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The authors raise a valid point in that segmented erythrocytes may be occasionally mistaken for platelets when manual counting is done. However, the platelet quantitation done at our hospital is similar to that done in most major hospitals throughout the United States.As clinicians, when platelet determinations are reported at 20,000 or less, we recognize that completely accurate determinations are not possible. Even if 50% of the "platelets" are in reality cellular fragments or debris, this does not negate a diagnosis of thrombocytopenia. When schistocytes and a hemolytic anemia are present, along with fever and transient neurological dysfunction, a clinical diagnosis of TTP can be made. We reported the case because the patient had the syndrome develop while taking an inhibitor of platelet aggregation, and the usual histological correlation was not present.
Lindquist JR. Segmented Erythrocytes Mistaken for Platelets-Reply. JAMA. 1982;247(22):3083. doi:10.1001/jama.1982.03320470031026
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