Lab Med Online.  2013 Oct;3(4):259-263.

A Case of Platelet Satellitism with Platelet Phagocytosis by Neutrophils and Platelet-neutrophil Agglutination

• Yoon KH

Abstract

Platelet satellitism is a rare phenomenon in which platelets adhere to the surface of neutrophils; in addition, platelet phagocytosis by neutrophils and monocytes is rare event. Although its clinical significance and pathophysiology are still unclear, platelet-neutrophil agglutination seems to be the end point of a process that is initiated by platelet satellitism and causes pseudothrombocytopenia and pseudoneutropenia. Differentiating pseudothrombocytopenia is essential to avoid unnecessary diagnostic testing and treatments. This report describes an unusual case of a 64 yr old man who presented with left flank pain and pseudothrombocytopenia, which was caused by platelet satellitism with platelet phagocytosis by neutrophils and platelet-neutrophil agglutination. Platelet satellitism occurred in the presence of ethylenediaminetetraacetic acid (EDTA) at room temperature or 4degrees C, but not at 37degrees C; however, platelet-neutrophil agglutination and pseudoleukopenia were observed in EDTA-treated blood only after a 2-hr incubation period at room temperature. Additionally, platelet satellitism could be induced in packed blood cells from a normal individual during a mixing assay with this patient's plasma. To the best of my knowledge, this is the first reported case of platelet satellitism with platelet phagocytosis by neutrophils and platelet-neutrophil agglutination in Korea.

Keyword

Platelet satellitism; Platelet phagocytosis; Platelet-neutrophil agglutination

MeSH Terms

Agglutination
Blood Cells
Blood Platelets
Diagnostic Tests, Routine
Edetic Acid
Flank Pain
Korea
Monocytes
Neutrophils
Phagocytosis
Plasma
Edetic Acid

Figure

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  Fig. 1 Peripheral blood smear of EDTA-anticoagulated blood showing (A) platelet satellitism and phagocytosis by neutrophils and (B) platelet- neutrophil agglutination (Wright stain, × 1,000).

Reference

1. Field EJ, MacLeod I. Platelet adherence to polymorphs. Br Med J. 1963; 2:388–389.

2. Cohen AM, Lewinski UH, Klein B, Djaldetti M. Satellitism of platelets to monocytes. Acta Haematol. 1980; 64:61–64.

3. Montague N, Blackwelder P, Alsayegh H, Ochoa R, Vial X, Byrne GE. Platelet satellitism and dual surface immunoglobulin light-chain expression in circulating splenic marginal zone lymphoma cells. Ann Diagn Pathol. 2013; 17:117–122.

4. Liso V, Bonomo L. Platelet satellitism to basophils in a patient with chronic myelocytic leukaemia. Blut. 1982; 45:347–350.

5. Lazo-Langner A, Piedras J, Romero-Lagarza P, Lome-Maldonado C, Sánchez-Guerrero J, López-Karpovitch X. Platelet satellitism, spurious neutropenia, and cutaneous vasculitis: casual or causal association? Am J Hematol. 2002; 70:246–249.

6. Signy AG, Green AE. Platelet adherence to polymorphs. Br Med J. 1963; 2:624.

7. Payne CM. Platelet satellitism: an ultrastructural study. Am J Pathol. 1981; 103:116–128.

8. Greipp PR, Gralnick HR. Platelet to leukocyte adherence phenomena associated with thrombocytopenia. Blood. 1976; 47:513–521.

9. Ha GY, Kim MY, Kim JR, Suh MK, Kweon SY, Cho HI. A case of EDTA dependent platelet phagocytosis by neutrophils in mycosis fungoides. Korean J Clin Pathol. 1998; 18:46–50.

10. Criswell KA, Breider MA, Bleavins MR. EDTA-dependent platelet phagocytosis. A cytochemical, ultrastructural, and functional characterization. Am J Clin Pathol. 2001; 115:376–384.

11. Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. Int J Lab Hematol. 2007; 29:4–20.

12. Moraglio D, Banfi G, Arnelli A. Association of pseudothrombocytopenia and pseudoleukopenia: evidence for different pathogenic mechanisms. Scand J Clin Lab Invest. 1994; 54:257–265.

13. Lombarts AJ, de Kieviet W, Franck PF, Baars JD. Recognition and prevention of two cases of erroneous haemocytometry counts due to platelet and white blood cell aggregation. The use of acid citrate dextrose as an auxiliary anticoagulant. Eur J Clin Chem Clin Biochem. 1992; 30:429–432.

14. Bizzaro N, Goldschmeding R, von dem Borne AE. Platelet satellitism is Fc gamma RIII (CD16) receptor-mediated. Am J Clin Pathol. 1995; 103:740–744.

15. Onder O, Weinstein A, Hoyer LW. Pseudothrombocytopenia caused by platelet agglutinins that are reactive in blood anticoagulated with chelating agents. Blood. 1980; 56:177–182.

16. Schimmer A, Mody M, Sager M, Garvey MB, Hogarth M, Freedman J. Platelet cold agglutinins: a flow cytometric analysis. Transfus Sci. 1998; 19:217–224.

17. van Vliet HH, Kappers-Klunne MC, Abels J. Pseudothrombocytopenia: a cold antoantibody against platelet glycoprotein GP IIb. Br J Haematol. 1986; 62:501–511.

18. Christopoulos C, Mattock C. Platelet satellitism and alpha granule proteins. J Clin Pathol. 1991; 44:788–789.

19. Bizzaro N. Platelet satellitosis to polymorphonuclears: cytochemical, immunological, and ultrastructural characterization of eight cases. Am J Hematol. 1991; 36:235–242.

20. Berkman N, Michaeli Y, Or R, Eldor A. EDTA-dependent pseudothrombocytopenia: a clinical study of 18 patients and a review of the literature. Am J Hematol. 1991; 36:195–201.

21. Zupańska B, Maślanka K. Analysis of 15 cases with platelet EDTA-dependent antibodies. Acta Haematol Pol. 1995; 26:361–365.

22. Vicari A, Banfi G, Bonini PA. EDTA-dependent pseudothrombocytopaenia: a 12-month epidemiological study. Scand J Clin Lab Invest. 1988; 48:537–542.

23. García Suárez J, Merino JL, Rodríguez M, Velasco A, Moreno MC. [Pseudothrombocytopenia: incidence, causes and methods of detection]. Sangre (Barc). 1991; 36:197–200.

24. Cohen AM, Cycowitz Z, Mittelman M, Lewinski UH, Gardyn J. The incidence of pseudothrombocytopenia in automatic blood analyzers. Haematologia (Budap). 2000; 30:117–121.

25. Bizzaro N, Brandalise M. EDTA-dependent pseudothrombocytopenia. Association with antiplatelet and antiphospholipid antibodies. Am J Clin Pathol. 1995; 103:103–107.

26. Huh JW, Kim MN, Chi HS. EDTA dependent pseudothrombocytopenia associated with anticardiolipin and antiplatelet antibodies. Korean J Clin Pathol. 1996; 16:599–606.

27. Kjeldsberg CR, Swanson J. Platelet satellitism. Blood. 1974; 43:831–836.

28. Lombarts AJ, de Kieviet W. Recognition and prevention of pseudothrombocytopenia and concomitant pseudoleukocytosis. Am J Clin Pathol. 1988; 89:634–639.

29. Bartels PC, Schoorl M, Lombarts AJ. Screening for EDTA-dependent deviations in platelet counts and abnormalities in platelet distribution histograms in pseudothrombocytopenia. Scand J Clin Lab Invest. 1997; 57:629–636.

30. Cunningham VL, Brandt JT. Spurious thrombocytopenia due to EDTA-independent cold-reactive agglutinins. Am J Clin Pathol. 1992; 97:359–362.