medigraphic.com
ISSN 2500-7106 (Digital)
ISSN 0123-2576 (Impreso)
Medicina & Laboratorio

2008, Número 11-12

<< Anterior Siguiente >>

Medicina & Laboratorio 2008; 14 (11-12)


Utilidad del extendido de sangre periférica: las plaquetas*

Campuzano MG

Idioma: Español
Referencias bibliográficas: 119
Paginas: 511-531
Archivo PDF: 1876.52 Kb.


RESUMEN

A pesar de los grandes avances tecnológicos relacionados con el hemograma, y en particular los derivados de los autoanalizadores de hematología, cada vez más sofisticados y completos, el extendido de sangre periférica continúa siendo el “estándar de oro” del diagnóstico hematológico. De acuerdo con las buenas prácticas de hematología, el extendido de sangre periférica está indicado en todos los hemogramas que muestren alguna desviación en los recuentos directos, indirectos o calculados, o cuando se sospeche clínicamente una enfermedad de origen hematológico o de origen no hematológico con manifestaciones hematológicas, aun con parámetros entre los rangos esperados. En el extendido de sangre periférica es posible observar alteraciones relacionadas con la morfología de los eritrocitos, leucocitos y las plaquetas. En este módulo se analizarán los aspectos más importantes de la morfología de las plaquetas, en particular: 1) el recuento de plaquetas que define los conceptos de trombocitopenia y trombocitosis, 2) l as variaciones en el tamaño, la morfología y los gránulos citoplasmáticos y su relación con las enfermedades plaquetarias asociadas, 3) los nuevos parámetros plaquetarios derivados de la incorporación de los autoanalizadores de hematología a los laboratorios clínicos, especialmente el volumen medio plaquetario y el ancho de distribución de las plaquetas y su relación con los aspectos morfológicos evidenciables en el extendido de sangre periférica, y 4) se aborda el problema de los resultados falsos bajos (seudotrombocitopenia) o altos (trombocitosis) y se dan pautas para su adecuado estudio sistemático cuando se presentan estos resultados. Este módulo, dedicado al análisis de la morfología de las plaquetas en el extendido de sangre periférica, provee al profesional de laboratorio elementos que le permiten identificar adecuadamente las diferentes alteraciones de estas células, en tanto que al médico le proporciona información para que relacione los hallazgos, tanto cuantitativos como morfológicos, con la clínica.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Campuzano-Maya G. Utilidad clínica del extendido de sangre periférica: los eritrocitos. Medicina & Laboratorio 2008; 14: 311-357.

  2. Campuzano-Maya G. Utilidad clínica del extendido de sangre periférica: los leucocitos. Medicina & Laboratorio 2008; 14: 411-455.

  3. Sociedad Colombiana de Patología Clínica. Manual de Codificación, Nomenclatura, Nivelación y Valores de Exámenes de laboratorio Clínico. Medellín, Colombia: Edimeco S.A.; 2008: 1-100.

  4. College of American Pathologists. Workload Recording Method & Personnel Management Manual. 1992

  5. República de Colombia, Ministerio de Protección Social. Resolución 1896 de 2001 por la cual se sustituye integralmente la Clasificación Única de Procedimientos en Salud.

  6. Campuzano-Maya G. ¿Cómo obtener un extendido de sangre periférica de óptima calidad? Medicina & Laboratorio 2008; 14: 125-145.

  7. Bessis M. Blood smears reinterpreted. New York, USA: Springer-Verlag; 1977: 1-265.

  8. Perkins SL. Examination of the blood and bone marrow. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, eds. Wintrobe’s clinical hematology. 11th ed. Philadelphia, PA, USA; Lipincott Williams & Wilkins. 2004: 1-25.

  9. Bain BJ. Blood cell morphology in health and disease. In: Lewis SM, Bain BJ, Bates I, eds. Dacie and Lewis practical haematology. 5th ed. Philadelphia, PA, USA; Churchill Livingston. 2006: 79-113.

  10. Bain BJ. Blood cells. A practical guide. 4th ed. Malden, Massachusetts USA: Blackwell Publishing; 2006.

  11. Campuzano-Maya G. Del hemograma manual al hemograma de cuarta generación. Medicina & Laboratorio 2007; 133: 511-550.

  12. Schulze H, Shivdasani RA. Mechanisms of thrombopoiesis. J Thromb Haemost 2005; 3: 1717-1724.

  13. Szalai G, LaRue AC, Watson DK. Molecular mechanisms of megakaryopoiesis. Cell Mol Life Sci 2006; 63: 2460-2476.

  14. Kaushansky K. Historical review: megakaryopoiesis and thrombopoiesis. Blood 2008; 111: 981-986.

  15. Pang L, Weiss MJ, Poncz M. Megakaryocyte biology and related disorders. J Clin Invest 2005; 115: 3332-3338.

  16. Kaushansky K, Roth GJ. Megakaryocytes and platelets. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, eds. Wintrobe’s clinical hematology. 11th ed. Philadelphia; Lipincott Williams & Wilkins. 2004: 605-650.

  17. George JN. Platelets. Lancet 2000; 355: 1531-1539.

  18. Bhattacharya CG. A simple method of resolution of a distribution into gaussian components. Biometrics 1967; 23: 115-135.

  19. Savage RA, Lucas FV, Hoffman GC. Spurious thrombocytosis caused by red blood cell fragmentation. Am J Clin Pathol 1983; 79: 144.

