Despite the ongoing development of automated hematology analyzers to optimize complete blood count results, platelet count still suffers from pre-analytical or analytical pitfalls, including EDTA-induced pseudothrombocytopenia. Although most of these interferences are widely known, laboratory practices remain highly heterogeneous. In order to harmonize and standardize cellular hematology practices, the French-speaking Cellular Hematology Group (GFHC) wants to focus on interferences that could affect the platelet count and to detail the verification steps with minimal recommendations, taking into account the different technologies employed nowadays. The conclusions of the GFHC presented here met with a "strong professional agreement" and are explained with their rationale to define the course of actions, in case thrombocytopenia or thrombocytosis is detected. They are proposed as minimum recommendations to be used by each specialist in laboratory medicine who remains free to use more restrictive guidelines based on the patient's condition.
Two cases of peripheral T-cell lymphoma, characterized by hepatosplenic presentation and gamma/delta T-cell receptor phenotype on malignant cells, are reported. Little is known about the chromosomal changes in these peculiar lymphomas. We report the cytogenetic analysis of these two patients. Isochromosome 7q and trisomy 8 were observed. These abnormalities were reported previously in five cases of gamma/delta T-cell lymphoma. These two patients had lymphomatous infiltration of the spleen, liver, bone marrow, and (in one case) lymph nodes. These abnormalities occurred in immunocompromised patients (i.e., immunosuppressive therapy for kidney transplantation and chemotherapy for Hodgkin's disease), without Epstein-Barr virus infection stigmata in tumor cells.
Schistocytes are circulating RBC fragments. The morphologic identification of schistocytes is difficult because the shapes to which they correspond are still under discussion. Automated hematology systems permit the possibility of direct measurement of RBC fragments. We compared schistocyte counts performed by different biologists and technicians with the automated counts by the ADVIA 120 (Bayer Health Care, Tarrytown, NY). The agreement between the ADVIA 120 and the average of the observers gives a correlation coefficient of 0.7274 (95% confidence interval, 0.6285-0.8019). The ADVIA 120 has a tendency to overestimate the count (average, +0.445%). No false-negative case was recorded. The maximum sensitivity (detection of 100% of samples with schistocytes) of the analyzer was determined at a threshold value of 0.25%, but the specificity was low (20%). Therefore, a blood smear examination remains necessary to confirm schistocyte presence. However, the clinical features correlated particularly with negative automated RBC fragments, and the high negative predictive value of RBC fragments ruled out thrombotic events (macroangiopathies or microangiopathies).
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