Platelet scatterplot as a primary tool for smear review in cases of thrombocytopenia

ABSTRACT Introduction: Thrombocytopenia is one of the most common pathologies encountered in laboratories. With reference to ISLH guidelines for smear review, a count of <100,000/μl should be reviewed with smear. Aims and Objectives: (1) To analyse the platelet scatterplot in cases of thrombocytopenia and decide on need for smear review. (2) To identify the cases of pseudo-thrombocytopenia through the platelet scatterplot pattern. Materials and Methods: This study was conducted from November 2023 to October 2024, at Neuberg Anand Reference Laboratory, Bengaluru. A total of 117,092 cases were processed in an automated analyser for platelet counts. Of these cases, 3118 cases of thrombocytopenia with defined inclusion criteria were considered. Results: A total of 1865 cases of moderate thrombocytopenia, 977 cases of severe thrombocytopenia and 276 cases of pseudo-thrombocytopenia were analysed. The platelet scatterplot was analysed in all the cases and were observed for pattern of events and subsequent distribution in the designated singlet/multiplet region. Conclusion: The automated haematology analysers are vital part of pathology laboratory and provide graphical data in the form of scatterplot. Platelet scatterplot is unique in cases of pseudo-thrombocytopenia. This study, being the first to analyse the platelet scatterplot with respect to reliability of platelet count and identify pre-analytical causes for thrombocytopenia, can be a valid primary tool in reviewing smear in cases of thrombocytopenia.