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.

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.

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.

For Your Information

Books

• Henry, John B. Clinical Diagnosis and Management by Laboratory Methods. Philadelphia: W. B. Saunders Co., 1996.

• Merck Manual of Medical Information. Ed. Robert Berkow, et al. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is John T. Lohr PhD.

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