Download PDF
Semin Thromb Hemost 2001; 27(3): 229-236
DOI: 10.1055/s-2001-15252
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Possibilities and Limitations of Automated Platelet Counting Procedures in the Thrombocytopenic Range

Dagmar Kunz
  • Institut für Klinische Chemie Und Pathobiochemie, Universitätsklinikum der RWTH, Aachen, Germany
Further Information

Publication History

Publication Date:
31 December 2001 (online)

    Permissions and Reprints

ABSTRACT

The clinical decision to proceed with prophylactic platelet transfusions is widely based on trigger points for platelet counts being equal to 20, 10, or even 5 × 10

@affil9:9/L. But an increasing number of publications show evidence that the conventional automated platelet counting methods are unable to provide consistently accurate results in this lower thrombocytopenic range. These measurement errors are mainly associated with the most commonly used impedance principle; optical methods seem to be more precise. The problems of counting imprecision in the low thrombocytopenic range can be avoided with direct or indirect immunological counting methods using monoclonal antibodies or by time-consuming manual procedures. But how should new counting procedures be evaluated? Which method should be used as the ``gold standard'' for platelet counting? A way out of this apparent dilemma is the application of a statistical procedure as proposed by Gautschi et al. This mathematical model allows a reference method independent evaluation of new methods by calculation of the limits of detection (LD) and limits of quantification (LQ) based on the imprecision profile of the investigated method. Using this evaluation procedure, it can be shown that immunological automated counting methods can provide reliable, sufficient, and prompt platelet counts, especially in the thrombocytopenic range.

