{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T14:45:56Z","timestamp":1780757156074,"version":"3.54.1"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Acute leukemias with hyperleukocytosis (&gt;\u2009100\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L) can produce cytoplasmic blast fragments that interfere with platelet counts, notably in impedance\u2010based methods, potentially masking severe thrombocytopenia and increasing hemorrhagic risk. While fluorescent platelet counting (PLT\u2010F) is promoted as platelet\u2010specific, its accuracy in the presence of blast fragments remains uncertain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study analyzed 269 blood samples from 87 patients with hypercellular acute leukemia. Blast fragments were identified on blood smears. Platelet counts by impedance were compared to optical (PLT\u2010O) and fluorescent (PLT\u2010F) methods when available. Flow cytometry (FC) quantification by CD41+\/CD61+ staining was performed in selected cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Blast fragments were observed in 26% of cases, predominantly in AML\u2010M5 and AML\u2010M1 subtypes. In the absence of blast fragments, PLT\u2010I, PLT\u2010O, and PLT\u2010F showed comparable results. However, in samples with blast fragments, PLT\u2010I frequently overestimated platelet counts compared to PLT\u2010O and PLT\u2010F. PLT\u2010F counts were closer to FC quantification but still overestimated platelet numbers in 6 of 16 samples with FC results, particularly in cases of severe leukocytosis. Notably, PLT\u2010F failed to trigger abnormal scattergram flags in all but one of the discrepant cases. PLT\u2010O provided results comparable to PLT\u2010F in most cases with blast fragments but also demonstrated limitations in select cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PLT\u2010O and PLT\u2010F methods both have limitations in hypercellular acute leukemias with blast fragments. FC remains the most reliable approach when blast fragments are present. Routine blood smear evaluations are essential for detecting interferences and ensuring accurate thrombocytopenia assessment in these high\u2010risk patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.14464","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T03:52:06Z","timestamp":1743565926000},"page":"622-631","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Overestimation of Automated Platelet Counts by Blast Fragments in Acute Hypercellular Leukemias: A Retrospective Study Comparing Impedance, Optical (<scp>PLT<\/scp>\u2010O), Fluorescent (<scp>PLT<\/scp>\u2010F), and <scp>CD41<\/scp>\/<scp>CD61<\/scp> Flow Cytometry Methods"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9357-4542","authenticated-orcid":false,"given":"Victor","family":"Bob\u00e9e","sequence":"first","affiliation":[{"name":"Department of Biological Hematology Rouen 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