Hassan Raza/LinkedIn
May 26, 2026, 11:05
Hassan Raza։ When the Platelet Count Lies – Think Artifact Before Disease
Hassan Raza, Consultant Hematologist and Transfusion Medicine Specialist, shared a post on LinkedIn:
“When the Platelet Count Lies: Think Artifact Before Disease
A 48-year-old man underwent routine pre-operative testing.
CBC showed:
- Platelet count: 820 × 10⁹/L
- Hemoglobin and WBC: normal
- No symptoms or history suggestive of thrombocytosis
- Patient clinically stable
However:
- Peripheral smear review shows no true increase in platelets
- Background contains numerous small particles/debris
What is the most likely explanation?
Answer: Spurious thrombocytosis due to platelet count artifact
What particles are miscounted as platelets?
Automated analyzers may misclassify particles in the platelet size range (2–20 fL), including:
- RBC fragments (schistocytes)
- Cell debris (leukocyte or erythrocyte fragments)
- Cryoglobulin / protein precipitates (e.g., in paraproteinemia)
- Lipid droplets in severe lipemia
- Platelet satellitism / clumps (EDTA-related)
Key teaching point։
Always confirm unexpected thrombocytosis with a peripheral blood smear, especially when clinical findings do not match the report.”
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