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Peprah S, Ogwang MD, Kerchan P, Reynolds SJ, Tenge CN, Were PA, Kuremu RT, Wekesa WN, Masalu N, Kawira E, Kinyera T, Otim I, Legason ID, Nabalende H, Dhudha H, Mumia M, Ayers LW, Biggar RJ, Bhatia K, Goedert JJ, Mbulaiteye SM. Mean platelet counts are relatively decreased with malaria but relatively increased with endemic Burkitt Lymphoma in Uganda, Tanzania, and Kenya. Br J Haematol 2020; 190:772-782. [PMID: 32395868 DOI: 10.1111/bjh.16700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
Platelet counts are decreased in Plasmodium falciparum malaria, which is aetiologically linked with endemic Burkitt lymphoma (eBL). However, the pattern of platelet counts in eBL cases is unknown. We studied platelet counts in 582 eBL cases and 2 248 controls enrolled in a case-control study in Uganda, Tanzania and Kenya (2010-2016). Mean platelet counts in controls or eBL cases with or without malaria-infection in controls versus eBLcases were compared using Student's t-test. Odds ratios (ORs) and two-sided 95% confidence intervals (95% CIs) were estimated using multiple logistic regression, controlling for age, sex, haemoglobin and white blood cell counts. Platelets were decreased with malaria infection in the controls [263 vs. 339 × 109 platelets/l, P < 0·0001; adjusted OR (aOR) = 3·42, 95% CI: 2·79-4·18] and eBL cases (314 vs. 367 × 109 platelets/l, P-value = 0·002; aOR = 2·36, 95% CI: 1·49-3·73). Unexpectedly, platelets were elevated in eBL cases versus controls in overall analyses (mean: 353 vs. 307 × 109 platelets/l, P < 0·0001; aOR = 1·41; 95% CI: 1·12-1·77), and when restricted to malaria-positive (mean 314 vs. 263 × 109 platelets/l, P < 0·0001; OR = 2·26; 95% CI: 1·56-3·27) or malaria-negative (mean 367 vs. 339 × 109 platelets/l, P < 0·001; OR = 1·46; 95% CI: 1·17-1·83) subjects. Platelets were decreased with malaria infection in controls and eBL cases but elevated with eBL.
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Affiliation(s)
- Sally Peprah
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin D Ogwang
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Patrick Kerchan
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Kuluva Hospital, Arua & African Field Epidemiology Network, Kuluva, Kampala, Uganda
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Constance N Tenge
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Moi University College of Health Sciences, Eldoret, Kenya
| | - Pamela A Were
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Academic Model Providing Access To Healthcare, Eldoret, Kenya
| | - Robert T Kuremu
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Moi University College of Health Sciences, Eldoret, Kenya
| | - Walter N Wekesa
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Moi University College of Health Sciences, Eldoret, Kenya
| | - Nestory Masalu
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Bugando Medical Center, Mwanza, Tanzania
| | - Esther Kawira
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Shirati Health, Education, and Development Foundation, and Shirati Hospital, Shirati, Tanzania
| | - Tobias Kinyera
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Isaac Otim
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Ismail D Legason
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Kuluva Hospital, Arua & African Field Epidemiology Network, Kuluva, Kampala, Uganda
| | - Hadijah Nabalende
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, St. Mary's Hospital, Lacor, Gulu & African Field Epidemiology Network, Kampala, Uganda
| | - Herry Dhudha
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Shirati Health, Education, and Development Foundation, and Shirati Hospital, Shirati, Tanzania
| | - Mediatrix Mumia
- EpideMiology of Burkitt Lymphoma in East African Children and Minors Study, Academic Model Providing Access To Healthcare, Eldoret, Kenya
| | - Leona W Ayers
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Robert J Biggar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. ACTA ACUST UNITED AC 2007; 29:4-20. [PMID: 17224004 DOI: 10.1111/j.1365-2257.2006.00870.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The widespread use of haematology analysers (HA) has led to a major improvement of cellular haematology, because of quick and accurate results found in most instances. However, in several situations, spurious results are observed. Inadequate blood samples, situations induced by the anticoagulant(s) used, peculiar changes related to the pathology in the patient, and technical considerations about performances of the various HA must be considered. Spurious thrombocytopenia occurs in several circumstances related to the presence of ethylenediamine tetra-acetic acid (EDTA) used as the anticoagulant. Mechanism of EDTA-dependent platelet (PLT) agglutination is related to circulating (auto)antibodies directed against normally hidden epitope(s) in the glycoprotein alpha IIb/beta IIIa complex from PLT membrane exposed only in the presence of EDTA. Other spuriously low PLT counts may be related to EDTA, including PLT rosetting around white blood cells (WBC; satellitism) and PLT-WBC aggregates, but mechanisms responsible for those latter phenomena are less well known. Spurious increase of PLT count may be related to several situations, including fragmented red blood cells, cytoplasmic fragments of nucleated cells, cryoglobulins, bacteria or fungi, and lipids. Flags generated in several of these situations alert the operator on possible abnormal findings and may identify the problem. Analysing only PLT parameters is not sufficient: in many situations the WBC differential scattergram is of crucial help for flagging. Flags generated depend on the software version on the HA used, the performance in detecting the same anomalies may differ according to which analyser is used, even those from the same manufacturer. Operators must be aware of the characteristics of their analyser and be able to recognize and circumvent anomalous results.
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Affiliation(s)
- M Zandecki
- Haematology Laboratory, University Hospital of Angers, Angers, France.
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van der Meer W, MacKenzie MA, Dinnissen JWB, de Keijzer MH. Pseudoplatelets: a retrospective study of their incidence and interference with platelet counting. J Clin Pathol 2003; 56:772-4. [PMID: 14514782 PMCID: PMC1770090 DOI: 10.1136/jcp.56.10.772] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Spurious platelet counts can be found in acute leukaemias, as a result of the fragmentation of blood cells. Microscopic examination of a blood smear should be performed to detect the presence of these so called pseudoplatelets. When present, the platelet count should be corrected because of the important clinical consequences that a lower platelet count may have in these patients. METHODS K(3)EDTA anticoagulated blood was measured on an automated blood cell counter, and a blood smear was made and stained according the May Grünwald-Giemsa method for microscopic observation. A 500 cell/particle differentiation was performed and the automated platelet count was corrected. RESULTS The incidence of pseudoplatelets in 169 patients with acute leukaemia was studied. Pseudoplatelets were detected in 43 patients (25.4%), and seven patients (4.1%) were re-classified as having a major bleeding risk (platelet count, < 15 x 10(9)/litre). CONCLUSIONS Platelets should be determined morphologically in patients with acute leukaemia and a routine screening method for the detection of pseudoplatelets should be developed.
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Affiliation(s)
- W van der Meer
- Department of Clinical Chemistry, University Medical Centre St Radboud, 6500 HB Nijmegen, The Netherlands.
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