Clinical Picture

Cryoglobulinemia detected as a PIC/POCdiscrepancy of the automated completeblood count

Delgado J, Jimenez C, Larrocha C, Viloria A. Cryoglobulinemiadetected as a PIC/POC discrepancy of the automated completeblood count.Eur J Haematol 2002: 69: 65–66. # Blackwell Munksgaard 2002.

Julio Delgado, Carmen Jimenez,Carmen Larrocha, Ana ViloriaDepartment of Haematology,

Hospital Universitario La Paz, Madrid, Spain

Correspondence: Julio Delgado,

Servicio de Hematologia, Hospital Universitario La Paz,

Planta 6 Diagonal, Paseo Castellana, 261,

28046 Madrid, Spain

Tel: +34-91-7277116, +34-91-3081076

Fax: +34-91-7277116

e-mail: jdelgon@terra.es

Accepted for publication 15 June 2002

A 75-yr-old woman was referred to our practicebecause of mild anemia, elevated erythrocyte sedi-mentation rate and IgG-kappa monoclonal protein(2600 mg dLx1) in serum immunoelectrophoresis.Physical examination was unremarkable except forthe presence of some purpuric papules on the armsand legs. A complete blood count was performedusing a Cell-Dyn 4000 analyser (Abbott Diagnost-ics), showing a marked discrepancy between plateletimpedance (1230r109 Lx1) and optical counts

(180r109 Lx1), also known as a PIC/POC discre-pancy.Furthermore,avery lowmeanplatelet volumewas noted (5.2 fL). To improve the accuracy of theplatelet count, a CD61 immunoplatelet count wasperformed (1, 2), and the result (414r109 Lx1) wasconcordant with a hemacytometry (chamber) count.Microscopic examination of a peripheral bloodsmear revealed the presence of small non-plateletparticles and small to medium blue inclusions inneutrophils and monocytes (Figs. 1 and 2). Sub-sequent laboratorywork-up confirmed thediagnosesof cryoglobulinemia and multiple myeloma.

Fig. 2. Peripheral blood film showing a monocyte with smallto moderate blue inclusions. May-Grunwald-Giemsa stain.

Fig. 1. Peripheral blood film showing a neutrophil withsmall blue inclusions and vacuoles. May-Grunwald-Giemsastain.

Eur J Haematol 2002: 69: 65–66Printed in UK. All rights reserved

Copyright # Blackwell Munksgaard 2002

EUROPEANJOURNAL OF HAEMATOLOGY

ISSN 0902-4441

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References

1. VON AHSEN N, EHRLICH B, SCOTT CS, RIGGERT J, OELLERICHM.Cryoglobulins interfere with platelet counts by optical andimpedance methods but not with the CD61 immunoplateletcount. Clin Chem 2001;47:1858–1860.

2. KUNZ D, KUNZ WS, SCOTT CS, GRESSNER AM. AutomatedCD61 immunoplatelet analysis of thrombocytopenicsamples. Br J Haematol 2001;112:584–592.

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