Article Data

  • Views 37
  • Dowloads 0

Case Report

Open Access

Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support


1Department of Laboratory Diagnostics, University Hospital Zagreb

DOI: 10.22514/SV121.102016.24 Vol.12,Issue S1,October 2016 pp.128-130

Published: 10 October 2016

*Corresponding Author(s): ANA MLINARIĆ E-mail:

PDF (422.64 kB)


Extracorporeal membranous oxygenation (ECMO) is a life-saving treatment for pae-diatric patients with cardiac or respiratory failure of diverse aetiology. ECMO sup-port is implemented only when all other available medications and procedures fail to treat the underlying cause of organ fail-ure. The reason for caution is a high risk of complications, including intravascular haemolysis, bleeding or clot formation, inflammation and sepsis. Platelet count is closely monitored in assessment of bleed-ing risk associated with ECMO support. Platelets are counted as a parameter of the complete blood count and can be measured using impedance or optical technology. We report a case of severe red blood cell (RBC) fragmentation in a neonate on ECMO in whom erroneously normal platelet counts were obtained by all available automated methods for platelet count in an emergen-cy laboratory. Based on those observations we have implemented an additional proce-dure for recognising interferences of frag-mented and microcytic RBCs that cause spuriously normal platelet counts.

Key words

platelet count, ECMO, frag-mented RBC, neonates, analytical interfer-ence

Cite And Share

ANA MLINARIĆ,GORDANA FRESSL JUROŠ,DUNJA ROGIĆ. Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support. Signa Vitae. 2016. 12(S1);128-130.


1. Chevuru SC, Sola MC, Theriaque DW, Hutson AD, Leung WCW, Perez JA, Analysis of Platelet Transfusion Usage Among Neo-nates on Extracorporeal Membrane Oxygenation. Pediatrics 2002;109(6):e89.

2. Bairdain S, Betit P, Craig N, Gauvreau K, Rycus P, Wilson JM, Thiagarajan R. Diverse Morbidity and Mortality Among Infants Treated with Venoarterial Extracorporeal Membrane Oxygenation. Cureus 2015;7(4):e263.

3. Plotz FB, Wildevuur WR, Wildevuur CRH, Delius RE, Bartlett RH. Platelet consumption during neonatal extracorporeal life support (ECLS). Perfusion 1992;7:27-33.

4. Maslach-Hubbard A, Bratton SL. Extracorporeal membrane oxygenation for pediatric respiratory failure: History, development and current status. World J Crit Care Med 2013;2(4):29-39.

5. Ninama NJ, Shah NK. Impedance platelet count in severe microcytosis-study of 161 patients. NHL J Med Scien 2014;3(1):32-6.

6. Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: a review. Part I: plate-lets. Int Jnl Lab Hem 2007;29:4–20.

7. Pan LL, Chen CM, Huang WT, Sun CK. Enhanced Accuracy of Optical Platelet Counts in Microcytic Anemia. Lab Medicine 2014;45(1):32-6.

8. van der Meer W, MacKenzie MA, Dinnissen JWB, de Keijzer HM. Pseudoplatelets: a retrospective study of their incidence and inter-ference with platelet counting. J Clin Pathol 2003;56:772–4.

9. Kunicka JE, Fischer G, Murphy J, Zelmanovic D. Improved Platelet Counting Using Two-Dimensional Laser Light Scatter. Am J Clin Pathol 2000;114:283-9.

10. International Council for Standardization in Haematology Expert Panel on Cytometry and International Society of Laboratory He-matology Task Force on Platelet Counting. Platelet Counting by the RBC/Platelet Ratio Method: A Reference Method. Am J Clin Pathol 2001;115:460-4.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time