Platelet larceny: spurious hypoxaemia due to extreme thrombocytosis

Abstract

Rapid oxygen consumption by markedly increased numbers of hypermetabolic leukocytes in leukaemic patients resulting in the apparent diagnosis of hypoxaemia on arterial blood gas analyses is termed leukocyte larceny.In the present report, a case of polycythaemia vera, extreme thrombocytosis, normal leukocyte counts and arterial hypoxaemia in the absence of clinical, radiological or physiological evidence of lung disease is described.This pseudohypoxaemia case was established by pulse oximetry, as well as by incubation of a blood specimen with potassium cyanide, and became less significant after the use of cytoreductive agents showed a proportionate increase in arterial oxygen tension as platelet counts decreased on serial arterial blood gas analyses.The present case report demonstrates spurious hypoxaemia due to extreme thrombocytosis and shows that, beside significant leukocytosis, even markedly elevated platelet counts can cause larceny of arterial blood oxygen.

A new method for the detection of microorganisms in blood cultures: Part I. Theoretical analysis and simulation of blood culture processes

“…Equation (6) describes the general respiration structure of the model that assumes the total O 2 loss to be a sum of the O 2 consumption by J cell populations and being functions of the population number density N j and assigned respiration rate k rj Typically contaminating microorganisms dominate O 2 consumption in the blood culture vials due to their high metabolic respiration rates. Yet, in the cases of leukemia or thrombocytosis leukocytes or platelets, respectively, might utilize most of the available O 2 (Qian et al, 2001; Mehta et al, 2008) especially when microbial counts are low.…”

Pseudohypoxemia From Leukocyte Larceny in a Patient With Chronic Myelogenous Leukemia

“…In situations with marked leukocytosis or thrombocytosis (causing “platelet larceny”), oxygen saturations obtained by ABG should be interpreted with caution [ 3 ]; pulse oximetry is the more accurate method of assessing oxygenation in such patients [ 4 ]. ABG analysis calculates oxygen saturation from PaO 2 , a measure of dissolved oxygen in plasma.…”

“…With normal cell counts, this is insignificant. However, in patients with leukemia or thrombocytosis, rapid oxygen consumption by the many cells present in the sample can give false readings [3]. This little-known concept could help avoid unnecessary testing and alterations in management, leading to better outcomes in this patient population.…”

“…With normal cell counts, this is insignificant. However, in patients with leukemia or thrombocytosis, rapid oxygen consumption by the many cells present in the sample can give false readings [ 3 ].…”

Leukocytotic Pseudohypoxaemia

“…Spurious hypoxaemia has been previously reported in association with hyperleukocytosis of leukaemias [1][2][3] , thrombocytosis of polycythaemia vera 4,5 and leukocytosis of bacterial infection 6 . When due to hyperleukocytosis, it has been variously called "leukocyte larceny" 7,8 , "false hypoxaemia" 6 , "pseudohypoxaemia" 1 and "oxygen steal" 9 .…”