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Massive RBC fragmentation masks severe thrombocytopenia in both impedance and optical platelet count measurements – a case report of a neonate on ECMO support

Extracorporeal membranous oxygenation (ECMO) is a life-saving treatment for paediatric patients with cardiac or respiratory failure of diverse aetiology. ECMO support is implemented only when all other available medications and procedures fail to treat the underlying cause of organ failure. The reason for caution is a high risk of complications, including intravascular haemolysis, bleeding or clot formation, inflammation and sepsis. Platelet count is closely monitored in assessment of bleeding risk associated with ECMO support. Platelets are counted as a parameter of the complete blood count and can be measured using impedance or optical technology. We report a case of severe red blood cell (RBC) fragmentation in a neonate on ECMO in whom erroneously normal platelet counts were obtained by all available automated methods for platelet count in an emergency laboratory. Based on those observations we have implemented an additional procedure for recognising interferences of fragmented and microcytic RBCs that cause spuriously normal platelet counts.

platelet count, ECMO, fragmented RBC, neonates, analytical interference

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