platelet count


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Platelet Count

 

Definition

A platelet count is a diagnostic test that determines the number of platelets in the patient's blood. Platelets, which are also called thrombocytes, are small disk-shaped blood cells produced in the bone marrow and involved in the process of blood clotting. There are normally between 150,000-450,000 platelets in each microliter of blood. Low platelet counts or abnormally shaped platelets are associated with bleeding disorders. High platelet counts sometimes indicate disorders of the bone marrow.

Purpose

The primary functions of a platelet count are to assist in the diagnosis of bleeding disorders and to monitor patients who are being treated for any disease involving bone marrow failure. Patients who have leukemia, polycythemia vera, or aplastic anemia are given periodic platelet count tests to monitor their health.

Description

Blood collection and storage

Platelet counts use a freshly-collected blood specimen to which a chemical called EDTA has been added to prevent clotting before the test begins. About 5 mL of blood are drawn from a vein in the patient's inner elbow region. Blood drawn from a vein helps to produce a more accurate count than blood drawn from a fingertip. Collection of the sample takes only a few minutes.
After collection, the mean platelet volume of EDTA-blood will increase over time. This increase is caused by a change in the shape of the platelets after removal from the body. The changing volume is relatively stable for a period of one to three hours after collection. This period is the best time to count the sample when using electronic instruments, because the platelets will be within a standard size range.

Counting methods

Platelets can be observed in a direct blood smear for approximate quantity and shape. A direct smear is made by placing a drop of blood onto a microscope slide and spreading it into a thin layer. After staining to make the various blood cells easier to see and distinguish, a laboratory technician views the smear through a light microscope. Accurate assessment of the number of platelets requires other methods of counting. There are three methods used to count platelets; hemacytometer, voltage-pulse counting, and electro-optical counting.
HEMACYTOMETER COUNTING. The microscopic method uses a phase contrast microscope to view blood on a hemacytometer slide. A sample of the diluted blood mixture is placed in a hemacytometer, which is an instrument with a grid etched into its surface to guide the counting. For a proper count, the platelets should be evenly distributed in the hemacytometer. Counts made from samples with platelet clumping are considered unreliable. Clumping can be caused by several factors, such as clotting before addition of the anticoagulant and allowing the blood to remain in contact with a capillary blood vessel during collection. Errors in platelet counting are more common when blood is collected from capillaries than from veins.
ELECTRONIC COUNTING. Electronic counting of platelets is the most common method. There are two types of electronic counting, voltage-pulse and electro-optical counting systems. In both systems, the collected blood is diluted and counted by passing the blood through an electronic counter. The instruments are set to count only particles within the proper size range for platelets. The upper and lower levels of the size range are called size exclusion limits. Any cells or material larger or smaller than the size exclusion limits will not be counted. Any object in the proper size range is counted, however, even if it isn't a platelet. For these instruments to work properly, the sample must not contain other material that might mistakenly be counted as platelets. Electronic counting instruments sometimes produce artificially low platelet counts. If a platelet and another blood cell pass through the counter at the same time, the instrument will not count the larger cell because of the size exclusion limits, which will cause the instrument to accidentally miss the platelet. Clumps of platelets will not be counted because clumps exceed the upper size exclusion limit for platelets. In addition, if the patient has a high white blood cell count, electronic counting may yield an unusually low platelet count because white blood cells may filter out some of the platelets before the sample is counted. On the other hand, if the red blood cells in the sample have burst, their fragments will be falsely counted as platelets.

Aftercare

Because platelet counts are sometimes ordered to diagnose or monitor bleeding disorders, patients with these disorders should be cautioned to watch the puncture site for signs of additional bleeding.

Risks

Risks for a platelet count test are minimal in normal individuals. Patients with bleeding disorders, however, may have prolonged bleeding from the puncture wound or the formation of a bruise (hematoma) under the skin where the blood was withdrawn.

Normal results

The normal range for a platelet count is 150,000-450,000 platelets per microliter of blood.

Key terms

Capillaries — The smallest of the blood vessels that bring oxygenated blood to tissues.
EDTA — A colorless compound used to keep blood samples from clotting before tests are run. Its chemical name is ethylene-diamine-tetra-acetic acid.
Hemocytometer — An instrument used to count platelets or other blood cells.
Phase contrast microscope — A light microscope in which light is focused on the sample at an angle to produce a clearer image.
Thrombocyte — Another name for platelet.
Thrombocytopenia — An abnormally low platelet count.
Thrombocytosis — An abnormally high platelet count. It occurs in polycythemia vera and other disorders in which the bone marrow produces too many platelets.

