Saleh Shamse Basha/LinkedIn
Apr 16, 2026, 14:05
Saleh Shamse Basha: When Platelet Counts Mislead, The PLT-F Becomes Critical
Saleh Shamse Basha, Senior Hematology Technologist (Reference Lab, HQ) at PureLab, shared a post on LinkedIn:
“When Platelets Lie… or Do They?
A recent hematology case:
- Platelet count (impedance): 3844 ×10⁹/L (!!)
- Histogram: abnormal distribution with clear overlap.
- Sysmex XR9000 detected abnormal PLT flag and reflexed to PLT-F channel then the PLT: 201×10⁹/L.
Let’s figure it out.
The question is: Is this a true extreme thrombocytosis, or are we looking at a classic analytical pitfall?
Additional findings:
- Marked microcytosis (MCV: 49.8 fL)
- Presence of schistocytes on peripheral smear.
- Anisopoikilocytosis.
In impedance-based counting (Coulter Principle), size is everything.
But when RBCs become very small—as in:
- Iron deficiency anemia
- Thalassemia
– and especially with RBC fragmentation (schistocytes)…
The analyzer may misclassify RBC fragments within the platelet size window Resulting in pseudothrombocytosis
That’s where PLT-F (fluorescent platelet count) becomes critical:
It differentiates platelets based on RNA content, not just size.”
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