KEYWORD

Platelet counting - thrombocytopenia - interferences - CD61 - flow cytometry

REFERENCES

  • 1 Slichter S J, Harker L A. Thrombocytopenia: mechanisms and management.  Clin Haematol . 1978;  7 523-539
    PubMedGoogle Scholar
  • 2 Beutler E. Platelet transfusion: the 20,000/μl trigger.  Blood . 1993;  81 1411-1413
    PubMedGoogle Scholar
  • 3 Sutor A H. Acute immune thrombocytopenia in childhood. Are we treating the platelet count?.  Semin Thromb Hemost 24;. 1998;  545-548
    PubMedGoogle Scholar
  • 4 Pisciotto P T, Benson K, Hume H. Prophylactic versus therapeutic platelet transfusion practices in hematology and/or oncology patients.  Transfusion . 1995;  35 498-502
    CrossrefPubMedGoogle Scholar
  • 5 Wallace E L, Churchill W H, Surgenor D M. Collection and transfusion of blood and blood components in the United States, 1992.  Transfusion . 1995;  35 802-812
    CrossrefPubMedGoogle Scholar
  • 6 Gaydos L A, Freireich E J, Mantel N. The quantitative relation between platelet count and hemorrhage in patients with acute leukemia.  N Engl J Med . 1962;  266 905-912
    CrossrefPubMedGoogle Scholar
  • 7 Gil-Fernandez J J, Alegre A, Fernandez-Villalta M J. Clinical results of a stringent policy on prophylactic platelet transfusion: non-randomized comparative analysis in 190 bone marrow transplant patients from a single institution.  Bone Marrow Transplant . 1996;  18 931-935
    PubMedGoogle Scholar
  • 8 Heckman, K D, Weiner G J, Davis C S, et al.. Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL.  J Clin Oncol . 1997;  15 1143-1149
    PubMedGoogle Scholar
  • 9 Rebulla P, Finazzi G, Marangoni F. A multicenter randomized study of the threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia.  N Engl J Med . 1997;  337 1870-1874
    CrossrefPubMedGoogle Scholar
  • 10 Want H, Frank M, Ehninger G. Safety and cost effectiveness of a 10 × 109/l trigger for prophylactic platelet transfusions compared with the traditional 20 × 109/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia.  Blood . 1998;  91 3601-3606
    PubMedGoogle Scholar
  • 11 Ancliff P J, Machin S J. Trigger factors for prophylactic platelet transfusion.  Blood Rev . 1998;  12 234-238
    CrossrefPubMedGoogle Scholar
  • 12 Bernstein S H, Nademanee A P, Vose J M. A multicenter study of platelet recovery and utilization in patients after myeloablative therapy and hematopoietic stem cell transplantation.  Blood . 1998;  91 3509-3517
    PubMedGoogle Scholar
  • 13 Rebulla P. Trigger for platelet transfusion.  Vox Sang . 2000;  78 179-182
    PubMedGoogle Scholar
  • 14 Gmur J, Burger J, Schanz U, Fehr J, Schaffner A. Safety of stringent prophylactic platelet transfusion policy for patients with acute leukemia.  Lancet . 1991;  338 1223-1226
    CrossrefPubMedGoogle Scholar
  • 15 Decary F, Ferner P, Giavedoni L. An investigation of nonhemolytic transfusion reactions.  Vox Sang . 1984;  46 277-285
    PubMedGoogle Scholar
  • 16 Dodd R Y. The risk of transfusion-transmitted infection.  N Engl J Med . 1992;  327 419-421
    PubMedGoogle Scholar
  • 17 Slichter S J. Prevention of platelet alloimmunization. In: Murawski K, Peetom F, eds. Transfusion Medicine: Recent Technological Advances New York: Liss 1986: 83-116
    Google Scholar
  • 18 Evans V J, Glasser L. Accuracy of low electronic platelet counts using platelet distribution curves.  Am J Med Technol . 1981;  47 15-18
    PubMedGoogle Scholar
  • 19 Koh T, Kabutomori O, Hishiyama M. Discrepancy of platelet numbers between automated blood cell analysis and manual counting in patients with thrombocytopenia.  Rinsho Byori . 1996;  44 889-694
    PubMedGoogle Scholar
  • 20 Dickerhoff R, Von Ruecker A. Enumeration of platelets by multiparameter flow cytometry using platelet-specific antibodies and fluorescent reference particles.  Clin Lab Haematol . 1995;  17 163-172
    PubMedGoogle Scholar
  • 21 Haung M L, Ho C H. Diagnostic value of an automatic hematology analyzer in patients with hematologic disorders.  Adv Ther . 1998;  15 137-141
    PubMedGoogle Scholar
  • 22 Armitage J O, Goeken J A, Feagler J R. Spurious elevation of the platelet count in acute leukemia.  JAMA . 1978;  239 433-437
    CrossrefPubMedGoogle Scholar
  • 23 Malcolm I D, Monks P, Katz M. Spurious thrombocytosis in acute myelocytic leukemia.  N Engl J Med . 1977;  298 1260-1264
    PubMedGoogle Scholar
  • 24 Stass S A, Holloway M L, Slease R B, Schumacher H R. Spurious platelet counts in hairy cell leukemia.  Am J Clin Pathol . 1977;  68 530-535
    PubMedGoogle Scholar
  • 25 Stass S A, Holloway M L, Peterson V. Cytoplasmic fragments causing spurious platelet counts in the leukemic phase of poorly-differentiated lymphocytic lymphoma.  Am J Clin Pathol . 1979;  71 125-131
    PubMedGoogle Scholar
