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Hassan Raza։ When the Platelet Count Lies – Think Artifact Before Disease
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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