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Ayatullah Gamal Wahab: When The Platelet Count Lies
Ayatullah Gamal Wahab/LinkedIn
Aug 20, 2026, 11:12

Ayatullah Gamal Wahab: When The Platelet Count Lies

Ayatullah Gamal Wahab, Assistant Lecturer at Ain Shams University, Clinical pathology specialist at EL Zaitoun Specialized Hospital, shared post on LinkedIn:

“When The Platelet Count Lies

Spurious or False Thrombocytosis in the CBC

Main visual: a real peripheral blood smear showing RBC fragments/schistocytes, with an analyzer-style PLT count appearing falsely elevated.

1.The Problem

  • PLT increased does not always mean true thrombocytosis.
  • Non-platelet particles may fall within the platelet counting range and be incorrectly classified as platelets.

2.What Can Fool The Analyzer?

  • RBC fragments or schistocytes
  • Marked microcytosis
  • RBC inclusions
  • WBC or cellular fragments
  • Cellular debris
  • Bacteria or other small particles – rare
  • Technical or sample-related interference․

3.Red Flags

  • Unexpectedly high PLT
  • Very low/discordant MPV
  • Abnormal platelet histogram/scattergram
  • Marked microcytosis or RBC fragmentation
  • PLT count inconsistent with the smear․

4.Don’t Trust The Number Alone

  • BC to Histogram/Scattergram to Peripheral smear.

5.How To Resolve It

  1. Review the peripheral smear
  2. Inspect PLT histogram or scattergram
  3. Identify non-platelet particles
  4. Repeat or confirm with an alternative platelet method when available
  5. Consider optical or fluorescence platelet counting
  6. Correlate with previous CBC and clinical findings․

Take Home Message

Before diagnosing thrombocytosis, make sure the analyzer is counting platelets – not fragments.”

Ayatullah Gamal Wahab

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Ayatullah Gamal Wahab Blood Health Hematology Hemostasis Hemostasis News Hemostasis Today High Platelet Count Medicine platelets RBC Thrombocytosis
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