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The report emphasizes that manual confirmation is typically needed when abnormal results occur. Using the platelet fluorescence (PLT-F) method, the platelet measurement is shown to match manual results more accurately. The case further links the interference to RBC fragments and provides supporting hematologic and microscopic observations.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/red-blood-cell-fragmentation-mimicking-platelet-recovery-in-a-patient-with-severe-pneumonia/405740/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/red-blood-cell-fragmentation-mimicking-platelet-recovery-in-a-patient-with-severe-pneumonia/405740.png","ImageObject",300,407,{"name":92,"@type":93},"Theodore","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What condition can cause a false increase in platelet count in automated analyzers?","Question",{"text":112,"@type":113},"Erythrocyte fragments can be similar in size to large platelets and may be misclassified, leading to spurious thrombocytosis. Manual counting is typically required to resolve this error.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was platelet count verified in this case?",{"text":117,"@type":113},"Platelet count was rechecked using the platelet fluorescence (PLT-F) channel on the Sysmex XN-9000. The PLT-F result demonstrated accuracy comparable to the manual method.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the microscopy and PLT-F scattergram show?",{"text":121,"@type":113},"Microscopy revealed erythrocyte fragments and obvious abnormalities with varying RBC sizes, including fragmented red blood cells. The PLT-F scattergram showed an abnormal dot cluster under the RBC cluster, consistent with interference.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},405740,1790716741,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Clinical Case Reports  \nCASE REPORT  OPEN ACCESS   \nRed Blood Cell Fragmentation Mimicking Platelet Recovery in a Patient With Severe Pneumonia  \nDongsha Shi  | Zuoliang Dong  \nDepartment of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, China Correspondence: Zuoliang Dong ([zuoliangdong@tmu.edu.cn](zuoliangdong@tmu.edu.cn))  \nReceived: 23 July 2025 | Revised: 31 October 2025 | Accepted: 18 November 2025  \nKeywords: fragment | PLT-F | severe pneumonia | spurious thrombocytosis  \n\n| ABSTRACT\u003Cbr>Here we present a case of red blood cell (RBC) fragmentation mimicking platelet (PLT) recovery. In such situations, the platelet count is typically verified by the manual method. In the present case, the platelet fluorescence (PLT-F) method demonstrated accuracy comparable to that of the manual approach. |  |\n| --- | --- |\n| 1 | Introduction | failure. Sputum culture results confirmed an Acinetobacter baumannii infection. He was diagnosed with severe pneumo- |\n| Erythrocyte fragments are similar in size to large platelets and | nia, septicopyemia complicated by acute hemolytic anemia. |\n| may occasionally be misclassified by automated analyzers, | Management included endotracheal intubation, mechanical |\n| which can lead to an inaccurate increase in platelet count. This issue is usually resolved through manual counting. We present | ventilation, and intravenous administration of antibiotics. |\n| a case offalse thrombocytosis caused by erythrocyte fragments, | His complete blood count (CBC) was performed by routine mode |\n| which was successfully identified and corrected using platelet fluorescence (PLT-F) channel on Sysmex XN-9000 automated | on the Sysmex XN-9000 (XN-9000; Sysmex Corporation, Kobe, Japan), which revealed hemoglobin of 70 g/L, a white blood |\n| hematology analyzer. | cell count (WBC) of 16.5 × 109/L, and a platelet (PLT) count of 423 × 109/L. The patient's condition worsened after admission, and his platelets progressively declined. On Day 3, his PLT count |\n| 2 | Case History | was decreased to 32 × 109/L. However, his PLT count returned to 329 × 109/L measured by impedance method (PLT-I) with an |\n| A 52-year-old man was admitted to our emergency department | alert message (PLT Abn Distribution) 2 days later (Figure 1). |\n| because of progressive dyspnea for a week, aggravated by cough- | We retested it by PLT-F channel which demonstrated a count of |\n| ing up phlegm and fever for 4 days. Total gastrectomy was per- | 36 × 109/L. The PLT-F scattergram (Figure 2) showed an abnor- |\n| formed because of gastric lymphoma 6 years ago. | mal dot cluster (red oval) under the RBC cluster, which exhibited similar side fluorescence as normal PLTs but relatively increased forward light scatter. Furthermore, microscopy (Figure 3) showed |\n| 3 | Differential Diagnosis, Investigations and | the presence of erythrocyte fragments and an obvious decreased |\n| Treatment | PLT count. The distribution of red blood cells is sparse, which is consistent with anemia. The morphology shows obvious abnor- |\n| On subsequent workup, a large area of ground-glass shadow in | malities, with varying sizes. Nucleated red blood cells and poly- |\n| the right lung was noted on a computed tomogram (CT) of the | chromatic red blood cells are easily observable, as are fragmented |\n| chest. His arterial blood gas indicated hypoxemic respiratory | red blood cells. The proportion of fragmented red blood cells |\n| This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.\u003Cbr>© 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. |  |\n\nClinical Case Reports, 2026; 14:e71740 1 of 3  \n[https://doi.org/10.1002/ccr3.71740](https://doi.org/10.1002/ccr3.71740)  \nreaches 25%, including helmet-shaped","cbCaicjGFWikx9Cx","https://ap.wps.com/l/cbCaicjGFWikx9Cx","pdf",415387,"English","# Introduction\n# Case History\n# Differential Diagnosis, Investigations and Treatment\n# Conclusion and Results\n# Discussion","[{\"question\":\"What condition can cause a false increase in platelet count in automated analyzers?\",\"answer\":\"Erythrocyte fragments can be similar in size to large platelets and may be misclassified, leading to spurious thrombocytosis. Manual counting is typically required to resolve this error.\"},{\"question\":\"How was platelet count verified in this case?\",\"answer\":\"Platelet count was rechecked using the platelet fluorescence (PLT-F) channel on the Sysmex XN-9000. The PLT-F result demonstrated accuracy comparable to the manual method.\"},{\"question\":\"What did the microscopy and PLT-F scattergram show?\",\"answer\":\"Microscopy revealed erythrocyte fragments and obvious abnormalities with varying RBC sizes, including fragmented red blood cells. The PLT-F scattergram showed an abnormal dot cluster under the RBC cluster, consistent with interference.\"}]","Red Blood Cell Fragmentation Mimicking Platelet Recovery in a Patient With Severe Pneumonia | PDF",1790561645]