Mystery cells, case #10

This is a rare finding that impacts mature neutrophils and can lead to pseudo-thrombocytopenia on a CBC machine.

Notice that only neutrophils are impacted, other cells are fine.

Do you recognize this rare phenomenon?

The images were captured last month on a CellaVision DM96:

25 thoughts on “Mystery cells, case #10”

  1. Platelet satellitism and Platelet clumping…this rare condition occur when IGg antibody is directed against the glycoprotein on the platelet membrane and when the antibody coats the platelets,there is now a tendency that platelets form a rosette around any neutrophils like bands, or the segmented and eosinophils causing automated machine not to platelets thus making the count low(falsely decreased).

    the platelet clumping can occur due to EDTA and can cause also false decrease of platelet count.need to redraw the patient using a citrated tube(blue) then multiply the result with 1.1 in my hospital we use 1.14 to get the accurate count of the platelets.

  2. We have seen this a number of times in our lab and it is EDTA mediated platelet satelitism. The Sysmex cell counters will most likely flag these cases as platelet clumping. The platelet count will most definitely be spurious.

  3. Platelet satellitism. In order to obtain an accurate platelet count,our policy is to repeat FBC on a citrate sample.

  4. An excellent example of Platelet satellitism. In order to obtain an accurate platelet count our policy is to repeat the FBC with a Sodium citrate sample.

  5. It is definitley platelet satellitism. You cannot give an accurate platelet count! EDTA usually just causes general clumping, not satellitism.

  6. Platelet satellitism, mostly due to EDTA usage as an anticoagulant

  7. What percentage of the neutrphils have this phenomena, platelet statellistism? Although the morphology of these cells appeared to be neutrophils, the actual phenotype of these cells have not been well-characterized or mentioned. We all know, morphology can be misled. Thus, if there is (are) specific marker(s) for these interesting cells, it would not only be very helpful to make the diagnsosis correctedly but also be very informative to uncover a potential undelying mechnism.

  8. I agree platelet satellitism due to EDTA. You can vortex the specimen for two minutes and rerun the CBC but verify with a slide estimate

  9. Platelet satellitism – it’s an in vitro phenomenon of platelets rosetting around neutrophils, and is observed exclusively in blood treated with EDTA as an anticoagulant at room temperature.

    Neither heparin nor citrate produces this rosetting I believe.

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