Abnormal results

An abnormally low platelet level (thrombocytopenia) is a condition that may result from increased destruction of platelets, decreased production, or increased usage of platelets. In idiopathic thrombocytopenic purpura (ITP), platelets are destroyed at abnormally high rates. Hypersplenism is characterized by the collection (sequestration) of platelets in the spleen. Disseminated intravascular coagulation (DIC) is a condition in which blood clots occur within blood vessels in a number of tissues. All of these diseases produce reduced platelet counts.
Abnormally high platelet levels (thrombocytosis) may indicate either a benign reaction to an infection, surgery, or certain medications; or a disease like polycythemia vera, in which the bone marrow produces too many platelets too quickly.

Resources

Books

Berktow, Robert, et al., editors. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

count

 [kownt]
a numerical computation or indication.
Addis count the determination of the number of erythrocytes, leukocytes, epithelial cells, and casts, and the protein content in an aliquot of a 12-hour urine specimen; used in the diagnosis and management of kidney disease.
blood count (blood cell count) see blood count.
blood count, complete a series of tests of the peripheral blood, including the erythrocyte count, erythrocyte indices, leukocyte counts, and sometimes platelet count.
blood count, differential differential leukocyte count.
erythrocyte count determination of the number of erythrocytes in a unit volume of blood that has been diluted in an isotonic solution, done with an automatic counter such as a flow cytometer. Called also red blood cell or red cell count.
leukocyte count determination of the number of leukocytes in a unit volume of blood, usually after the erythrocytes have been lysed and the blood has been diluted; it may be done either manually with a hemacytometer or electronically. See total leukocyte c. and differential leukocyte c. Called also white blood cell or white cell count.
leukocyte count, differential a leukocyte count that calculates the percentages of different types. See also total leukocyte count.
leukocyte count, total a leukocyte count measuring the total number of all the types in a given volume of blood. See also differential leukocyte count.
platelet count determination of the total number of platelets per cubic millimeter of blood; the direct platelet count simply counts the cells using a microscope, and the indirect platelet count determines the ratio of platelets to erythrocytes on a peripheral blood smear and computes the number of platelets from the erythrocyte count.
red blood cell count (red cell count) erythrocyte count.
reticulocyte count a calculation of the number of reticulocytes in 1 cu mm of peripheral blood, recorded either as an absolute number or as the percentage of the erythrocyte count. It provides a means of assessing the erythropoietic activity of the bone marrow.
white blood cell count (white cell count) leukocyte count.

platelet count

a blood test that is performed on all patients who develop petechiae, spontaneous bleeding, or increasingly heavy menses. It is also used to monitor the course of the disease or therapy for thrombocytopenia or bone marrow failure.

platelet count

Enumeration of circulating platelets Specimen Blood, EDTA–lavender top-tube Ref range 150-450 x 109/L–US: 150-400 000/µL–mm3; 'panic' values: < 20 x 109/L–US: < 20 000/µL; > 1000 x 109/L–US: 1,000,000/µL ↑ in Myeloproliferative disorders and/or polycythemia vera, and less commonly with infections, blood loss, and splenectomy; rare causes of ↑ PC include anemia–hemolytic, iron-deficiency,
sickle cell, cirrhosis, collagen vascular disease, cryoglobulinemia, drugs–
epinephrine, OCs, exercise, hemorrhage, hypoxia, ITP, post-partum, pregnancy, rheumatoid arthritis, TB ↓ in < 0.02 x 1012/L–US: 20 000/mm3–µL are associated with ↑ bleeding tendency; platelets are ↓ in malignacies of bone, GI tract, brain, leukemia, kidney or liver disease, aplastic anemia, DIC, ITP, SLE, drugs associated with ↓ PC: aspirin, chemotherapeutic agents, chloromycetin, phenylbutazone, quinidine, thiazide diuretics, tolbutamide. See Platelet concentrate.

count

a numerical computation or indication.

differential count
a count, on a stained blood smear, of the proportion of different types of leukocytes (or other cells), previously expressed in percentages but now usually reported in absolute numbers (109/l) for a better indication of abnormalities that may exist.
milk cell count
platelet count
the count of the total number of platelets per liter (109/l) of blood by counting the platelets in a counting chamber, a hematology analyzer, or by estimating the number on a stained blood smear.
sperm count
see semen concentration.
total bacterial count
determination of the total number of bacteria in the sample examined microscopically, then a calculation of the number per ml. These do not distinguish between viable and non-viable organisms. See also breed's direct smear method.
viable bacterial cell count
enumerating the number of viable bacteria present in a sample based on counting the number of colonies from a given dilution.
wool count
an arbitrary number given to wool to indicate its fiber diameter, e.g. 60's, based on an eyeball assessment of the number of hanks of yarn that could be spun from one pound of wool. Now superseded by measurement of the diameter, e.g. 20 microns.
worm count
a total worm count requires a freshly slaughtered cadaver, collection of intestinal or other fluid in an aliquot sample; in the case of lungs it is necessary to digest the tissue; counting actual worms and by multiplication measuring the total worm burden.

