Pseudo-Thrombocytosis Caused by Extreme Microcytosis in a Patient with Alpha Thalassemia Trait
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Pseudo-Thrombocytosis Caused by Extreme Microcytosis in a Patient with Alpha Thalassemia Trait Alexander A. Slota1
•
Devin Malik2 • Diane Hall3
Received: 16 September 2019 / Accepted: 1 June 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
Keywords Thrombocytosis Microcytosis Alpha thalassemia Peripheral smear While automated blood counts have revolutionized laboratory medicine and hematology, there are instances in which visualization of a peripheral blood smear is superior to instrument values. We describe a 57-year-old African American male with alpha thalassemia trait with spurious thrombocytosis. While thrombocytopenia can be a complication of hypersplenism in thalassemia [1], thrombocytosis is rare in alpha thalassemia trait [2]. Our patient’s baseline platelet count was 250 9 109/L. However, laboratory results noted transiently elevated platelet counts routinely between 1200 9 109/L and 2000 9 109/L. He also had anemia (hemoglobin 85 g/L) and microcytosis (MCV 56.9 fl).
Extensive hematologic workup at a regional cancer center was subsequently pursued which showed negative JAK2 and BCR/ABL mutation studies. No dysplasia was seen on bone marrow examination. Upon referral to our institution, routine peripheral blood smear showed normal platelet count with marked anisocytosis, microcytosis, and poikilocytosis including elliptocytosis and tear drop cells (Fig. 1). The small sized microcytic red cells were being interpreted as platelets on the automated analyzer, leading to falsely elevated platelet count (Fig. 2). Platelet fluorescence was performed with Sysmex XN-1000, confirming a platelet count of 222 9 109/L, consistent with the baseline value. The purpose of this case is to emphasize the necessity to visualize blood smears prior to performing unnecessary and expensive workup for hematologic diseases.
& Alexander A. Slota [email protected] 1
Department of Internal Medicine, Henry Ford Allegiance Health, 205 N East Ave, Jackson, MI 49201, USA
2
Department of Hematology and Medical Oncology, Henry Ford Allegiance Health, 1100 E Michigan Ave Ste 307, Jackson, MI 49201, USA
3
Department of Pathology, Henry Ford Allegiance Health, 205 N East Ave, Jackson, MI 49201, USA
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Indian J Hematol Blood Transfus
References 1. Vichinsky E (2010) Complexity of alpha thalassemia: growing health problem with new approaches to screening, diagnosis, and therapy. Ann N Y Acad Sci 1202:180–187 2. Taylor S, Strauch S, Lewis S (2015) Thrombocytosis in a patient with alpha thalassemia trait. Lab Med 46:e7–e12 Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Fig. 1 Peripheral blood smear showing anisocytosis and marked microcytosis which was misinterpreted as platelets on the hematology analyzer. (Wright’s stain, 500 9)
Fig. 2 RBC and platelet histograms, indicating low red cell volume in the setting of alpha thalassemia trait and resultant incorrect large mean platelet volume
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