Flow cytometry and thromboelastography to assess platelet counts and coagulation in patients with haematological malignancies.
Alex Gatt, Fabian Bonello, Raphael Buttigieg, Samuel Debono, Patricia Brincat, Charlie Grima, Peter Gatt, Thomas Lofaro, Stefan Laspina
Author Information
Alex Gatt: Pathology Department, University of Malta Medical School, Msida, Malta Haematology-Oncology Department, Mater Dei Hospital, Msida, Malta.
Fabian Bonello: Pathology Department, University of Malta Medical School, Msida, Malta.
Raphael Buttigieg: Pathology Department, University of Malta Medical School, Msida, Malta.
Samuel Debono: Pathology Department, University of Malta Medical School, Msida, Malta.
Patricia Brincat: Haematology-Oncology Department, Mater Dei Hospital, Msida, Malta.
Charlie Grima: Perfusion Department, Department of Surgery, Mater Dei Hospital, Msida, Malta.
Peter Gatt: Perfusion Department, Department of Surgery, Mater Dei Hospital, Msida, Malta.
Thomas Lofaro: Haematology-Oncology Department, Mater Dei Hospital, Msida, Malta Haematology Department, Guy's & St Thomas' Hospital, London, United Kingdom.
Stefan Laspina: Haematology-Oncology Department, Mater Dei Hospital, Msida, Malta Blood Transfusion Department, Mater Dei Hospital, Msida, Malta.
BACKGROUND: Accurate platelet counts (PC) are necessary in order to follow recommendations for prophylactic platelet transfusion. We carried out a study comparing the standard way of counting platelets using a routine analyser and compared it with PC determined by flow cytometry (FC) and haemostatic data obtained with thromboelastography (TEG). MATERIALS AND METHODS: The study was carried out on 24 patients with haematological malignancies, all given one adult dose of platelets. The PC was determined before and after transfusion using an automated blood cell counter and FC. Citrated, "native" whole blood TEG was carried out before and after platelet transfusion to assess global haemostasis. RESULTS: No bleeding was observed in any of the subjects. Thirty-one assessments were performed in the 24 patients. The mean pre-transfusion PC were 9.8 and 13��10(9)/L with the automated counter and FC, respectively with a difference of 3.7 (p=0.0011). Excellent correlation was observed between the two counts (r=0.89; p<0.0001). Mean post-transfusion increments were 23 and 29��10(9)/L for the routine counter and FC, respectively. Using the immunological PC, patients would not have qualified for transfusion in 18.2% of cases since their PC was >20��10(9)/L. TEG showed a shortened reaction time in 69.6% of cases and a normal mean K time of 6.7 min. Only 9% had a low �� angle signifying hypocoagulability. The maximum amplitude was reduced in the majority of cases but normal in 25% despite PC<20��10(9)/L. Mean activated partial thromboplastin time, prothrombin time and fibrinogen were normal prior to transfusion. DISCUSSION: Although higher PC as assessed by FC could potentially have an impact on platelet transfusion practices, TEG was sensitive enough to detect PC<10��10(9)/L and some between 10-20��10(9)/L. Whether patients with the latter PC are more prone to bleeding remains to be verified in larger studies.
