteScore

4.50

自引率

6.70%

发文量

211

审稿时长

6-12 weeks

期刊介绍： The International Journal of Laboratory Hematology provides a forum for the communication of new developments, research topics and the practice of laboratory haematology. The journal publishes invited reviews, full length original articles, and correspondence. The International Journal of Laboratory Hematology is the official journal of the International Society for Laboratory Hematology, which addresses the following sub-disciplines: cellular analysis, flow cytometry, haemostasis and thrombosis, molecular diagnostics, haematology informatics, haemoglobinopathies, point of care testing, standards and guidelines. The journal was launched in 2006 as the successor to Clinical and Laboratory Hematology, which was first published in 1979. An active and positive editorial policy ensures that work of a high scientific standard is reported, in order to bridge the gap between practical and academic aspects of laboratory haematology.