platelet

a small disk or platelike structure, the smallest of the formed elements in blood. Blood platelets (called also thrombocytes) are disk-shaped, non-nucleated blood elements with a very fragile membrane; they tend to adhere to uneven or damaged surfaces. They average about 250,000 per cubic millimeter of blood and are formed in the red bone marrow by fragmentation of megakaryocytes, the largest of the bone marrow cells. Platelet production is controlled by a hormone, thrombopoietin, and regulatory lymphocytes acting at the stem cell level. At any given time about one-third of the total blood platelets can be found in the spleen; the remaining two-thirds are in the circulating blood.
The functions of platelets are related to the clotting of blood. Because of their adhesion and aggregation capabilities platelets can occlude small breaks in blood vessels and prevent the escape of blood. Platelets which have adhered to exposed collagen in damaged vessels release ADP in milliseconds which in turn initiates the synthesis of thromboxane A2, a very potent prostaglandin which causes platelet aggregation and localized vasoconstriction. Fibrinogen, factors V and VIII, calcium ions, platelet phospholipid (PF-3), associated with the platelet membrane are also released. Substances contained within the platelet granules such as thromboglobulin, heparin neutralizing activity (PF-4) mitogens such as platelet derived growth factor, thrombospondin, ADP, serotonin and calcium ions are also released by aggregated platelets.

platelet-activating factor (PAF)
see platelet-activating factor.
platelet adhesion
the adherence of platelets to any area with damaged blood vessels; an important component of hemostasis.
platelet aggregation
the progressive accumulation of platelets, attracted by other platelets once adhesion begins. Thromboxane A2 causes irreversible platelet aggregation.
platelet aggregation test
a known platelet aggregating factor such as collagen, ADP or thrombin is added to a suspension of the platelets under test and the degree of aggregation measured by decrease in turbidity of the suspension.
platelet count
may be performed directly (in a hemocytometer chamber) or indirectly (estimating from the stained blood smear by number per field or in comparison to the number of white blood cells), expressed as number of cells per liter of blood.
platelet-derived growth factor
one of three growth factors released by platelets which undergo the release reaction; the growth factors stimulate endothelial cell proliferation.
platelet distribution width (PDW)
an indication of variation in platelet size which can be a sign of active platelet release.
platelet factor 3 (PF-3) test, platelet release test
test the antiplatelet activity of serum; used to detect circulating antiplatelet antibodies. Antibody-antigen reactions involving platelets cause the release of PF-3 from platelets which in turn shortens the contact-activated clotting time of platelet-rich plasma (PRP).
platelet factors
factors important in hemostasis which are contained in or attached to the platelets: platelet factor 1 is adsorbed clotting factor V from the plasma; platelet factor 2 is an accelerator of the thrombin-fibrinogen reaction; platelet factor 3 is a phospholipid with potent procoagulant activity; platelet factor 4 is capable of inhibiting the activity of heparin (heparin neutralizing activity).
mean platelet volume (MPV)
elevated level is an indication of increased megakaryocyte shedding of platelets and decreased level is seen in thrombocytopenia.
platelet plug formation
see platelet aggregation (above).
platelet release reaction
measured by the degree of secondary ADP-mediated aggregation that occurs. This is assessed by the amount of PF-4, PF-3 or serotonin, etc. released.
platelet retention
tested by testing the adhesiveness of a suspension of the subject platelets to a glass bead column or standard size filter.
platelet rich plasma
plasma prepared by centrifugation to separate out red blood cells but not platelets for transfusion.
platelet storage-pool disease
an inherited autosomal thrombopathia in American foxhounds and cats characterized by a deficiency of platelet storage granules.
platelet transfusion
transfusion of fresh, nonchilled whole blood is the usual method of transfusing platelets to an animal with thrombocytopenia.
References in periodicals archive ?
The association between retPLT level and platelet count is depicted in Figure 4, A; a significant increase in retPLT level with increasing platelet count is evident (Spearman [rho] = 0.
In this patient, a high platelet count may have strongly contributed to the appearance of the thrombus.
HIT rarely causes platelet counts to drop below 30,000 cells/[micro]L, and thus platelet counts below this number strongly suggest abciximab as the etiology (10).
Finally, laboratories can use the MPV, along with the PDW and platelet count, to write decision rules where cases likely to have platelet clumps or giant platelets are reviewed even when a standard instrument flag is not raised.
Second, many of our patients who had reactive thrombocytosis were discharged from the ICU when the platelet count was still high.
Finally on day 6, despite steroids and IVIG, her hemoglobin and platelet counts did not improve; therefore, a decision to give rituximab was made.
During December 2009-January 2010, platelet counts were estimated for more than 2500 patients with fever attending the two selected hospitals.
In the case of this juvenile patient, the platelet count was repeated and rechecked to confirm the original result of 2000/[micro]l.
3 INR, and a platelet count of [less than or equal to] 80 x [10.
Their platelet count is still low but it is above our benchmark and platelet transfusion would be done only if it drops below 15,000-mark.
His platelet count is still low, but they say he has pseudothrombocytopenia.

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