The platelet (PLT) count plays a critical role for the diagnosis, treatment and monitoring of patients with many hematological and non-hematological diseases. Inaccuracy in PLT counting can have significant clinical impact, especially at the transfusion trigger levels. If the PLT count is falsely elevated, it could result in a missed PLT transfusion, exposing the patient to the risk of a potentially life-threatening bleeding incident. On the other hand, if the PLT count is falsely decreased, it may lead to unnecessary PLT transfusion with all the hazards associated with it.

Automated hematology analyzers utilize different approaches to accurately resolve PLT populations from other cellular elements of the blood. These include electrical impedance, optical flow cytometry, and fluorescent methods. The reference method for PLT counting is dual-color flow cytometry (CD41/61), but it is resource-intensive, expensive, and is not practical for use in routine laboratory practice. Technologies that are routinely used for PLT enumeration have different performance characteristics and sensitivities to common interferences, especially at the low end of the PLT measuring range. These interfering factors include red blood cells (RBC) with low volume (microcytes, schistocytes, and spherocytes), fragmented white blood cells (WBC), cryoglobulins, lipemia (hyperchylomicronemia and infusion with lipid emulsions) and the presence of giant PLTs and PLT clumps. Understanding the measurement principles and the associated performance characteristics can help guide appropriate medical decisions.

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