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Chen D, Uhl CB, Bryant SC, Krumwiede M, Barness RL, Olson MC, Gossman SC, Erdogan Damgard S, Gamb SI, Cummins LA, Charlesworth JE, Wood-Wentz CM, Salisbury JL, Plumhoff EA, Van Cott EM, He R, Warad DM, Pruthi RK, Heit JA, Nichols WL, White JG. Diagnostic laboratory standardization and validation of platelet transmission electron microscopy. Platelets 2018; 29:574-582. [PMID: 29863946 DOI: 10.1080/09537104.2018.1476682] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Platelet transmission electron microscopy (PTEM) is considered the gold standard test for assessing distinct ultrastructural abnormalities in inherited platelet disorders (IPDs). Nevertheless, PTEM remains mainly a research tool due to the lack of standardized procedures, a validated dense granule (DG) count reference range, and standardized image interpretation criteria. The aim of this study was to standardize and validate PTEM as a clinical laboratory test. Based on previously established methods, we optimized and standardized preanalytical, analytical, and postanalytical procedures for both whole mount (WM) and thin section (TS) PTEM. Mean number of DG/platelet (plt), percentage of plts without DG, platelet count (PC), mean platelet volume (MPV), immature platelet fraction (IPF), and plt light transmission aggregometry analyses were measured on blood samples from 113 healthy donors. Quantile regression was used to estimate the reference range for DG/plt, and linear regression was used to assess the association of DG/plt with other plt measurements. All PTEM procedures were standardized using commercially available materials and reagents. DG interpretation criteria were established based on previous publications and expert consensus, and resulted in improved operator agreement. Mean DG/plt was stable for 2 days after blood sample collection. The median within patient coefficient of variation for mean DG/plt was 22.2%; the mean DG/plt reference range (mid-95th %) was 1.2-4.0. Mean DG/plt was associated with IPF (p = .01, R2 = 0.06) but not age, sex, PC, MPV, or plt maximum aggregation or primary slope of aggregation (p > .17, R2 < 0.02). Baseline ultrastructural features were established for TS-PTEM. PTEM was validated using samples from patients with previously established diagnoses of IPDs. Standardization and validation of PTEM procedures and interpretation, and establishment of the normal mean DG/plt reference range and PTEM baseline ultrastructural features, will facilitate implementation of PTEM as a valid clinical laboratory test for evaluating ultrastructural abnormalities in IPDs.
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Affiliation(s)
- Dong Chen
- a Division of Hematopathology , Mayo Clinic , Rochester , Minnesota , USA
| | - Cindy B Uhl
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | - Sandra C Bryant
- c Division of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , Minnesota , USA
| | - Marcy Krumwiede
- d Departments of Laboratory Medicine, Pathology, and Pediatrics , University of Minnesota School of Medicine , Minneapolis , Minnesota , USA
| | - Ryan L Barness
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | - Mary C Olson
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | - Susan C Gossman
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | | | - Scott I Gamb
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | - Lisa A Cummins
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | - Jon E Charlesworth
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | - Christina M Wood-Wentz
- c Division of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , Minnesota , USA
| | - Jeffrey L Salisbury
- b Electron Microscope Core Facility , Mayo Clinic , Rochester , Minnesota , USA
| | | | - Elizabeth M Van Cott
- e Department of Pathology , Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts , USA
| | - Rong He
- a Division of Hematopathology , Mayo Clinic , Rochester , Minnesota , USA
| | - Deepti M Warad
- a Division of Hematopathology , Mayo Clinic , Rochester , Minnesota , USA
| | - Rajiv K Pruthi
- a Division of Hematopathology , Mayo Clinic , Rochester , Minnesota , USA
| | - John A Heit
- a Division of Hematopathology , Mayo Clinic , Rochester , Minnesota , USA
| | - William L Nichols
- a Division of Hematopathology , Mayo Clinic , Rochester , Minnesota , USA
| | - James G White
- d Departments of Laboratory Medicine, Pathology, and Pediatrics , University of Minnesota School of Medicine , Minneapolis , Minnesota , USA
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