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A characteristic flow cytometric pattern with broad forward scatter and narrowed side scatter helps diagnose immune thrombocytopenia (ITP)

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Abstract

Various disorders cause severe thrombocytopenia, which can lead to critical hemorrhage. Procedures that rapidly support the diagnosis and risk factors for serious bleeding were explored, with a focus on immune thrombocytopenia (ITP). Twenty-five patients with thrombocytopenia, including 13 with newly diagnosed ITP, 3 with chronic ITP, 6 with aplastic anemia (AA), and 3 with other thrombocytopenia (one acute myeloid leukemia, one acute lymphoblastic leukemia, and one hemophagocytic lymphohistiocytosis), were reviewed. In addition to platelet-related parameters obtained by an automated hematology analyzer, flow cytometric analysis of platelets was performed. A characteristic flow cytometric pattern with broad forward scatter and narrowed side scatter, which is specific to ITP, but not other types of thrombocytopenia, was found. CD62P-positive platelets were increased in newly diagnosed ITP cases compared to control (P < 0.0001), AA (P = 0.0032). Moreover, detection of dramatic changes in these parameters on sequential monitoring may suggest internal hemorrhage, even absent skin or visible mucosal bleeding. The bleeding score for visible mucosae had a negative correlation with platelet count and a positive correlation with immature platelet fraction (%), forward scatter, and CD62P. This characteristic flow cytometric pattern makes it possible to distinguish ITP from other thrombocytopenic disorders.

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Authors and Affiliations

  1. Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan

    Raita Araki, Ryosei Nishimura, Rie Kuroda, Toshihiro Fujiki, Shintaro Mase, Kazuhiro Noguchi, Yasuhiro Ikawa, Hideaki Maeba & Akihiro Yachie

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  1. Raita Araki
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  2. Ryosei Nishimura
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  3. Rie Kuroda
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  4. Toshihiro Fujiki
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  5. Shintaro Mase
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  6. Kazuhiro Noguchi
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Correspondence to Ryosei Nishimura.

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12185_2018_2454_MOESM1_ESM.tiff

Supplementary Figure S1. Platelet distribution patterns of all cases of various thrombocytopenia types on FSC–SSC plots. The characteristic distribution pattern of ITP with broad FSC and narrowed SSC is never seen in aplastic anemia, leukemia, and hemophagocytic lymphohistiocytosis. Red dots indicate platelets, and dark gray dots indicate red blood cells. (TIFF 1521 kb)

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Araki, R., Nishimura, R., Kuroda, R. et al. A characteristic flow cytometric pattern with broad forward scatter and narrowed side scatter helps diagnose immune thrombocytopenia (ITP). Int J Hematol 108, 151–160 (2018). https://doi.org/10.1007/s12185-018-2454-y

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  • DOI: https://doi.org/10.1007/s12185-018-2454-y

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