  • 26 Sugimoto T, Saigo K, Ryo R, Yamaguchi N. Giant platelet-like cell fragments produced from abnormal promyelocytes in acute myelogenous leukemia.  Rinsho Byori . 1998;  46 182-187
    PubMedGoogle Scholar
  • 27 Hammerstrom H. Spurious platelet counts in acute leukemia with DIC due to cell fragmentation.  Clin Lab Haematol . 1992;  14 239-243
    PubMedGoogle Scholar
  • 28 Akwari A M, Ross D W, Stass S A. Spuriously elevated platelet count due to microspherocytosis.  Am J Clin Pathol . 1982;  77 220-221
    PubMedGoogle Scholar
  • 29 Cornbleet J. Spurious results from automated cell counters.  Lab Med . 1983;  14 509-512
    PubMedGoogle Scholar
  • 30 Paterakis G, Konstantopoulos K, Loukopoulos D. Spuriously increased platelet count due to microcyte interference.  Am J Hematol . 1994;  46 46-51
    PubMedGoogle Scholar
  • 31 Sutor A H. Thrombozytenzählung bei Thrombozytopenie.  Paediatr Prax . 1995/96;  50 43-52
    PubMedGoogle Scholar
  • 32 Pinkowski R. Difference between impedance and optical platelet counts in patients with microcytosis of red blood cells.  Lab Hematol . 1999;  5 22-27
    PubMedGoogle Scholar
  • 33 Morton B D, Orringer E P, LaHart L A, Stass S A. Pappenheimer bodies. An additional cause for a spurious platelet count.  Am J Clin Pathol . 1980;  74 310-311
    PubMedGoogle Scholar
  • 34 Howard C A. An atypical spike in a platelet histogram caused by a type I cryoglobulinaemia.  Lab Med . 1994;  25 770-773
    PubMedGoogle Scholar
  • 35 Harrison P, Horton A, Grant D, Briggs C, Machin S. Immunoplatelet counting: a proposed new reference procedure.  Br J Haematol . 2000;  108 228-235
    CrossrefPubMedGoogle Scholar
  • 36 Stanworth S J, Denton K, Monteath J, Patton W N. Automated counting of platelets on the Bayer Advia 120 analyzer.  Clin Lab Haematol . 1999;  2 113-117
    PubMedGoogle Scholar
  • 37 Rosas-Baruch A, Salas-Montiel R, Loria A, Majluf-Cruz A. External quality control program of four blood cell counters.  Rev Invest Clin . 1999;  51 289-292
    PubMedGoogle Scholar
  • 38 Kawai Y, Takeuchi K, Shimizu N. Accuracy, precision and clinically acceptable level of complete blood cell count by an automated multichannel hematology analyzer.  Rinsho Byori 47;. 1999;  343-352
    PubMedGoogle Scholar
  • 39 Tanaka C, Ishii T, Fujimoto K. Flow cytometric platelet enumeration in utilizing monoclonal antibody CD42a.  Clin Lab Haematol . 1996;  18 265-269
    PubMedGoogle Scholar
  • 40 Passing H, Bablok W. A new biometrical procedure for testing the equality of measurements from two different analytical methods.  J Clin Chem Biochem . 1983;  21 709-720
    PubMedGoogle Scholar
  • 41 Lawrence J B, Yomtovian R A, Dillmann C. Reliability of automated platelet counts; comparison with manual method and utility for prediction of clinical bleeding.  Am J Hematol . 1995;  48 244-250
    PubMedGoogle Scholar
  • 42 ICSH (International Council for Standardization in Haematology). Protocol for evaluation of automated blood cell counters.  Clin Lab Haematol . 1984;  6 69-84
    PubMedGoogle Scholar
  • 43 ICSH (International Council for Standardization in Haematology). Guidelines for the evaluation of blood cell analysers including those used for differential leukcocyte and reticulocyte counting and cell marker applications.  Clin Lab Haematol . 1994;  16 157-174
    PubMedGoogle Scholar
  • 44 Ault K A. Platelet counting: is there room for improvement?.  Lab Hematol . 1996;  2 139-143
    PubMedGoogle Scholar
  • 45 Haenseler E, Fehr J, Keller H. Estimation of lower limits of manual and automated platelet counting.  Am J Clin Pathol . 1996;  105 782-787
    PubMedGoogle Scholar
  • 46 Gautschi K, Keller B, Keller H, Pei P, Vonderschmitt D J. A new look at the limits of detection (LD), quantification (LQ) and power of definition (PD).  Eur J Clin Chem Clin Biochem . 1993;  31 433-440
    PubMedGoogle Scholar
  • 47 Neumüller J, Schwartz D W, Mayr W R. Demonstration by flow cytometry of the numbers of residual white blood cells and platelets in filtered red blood cell concentrates and plasma preparations.  Vox Sang . 1997;  73 220-229
    CrossrefPubMedGoogle Scholar
  • 48 Davis B H, Bigelow N C. Indirect immunoplatelet counting by flow cytometry as a reference method for platelet count calibration.  Lab Hematol . 1999;  5 15-21
    PubMedGoogle Scholar
  • 49 Kunz D, Hoeffkes H G, Kunz W S, Gressner A M. A standardized flow cytometric method for the accurate determination of platelet counts in patients with severe thrombocytopenia.  Cytometry . 2000;  42 284-289
    PubMedGoogle Scholar
  • 50 Kickler T S, Rothe M, Blosser L, Schisano T, van Hove L. Improving platelet transfusion therapy using the ImmunoPLT method on the Cell-Dyn 4000.  Lab Hematol . 1998;  4 80-87
    PubMedGoogle Scholar
  • 51 Kunz D, Kunz W S, Scott S C, Gressner A M. Automated CD61 immunoplatelet analysis of thrombocytopenic samples.  Br J Haematol (in press).
    PubMedGoogle Scholar