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Overcoming Platelet Aggregation Interference: Evaluation of the Complete Blood Count, Differential, and Reticulocyte
Jia-le Gong1, Qing Liao1, Chao-Jun Duan1
1Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background:
This study assessed the ability of the complete blood count, differential, and reticulocyte (CDR) mode of the Mindray BC-6800 Plus analyzer to correct platelet aggregation by disaggregating platelets, evaluating how aggregation severity impacts accuracy to define an objective threshold for resampling.
Methods:
Agreement was assessed between CDR mode and the electrical impedance method for platelet counts in normal specimens using Pearson correlation, Passing-Bablok regression, and Bland-Altman analysis. The CDR mode's ability to correct false elevations caused by microcytes/fragments and false reductions caused by large platelets was evaluated by comparing CDR channel platelet count results (PLT-OF) with smear-estimated values (PLT-M) and fluorescence-method results (PLT-F). Disaggregation efficacy in aggregated samples was analyzed using the MC-80 digital morphology system. The optimal disaggregation threshold was determined by ROC analysis.
Results:
In normal specimens, PLT-OF showed a significant correlation with the electrical impedance-method platelet count results (PLT-I) (r = 0.999, P < 0.001). Passing-Bablok regression (PLT-I = 1.00 × PLT-OF) and Bland-Altman analysis demonstrated excellent agreement. For samples with PLT-I false abnormalities, the CDR mode effectively corrected both false elevations (due to microcytes/fragments) and false reductions (due to large platelets), showing no significant differences between PLT-OF and PLT-M or PLT-F (P > 0.05). In platelet-aggregated specimens, PLT-OF was significantly higher than PLT-I (P < 0.001). ROC analysis established 162 aggregates as the optimal threshold for effective disaggregation [area under the curve (AUC) = 0.776]. The dissociation rate was significantly greater in the mild vs severe-aggregation group (P = 0.004). Combining aggregate count with a PLT-OF to PLT-I difference (>115 × 109/L) improved prediction accuracy (AUC = 0.841).
Conclusion:
The CDR channel of the Mindray BC-6800 Plus analyzer effectively corrects spurious platelet counts.
