Contributed by Brian K. Theisen, MD and Raymond E. Felgar MD, PhD
An 82 year old female with a medical history of mitral regurgitation and prolapse and moderate coronary artery disease presented to the emergency department with increased dyspnea on exertion. She underwent coronary artery bypass graft and mitral valve repair surgery. A post-operative CBC demonstrated a mildly elevated white blood cell count, normocytic anemia with occasional ovalocytes and acanthocytes and thrombocytopenia. A peripheral blood smear was sent for pathology review.
The post-operative complete blood count and differential revealed the following:
Morphologic review of the peripheral blood smear revealed neutrophils surrounded by platelets as well as prominent phagocytosis of the platelets by neutrophils (see image). This phenomenon was not observed in association with other cells (i.e. red blood cells, eosinophils, monocytes or lymphocytes). Due to the association of the platelets with neutrophils, the automated instrument count was not accurately reflecting the platelet count.