HEMATOLOGY
THE STUDY OF BLOOD AND ITS COMPONENTS
  • About
  • Contact
  • Collecting & Processing of Blood: Pre-Analytical
  • Blood
  • Phlebotomy and Venipuncture
  • Capillary Samples & Skin Punctures
  • The Complete Blood Count (CBC) and Differential
  • Red Blood Cells
  • White Blood Cells
  • Platelets
  • Red Blood Cell Inclusions and Abnormalities
  • Anemias
  • White Blood Cell Inclusions and Abnormalities
  • Leukemias
  • Platelet Abnormalities
  • Coagulation
  • Coagulation Disorders
    • Artifacts in Peripheral Blood Smears
  • Blood Parasites
  • References
  • Hemacytometer

Platelet Abnormalities and Conditions:

Platelet Satellitism

Pseudothrombocytopenia is a problem with the sample in-vitro (in the test tube) that is causing a falsely low platelet count.  This is a phenomenon that occurs when the anticoagulant in the lavender-top tube (K2EDTA) causes the platelets to clump , leading to a falsely low platelet count.   If this occurs, blood can be collected in and tested from a blue-top sodium citrate tube.   The anticoagulant clumps with cold agglutinins present on the platelets.  Multiple myeloma patients also tend to have this problem,  so it is good to check the patient's history if you see this occurrence, since it is uncommon.  Automated instruments can also cause this false-positive to occur. 
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Platelets are seen sticking to neutrophils in this image showing platelet satellitism. This condition is only observed in EDTA anticoagulated blood or in certain lymphomas associated with vasculitis. By Paulo Henrique Orlandi Mourao - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8792971
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By Guy Waterval - Own work, Apache License 2.0, https://commons.wikimedia.org/w/index.php?curid=53570835
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Marginal Zone B-Cell Lymphoma and Mantle Cell Lymphoma may exhibit platelet satellitism; By Osaretin - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=51158894
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Blood for CBC and CBC w/differentials and platelet count/function is drawn into a lavender-top tube containing K2 EDTA anticoagulant, as seen in the picture above

Giant Platelets

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Two giant platelets seen here; By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=7761823
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Giant Platelets are often seen with May-Hegglin Anomaly; By Paulo Henrique Orlandi Mourao - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8799648
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A giant platelet seen in the peripheral blood; By Ed Uthman from Houston, TX, USA - Giant Platelet, Peripheral Blood SmearUploaded by CFCF, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=30104557
Giant platelets are seen in many blood conditions, including malaria, and should not be confused with the Plasmodium spp parasite growing trophozoite or gametocyte forms.
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An example of malaria in peripheral blood and 2 giant platelets

Platelet Clumping

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Platelet clumping seen in May Grunwald-Giemsa microscopy; By Tleonardi - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=3159041
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Platelet clumping observed in a patient; By Prof. Erhabor Osaro - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=36814529

 Thrombocythemia or Thrombocytosis

Thrombocythemia, or thrombocytosis, is a high platelet count.  It is usually reactive.  Some conditions that cause this include:
  • trauma
  • bleeding (most common cause)
  • blood clots (thrombosis, deep vein thrombosis, embolism)
  • acute infection
  • inflammation
  • malignancy
  • tissue damage
  • iron deficiency
  • post-surgery
  • certain drugs
  • rebound after bone marrow suppression
  • seen in acute myeloid leukemia (AML)
  • seen in myelofibrosis
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Essential thrombocytosis or thrombocythemia; This is too many platelets; By Erhabor Osaro (Associate Professor) - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=32131622
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Reactive thrombocytosis secondary to septicemia. By Prof. Erhabor Osaro - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=36814530
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Thrombocytosis is an increase in the amount of platelets, putting a patient at risk for blood clots. It may be a primary condition, due to a blood condition such as a myeloproliferative disorder such as Polycythemia vera, myelofibrosis, Chronic Myeoloid Leukemia, or essential thrombocytosis, or it may be reactive/secondary, due to conditions such as surgery, inflammation, splenectomy, a hemorrhage, hyposplenism or asplenism or even septicemia. By Prof. Erhabor Osaro - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=36814533

Disseminated Intravascular Coagulation:

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A blood clot in DVT (deep vein thrombosis) due to thrombocytosis
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Signs and symptoms to look for when someone has DVT: swelling, redness, heat, tight skin, patient will have pain
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An ultrasound image of DVT; By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=13244779
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The formation of a blood clot; By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=28761809
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By en:User:Persian Poet Gal - http://en.wikipedia.org/wiki/Image:Blood_clot_diagram.png, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1638211
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THROMBOCYTOPENIA:

Decreased production of platelets can be caused by the following conditions:
  • dehydration
  • vitamin B12 or folate deficiency (pernicious anemia)
  • leukemia
  • anemia
  • myelodysplastic syndrome
  • liver failure
  • sepsis
  • infection
  • genetic/hereditary condition

Increased destruction of platelets can be caused by the following conditions:
  • purpura
  • hemolytic uremic syndrome
  • disseminated intravascular coagulation
  • hemoglobinuria
  • lupus
  • infection
  • Gaucher's disease
  • medications such as heparin or others
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Thrombocytopenia is a decrease in the amount of platelets, putting a patient at risk of hemorrhage and blood loss. In this image, this patient is almost completely devoid of all platelets. By Prof. Erhabor Osaro - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=36814531
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Thrombotic thrombocytopenic purpura (TTP) is seen in this image, which is a condition where small blood clots form throughout the circulation, resulting in the dissipation and destruction of platelets and a low platelet count.By Erhabor Osaro (Associate Professor) - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=32131623
Thrombocytopenia is a low platelet count.  It can be either inherited or acquired.  Some common conditions causing

Purpura:

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By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11857197
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By User:Hektor - the English Wikipedia: http://en.wikipedia.org/wiki/Image:Purpura.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=1222775

Petechiae:

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By The original uploader was Seasurfer at Chinese Wikipedia - http://www.cdc.gov/ncidod/dvbid/dengue/slideset/set1/vi/slide07.htm, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2111479
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By Photo Credit:Content Providers: CDC/Dr. Heinz F. Eichenwald - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3183.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−Transwiki approved by: w:en:User:Dmcdevit, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4394124
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By Mdscottis - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24734024

Easy Bruising:

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By Thegoldenoriole - Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=14656475

Frequent Nosebleeds and Gum Bleeds:

Classic Hemophilia:

Hemophilia is a genetic disorder resulting from a deficiency of specific clotting factors.  Symptoms can range from mild to moderate to severe.  Prolonged bleeding, easy bruising, hematomas and excessive nose and gum bleeds are common symptoms. Join swelling and pain may occur if there is bleeding into the joints.

Genetically speaking, hemophilia is an X-linked disorder in males, transmitted by the asymptomatic carrier (mother-to-son). Factor VIII is a clotting factor in the intrinsic clotting cascade that is missing, therefore any very minor trauma can cause a bleeding episode.

Diagnosis is based on clinical blood tests, including platelet count, bleeding time, prothrombin time (PT), prolonged partial thromboplastin time (PTT), and factor VIII assay.

Hemophilia has no cure, but symptoms can be managed by treating the patient with concentrated factor VIII, transfusing whole blood when necessary, and avoidance of situations that may initiate bleeding episodes.
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Queen Victoria carried hemophilia to her son, who was affected and had symptoms
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By XlinkRecessive.jpg: National Institutes of Healthderivative work: Drsrisenthil - XlinkRecessive.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=12046961
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