Abstract
Background
The automated hematologic analyzer has increased the precision and accuracy for platelet counting. However, spurious elevations of automated platelet counts occur occasionally in patients receiving chemotherapy or radiotherapy for solid organ tumors, leukemia, and other lymphomas. The CELL-DYN Sapphire analyzer (Abbott, USA) detects platelets with a CD61 monoclonal antibody and uses both impedance and optical technologies; thus, it is expected to present more accurate platelet counts.
Methods
We evaluated platelet counts obtained with the CELL-DYN Sapphire impedance, optical, and CD61 methods and compared them with the results obtained with the XE-2100 analyzer (Sysmex, Japan). We analyzed 111 samples from hospitalized patients with various hematologic diseases, who were receiving chemotherapy or radiotherapy.
Results
The results from the impedance, optical, and CD61 methods of CELL-DYN Sapphire and those from XE-2100 showed significant linearity, with correlation coefficients greater than 0.99. Three cases had significantly different platelet counts among the different methods used. Microscopic examination of these three cases showed very low platelet counts that corresponded with the low counts from the CD61 methods. It should be noted that because the automated blood counter assesses cell populations by their dimensions, many cellular fragments that were of the same size or smaller than platelets were thus counted as platelets.
Conclusions
The CELL-DYN Sapphire analyzer has good precision, linearity and performance, comparable with the XE-2100 analyzer. As the CD61 methods of CELL-DYN Sapphire is specific for platelet, this method may reduce the interference from other blood components and count the exact platelet numbers.
Figures and Tables
References
1. Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. Int J Lab Hematol. 2007; 29:4–20.
2. 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; 31:151–160.
3. Malcolm ID, Monks P, Katz M. Spurious thrombocytosis in acute myelocytic leukemia. N Engl J Med. 1978; 298:1260.
4. Ballard HS, Sidhu G. Cytoplasmic fragments causing spurious platelet counts in hairy cell leukemia: ultrastructural characterization. Arch Intern Med. 1981; 141:942–944.
5. Hammerstrom J. Spurious platelet counts in acute leukaemia with DIC due to cell fragmentation. Clin Lab Haematol. 1992; 14:239–243.
6. Li S, Salhany KE. Spurious elevation of automated platelet counts in secondary acute monocytic leukemia associated with tumor lysis syndrome. Arch Pathol Lab Med. 1999; 123:1111–1114.
7. van der Meer W, MacKenzie MA, Dinnissen JW, de Keijzer MH. Pseudoplatelets: a retrospective study of their incidence and interference with platelet counting. J Clin Pathol. 2003; 56:772–774.
8. International Council for Standardization in Haematology Expert Panel on Cytometry. International Society of Laboratory Hematology Task Force on Platelet Counting. Platelet counting by the RBC/platelet ratio method. A reference method. Am J Clin Pathol. 2001; 115:460–464.
9. World Health Organization. Diagnostic Imaging and Laboratory Technology International Council for Standardization in Haematology. Expert Panel on Cytometry. Recommended methods for the visual deterdetermination of white blood cell count and platelet count. Updated on 2000. http://apps.who.int/iris/handle/10665/66241.
10. 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; 134:634–647.
11. Harrison P, Ault KA, Chapman S, Charie L, Davis B, Fujimoto K, et al. International Society of Laboratory Hematology Task Force for the Reference Platelet count. An Interlaboratory Study of a candidate reference method for platelet counting. Am J Clin Pathol. 2001; 115:448–459.
12. Buttarello M, Plebani M. Automated blood cell counts: state of the art. Am J Clin Pathol. 2008; 130:104–116.