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What does mega platelets in peripheral smear test indicate?

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Posted on Mon, 21 Jul 2014
Question: Hi,
My father is 60 years old. On 21st of XXXXXXX he had a complete health check up. His platelet count came at 70000. The dr. asked to repeat the test. We repeated the test 3 more times. The platelet counts were 81000, 88000 and 74000 respectively. The ESR counts were 40, 20 and 23 respectively.
WBC and RBC were normal. Haemoglobin was 13.8, 13.2 and 13 respectively.

In the last peripheral smear , mega platelets were found. Also mild aniscocytosis and mild poikilocytosis were reported.

The primary physician was concerned and asked us to see a haemotologist.
I have looked up on Google and all I find are extremely fatal diseases.
Is it possible that he might be suffering from something simpler?

His liver and spleen are normal.

The physician has also advised to undergo Vitamin B12 and ferrate tests.
Please let me know in detail doctor.
doctor
Answered by Dr. Indranil Ghosh (5 hours later)
Brief Answer:
May be Vit B12 or folate deficiency

Detailed Answer:
Hi
Thanks for your query.

Sometimes giant (or mega) platelets lead to a false low platelet count as these large platelets are not counted by a machine. However, this can be corrected on seeing the smear. If even on smear platelet counts are low, then B12 or folate deficiency is most common cause. Once that is ruled out we have to think of some disorder of excess platelet destruction or reduced platelet production.

For that a bone marrow exam suffices. If the bone marrow is normal then it is most likely excess platelet destruction, either because of some infections, large spleen or some unexplained cause. This is easier to manage.

However, if the bone marrow is abnormal then only we are left with the serious illnesses like bone marrow dysplasia (abnormal cell production), blood cancers, etc.

So you can see that based on these reports it can be either no illness or easy to treat illness or even some serious disease (rare instance). Unless we do all the workup it will be difficult to comment.

Hope I have answered your query. I will be available to answer further followup queries, if any.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (12 minutes later)
Hi doctor,

on manual examination his platelet count was 1,50,000.
However, on the machine examination, his platelet count was 74000 only.

Does this lead to a change in your opinion?

doctor
Answered by Dr. Indranil Ghosh (10 minutes later)
Brief Answer:
Then it is the first condition I have listed

Detailed Answer:
Because of giant platelets machine count is low but smear count is normal. This is quite common. Nothing to worry.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (4 minutes later)
Hi Doctor,

Six month earlier he had a cbc all his blood counts were normal. No mega platelets were found.

Now his platelets are constantly reduced under the machine.

Can I breathe a XXXXXXX of relief?

Also, the low esr and normal manual platelet count , is it a good suggestion that there is no malignancy?

doctor
Answered by Dr. Indranil Ghosh (5 hours later)
Brief Answer:
Does not look like malignancy

Detailed Answer:
I don't see any definite sign of malignancy. But surely he will need followup counts and smear manual exam so that we don't miss such a thing.

But, probability is quite low at this point.

Regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Indranil Ghosh (11 hours later)
Hi doctor,

I have seen his RBC morphology. It shows the presence of elliptocytes (occasional).

No macrocytes, microcytes or normoblasts are seen.

mild aniscocytosis and mild poikilocytosis were laso reported.


Please suggest if the presence of elliptocytes is something to be worried about.

doctor
Answered by Dr. Indranil Ghosh (2 hours later)
Brief Answer:
As the hemoglobin is normal these may be normal

Detailed Answer:
These findings are important if hemoglobin is low. So I don't think there is anything to worry of at this point.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Dr. Indranil Ghosh

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Practicing since :2004

Answered : 1631 Questions

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What does mega platelets in peripheral smear test indicate?

Brief Answer: May be Vit B12 or folate deficiency Detailed Answer: Hi Thanks for your query. Sometimes giant (or mega) platelets lead to a false low platelet count as these large platelets are not counted by a machine. However, this can be corrected on seeing the smear. If even on smear platelet counts are low, then B12 or folate deficiency is most common cause. Once that is ruled out we have to think of some disorder of excess platelet destruction or reduced platelet production. For that a bone marrow exam suffices. If the bone marrow is normal then it is most likely excess platelet destruction, either because of some infections, large spleen or some unexplained cause. This is easier to manage. However, if the bone marrow is abnormal then only we are left with the serious illnesses like bone marrow dysplasia (abnormal cell production), blood cancers, etc. So you can see that based on these reports it can be either no illness or easy to treat illness or even some serious disease (rare instance). Unless we do all the workup it will be difficult to comment. Hope I have answered your query. I will be available to answer further followup queries, if any.