This week’s case comes from a fascinating share by a colleague, reminding us all why we should never ignore an automated analyser flag!

The 52 year old patient presented to the emergency department with an unexplained fever. The initial FBC showed a normal white cell count but a closer look at the parameters revealed a deeper issue.

Key FBC Results:

• WBC: 4.99 x 10⁹/L
• Hb: 124 g/L
• Platelets: 58 x 10⁹/L

The analyser flagged the sample for an abnormal platelet distribution. Looking at a platelet count of 58, the biomedical scientist on duty immediately performed a wet preparation to check for EDTA induced platelet clumping.

Instead of clumps, they noticed the following on the wet prep:

A blood film was made:

Drop your guesses and observations in the comments! As always, you can follow the discussion on LinkedIn.

Special thanks to Cha Wei Lee for sharing this case and blood film.