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
- Review the peripheral smear
- Inspect PLT histogram or scattergram
- Identify non-platelet particles
- Repeat or confirm with an alternative platelet method when available
- Consider optical or fluorescence platelet counting
- Correlate with previous CBC and clinical findings․
Take Home Message
Before diagnosing thrombocytosis, make sure the analyzer is counting platelets – not fragments.”
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