Platelet Satellitism and Neutrophil Thrombophagocytosis

in a Patient with Chronic Lymphocytic Leukemia

Preeti Khetarpal, Steve Marionneaux, Brenda Sarduy St. Vincent’s Comprehensive Cancer Center, New York, NY, United States

INTRODUCTION Table 1: Platelet Count and Peripheral Smear Findings RESULTS

Platelet satellitism (PS) and neutrophil thrombophagocytosis (NT) are in-vitro • Blood drawn in EDTA and stored at 23°C demonstrated a decreasing
phenomena due to EDTA sensitivity and IgG autoantibodies to platelet glycoprotein IIb/ EDTA EDTA EDTA Sodium citrate platelet count over time that was likely related to the presence of PS
Time and NT (see table).
IIIa (Shahab & Evans, 1998)(Lee & Tripathy, 2000). Both have been implicated as 23°C 37°C 4°C 23°C
• Incubating the EDTA sample at 37°C did not show PS/NT at any time
causes of pseudothrombocytopenia. There have been only rare reports of PS and NT interval, and there was no subsequent lowering of the platelet count.
Platelet count
occurring simultaneously (Yoo, Weems & Lessin, 1982). In this report, we present a Time post- Platelet count Smear Platelet count Smear Platelet count Smear Smear
(x1000/µL)+ • In the samples collected in sodium citrate; platelet counts were inversely
case of PS and NT occurring together in a patient diagnosed with chronic lymphocytic collection (x1000/µL) findings (x1000/µL) findings (x1000/µL) findings findings
10% proportional to the degree of platelet clumping observed over time. PS/NT
leukemia (CLL). We performed a study to determine whether various anticoagulants, were not observed in any of these samples.
No PS, No NT
temperature, and time had an effect on the presence of PS/NT and platelet counts. Rare PS, • Smears prepared directly from a fingerstick did not demonstrate PS/NT.
Rare platelet
5 mins 225 No NT -- -- -- -- 239
clumps
(Figure 1)
(Figure 2)
CASE REPORT No PS, No NT DISCUSSION
We describe a 70 year old female with a history of Rai stage II B cell CLL and associated 30 mins 197 PS, NT 219 No PS, No NT 180 PS, NT 206 1+ platelet • As others have reported, our findings suggest that PS and NT are in-vitro,
hypogammaglobulinemia, initially diagnosed in June 2005. Laboratory evaluation at clumps temperature dependent, EDTA related phenomenon that are not associated
diagnosis revealed: with other anticoagulants
• White blood cell (WBC) count: 44, 000/µL No PS, No NT • The risk for pseudothrombocytopenia was present and more evident
• Absolute lymphocyte count: 36, 520/µL 60 mins 192 PS, NT 213 No PS, No NT 195 PS, NT 120 1+ platelet over time
• Hemoglobin: 11.3 g/dL clumps • The negative fingerstick smear confirms that PS/NT are not in-vivo
• Platelets: 162, 000/µL
phenomenon
No PS, No NT • Interestingly, citrate appeared to induce platelet clumping. Therefore this
Examination of the peripheral blood smear revealed the presence of both platelet PS, NT No PS, No NT 2+ platelet
120 mins 164 214 177 PS, NT 70 anticoagulant would not have been an acceptable alternative for obtaining
satellitism and neutrophil thrombophagocytosis. The patient received first-line (Figure 3) (Figure 4) clumps an accurate platelet count in this patient.
treatment with chlorambucil and prednisone. Since then, she has had two relapses. (Figure 5)
She was treated with fludarabine for the first relapse and, most recently, a course (PS: Platelet Satellitism; NT: Neutrophil phagocytosis)
Based on the findings of our study we conclude the following: In order
of bendamustine. Throughout her disease course, platelet satellitism and neutrophil to obtain accurate platelet counts in patients with observed platelet
satellitism and neutrophil thrombophagocytosis, the EDTA sample should
thrombophagocytosis have been observed on the peripheral blood smear. be recollected and maintained at 37oC prior to testing.

MATERIALS AND METHODS

• Testing was performed October, 2008. Samples were collected through standard SELECTED REFERENCES
venipuncture using different anticoagulants (see below) 1. Shahab N, Evans ML, Platelet satellitism. N Engl J Med 1998;338:591-591.
2. J.C. Lee, Kumud Tripathy, Neutrophilic Thrombophagocytosis. Arch Pathol
Lab Med-Vol 124, October 2000.
3. Yoo D, Weems H, Lessin LS. Platelet to leukocyte adherence phenomena.
(Platelet satellitis) and phagocytosis by neutrophils associated with in vitro
platelet dysfunction. Acta Haematol. 1982;68(2):142-8.

Figure 1: EDTA 23oC at 5 mins Figure 2: Sodium Citrate 23oC at 5 mins

After 2 hours

Sodium
K3EDTA Citrate (3.2%)

• Platelet counts were performed on the Coulter LH 750 analyzer (Beckman Coulter,
Hialeah, FL).
• Blood smears were prepared directly from a fingerstick as well as the
Intracytoplasmic Platelets
anticoagulated tubes.
• All smears were stained with Wright’s – Giemsa.
• Platelet counts and smear reviews were performed at different times and temperature.
Figure 3: EDTA 23oC Figure 4: EDTA 37oC Figure 5: Sodium Citrate 23oC

StV_LabPoster_np_ps.F.indd 1 5/6/09 2:39 PM