The right PLT count when it matters. 20/4/2016 Sysmex Användarmöte Sverige Pieter Steenhuis Sysmex Europe

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1 The right PLT count when it matters 20/4/2016 Sysmex Användarmöte Sverige Pieter Steenhuis Sysmex Europe

2 Agenda Introduction Identify samples with unreliable PLT counts due to platelet clumps Optimise your thrombopoiesis workflow 04 Get more clinical information with the immature platelet fraction

3 Reliable platelet counts The immature platelet fraction information about platelet production in the bone marrow

4 The XN-Series An expert in platelet management» PLT-I Detection of incorrect counts due to platelet clumps and giant platelets» PLT-O» Automatic reflex measurements» PLT-F» Automatic reflex measurements» Immature Platelet Fraction (IPF) TWO IPF# 4

5 The XN-Series An expert in platelet management 207,000 PLT/µl 40 fl 5

6 Fluorescence flow cytometry RET channel PLT-F channel WDF channel WPC channel WNR channel 6

7 PLT-F channel: Interaction reagents and thrombocytes Cellpack DFL perforates cell membranes Fluorocell PLT stains nucleic acids in thrombocytes 7

8 Identify samples with unreliable PLT counts due to platelet clumps

9 Prevent false low PLT counts due to platelet clumps False low platelet counts could result in unnecessary transfusions 9

10 What s the meaning of the PLT Clumps? flag? Platelet clumps may be present in the sample The PLT count may be unreliable due to clumps 10

11 Platelet aggregation and agglutination Platelet aggregation is irreversible» Activation of platelets due to» Heparin treatment» Poor sample collection» Shape change and production of fibrin mesh Platelet agglutination is reversible» Cold antibody-induced» Warm antibody-induced 11

12 PLT Clumps? doesn t indicate the presence of clumps! It indicates that the PLT count may be unreliable due to clumps!

13 Analyser results 1. Flag PLT Clumps? PLT count may be unreliable and a smear review is recommended 2. Flag Giant PLT PLT count is reliable and can be reported 3. Flag Giant PLT AND action message PLT PLT-I count is unreliable and a PLT-F reflex measurement is performed to obtain a reliable PLT count from the analyser 13

14 Summary» The flag PLT Clumps? doesn t indicate the presence of platelet clumps» The flag PLT Clumps? indicates that the PLT count may be unreliable due to clumps» New flag Giant PLT will be introduced to reduce the number of samples with false-positive PLT Clumps? flags 14

15 Optimise your thrombopoiesis workflow

16 Coming soon TWO TWO Thrombopoiesis Workflow Extended IPU Optimisation PLT-F channel 16

17 PLT-F triggers within TWO» Low PLT-I» Action message PLT» Unclear thrombocytopenia in unknown patients» Previous PLT-F during thrombocytopenia monitoring 17

18 PLT (x 10 3 /µl) Comparing comparable technologies CD61 PLT-I PLT-O PLT-F Day1 Day3 Day5 Day6 Tanaka et al. J Clin Lab Anal 2014; 28(5):

19 In summary, the TWO can be used to...» Select the appropriate methodology» Optimise the laboratory workflow» Point out the consequences of a high/low IPF 19

20 Get more clinical information with the immature platelet fraction

21 Thrombocyte maturation Megakaryoblast (bone marrow, 25%) No thrombocyte production Megakaryocyte (bone marrow, 75%) Thrombocyte production 4-5 Days Immature (reticulated) thrombocyte Budding from megakaryocytes High RNA content IPF 1-2 Days Immature (reticulated) thrombocyte Decreasing RNA content (young giant thrombocyte in peripheral blood) Mature thrombocyte 2-20 fl Life span ± 10 days 10 Days 21

22 IPF platelet underproduction vs. increased destruction Under normal conditions, thrombopoiesis is in balance Formation (bone marrow) Destruction (circulation/spleen) Imbalance / thrombocytopenia Inadequate formation / Normal destruction OR Normal formation / Elevated destruction 22

23 Clinical value of IPF and IPF# Psaila B et al. Blood 2012; 119(17):

24 IPF in coronary artery disease patients Grove EL et al. Thromb Haemost 2009; 101(1):

25 A high IPF# is associated with residual platelet aggregation in patients treated with aspirin Thromb Haemost (1): JACC Cardiovasc Interv (8): J Thromb Haemost (1):

26 Clinical value of IPF# Ibrahim H et al. J Am Coll Cardiol 2014; 64(20):

27 Summary» Immature platelets have more reactivity potential than mature platelets» IPF and IPF# may therefore be risk factors in coronary artery disease patients» IPF# best indicator of successful platelet production in ITP» IPF# may be especially useful because it s independent on the PLT count» IPF# will not be affected by platelet transfusions 27

28 The XN-Series An expert in platelet management Productivity value PLT count Clinical value Correct low PLT count False low PLT count Correct high PLT count False high PLT count New flagging Micro RBC Fragments IPF Giant platelets TWO TWO PLT reflex Giant platelets PLT clumps IPF Giant platelets TWO PLT reflex PLT-F PLT-I or PLT-F PLT-I or PLT-F PLT-F PLT-F PLT-I or PLT-F PLT-F PLT consumption Marrow recovery Correct count Correct count PLT aggregation Malignant PLT production Correct count Correct count PLT production Marrow stress Unnecessary PLT-F PLT Agglutination Reactive PLT production Unnecessary PLT-F 28

29 The XN-Series An expert in platelet management Thank you for your attention