  20. Ballard HS, Sidhu G. Cytoplasmic fragments causing spurious platelet counts in hairy cell leukemia: ultrastructural characterization. Arch Intern Med 1981; 141: 942-944.

  21. Patel KJ, Hughes CG, Parapia LA. Pseudoleucocytosis and pseudothrombocytosis due to cryoglobulinaemia. J Clin Pathol 1987; 40: 120-121.

  22. Pewarchuk W, VanderBoom J, Blajchman MA. Pseudopolycythemia, pseudothrombocytopenia, and pseudoleukopenia due to overfilling of blood collection vacuum tubes. Arch Pathol Lab Med 1992; 116: 90-92.

  23. Easton JA, Fessas C. The incidence of Döhle bodies in various diseases and their association with thrombocytopenia. Br J Haematol 1966; 12: 54-60.

  24. García-Suárez J, Merino JL, Rodríguez M, Velasco A, Moreno MC. Pseudotrombocitopenia: incidencia, causas y métodos de detección. Sangre (Barc) 1991; 36: 197-200.

  25. Silvestri F, Virgolini L, Savignano C, Zaja F, Velisig M, Baccarani M. Incidence and diagnosis of EDTA-dependent pseudothrombocytopenia in a consecutive outpatient population referred for isolated thrombocytopenia. Vox Sang 1995; 68:35-39.

  26. Payne BA, Pierre RV. Pseudothrombocytopenia: a laboratory artifact with potentially serious consequences. Mayo Clin Proc 1984; 59: 123-125.

  27. Berkman N, Michaeli Y, Or R, Eldor A. EDTAdependent pseudothrombocytopenia: a clinical study of 18 patients and a review of the literature. Am J Hematol 1991; 36: 195-201.

  28. Skinnider LF, Musclow CE, Kahn W. Platelet satellitism--an ultrastructural study. Am J Hematol 1978; 4: 179-185.

  29. Cohen AM, Lewinski UH, Klein B, Djaldetti M. Satellitism of platelets to monocytes. Acta Haematol 1980; 64: 61-64.

  30. Español I, Muñiz-Díaz E, Domingo-Claros A. The irreplaceable image: Platelet satellitism to granulated lymphocytes. Haematologica 2000; 85: 1322.

  31. Savage RA. Pseudoleukocytosis due to EDTA-induced platelet clumping. Am J Clin Pathol 1984; 81: 317-322.

  32. Matarazzo M, Conturso V, Di Martino M, Chiurazzi F, Guida G, Morante R. EDTA-dependent pseudothrombocytopenia in a case of liver cirrhosis. Panminerva Med 2000; 42: 155-157.

  33. Isobe T, Fujita T, Kinoshita S, Terao C, Yamaguchi N. Pseudothrombocytopenia with cold-type platelet agglutinins. Jpn J Med 1983; 22: 9-13.

  34. McGregor DH, Davis JW, Liu PI, Gates E, Poindexter AR. Platelet satellitism: experimental studies. Lab Invest 1980; 42: 343-355.

  35. D’Onofrio G, Mancini S, Starti S, Landolfi R, Mango G. Platelet clumping without pseudothrombocytopenia: a laboratory artifact in myeloproliferative disorders. Haematologica 1985; 70: 461-462.

  36. Solanki DL, Blackburn BC. Spurious thrombocytopenia during pregnancy. Obstet Gynecol 1985; 65: 14S-17S.

  37. Schrezenmeier H, Muller H, Gunsilius E, Heimpel H, Seifried E. Anticoagulant-induced pseudothrombocytopenia and pseudoleucocytosis. Thromb Haemost 1995; 73: 506-513.

  38. Mori M, Kudo H, Yoshitake S, Ito K, Shinguu C, Noguchi T. Transient EDTA-dependent pseudothrombocytopenia in a patient with sepsis. Intensive Care Med 2000; 26: 218-220.

  39. Cesca C, Ben-Ezra J, Riley RS. Platelet satellitism as presenting finding in mantle cell lymphoma. A case report. Am J Clin Pathol 2001; 115: 567- 570.

  40. Hosseinzadeh M, Kumar PV, Rahemi M. Platelet satellitism in lupus erythematosus resolving after treatment. Acta Haematol 2006; 115: 131-132.

  41. Reed BW, Go RS. Pseudothrombocytopenia associated with multiple myeloma. Mayo Clin Proc 2006; 81: 869.

  42. Hsieh AT, Chao TY, Chen YC. Pseudothrombocytopenia associated with infectious mononucleosis. Arch Pathol Lab Med 2003; 127: e17-18.

  43. Imai H, Nakamoto Y, Miki K, Miyakuni T, Miura AB. Pseudothrombocytopenia and IgA-related platelet agglutinin in a patient with IgA nephritis. Nephron 1983; 34: 154-158.

  44. Kozak M, Dovc T, Rozman P, Blinc A. A case of pseudothrombocytopenia after infusion of abciximab in vivo and anticoagulant-independent platelet clumping after rechallenge with abciximab in vitro. Wien Klin Wochenschr 2000; 112: 138-141.

  45. Bizzaro N, Brandalise M. EDTA-dependent pseudothrombocytopenia. Association with antiplatelet and antiphospholipid antibodies. Am J Clin Pathol 1995; 103: 103-107.

  46. Bizzaro N, Fiorin F. Coexistence of erythrocyte agglutination and EDTA-dependent platelet clumping in a patient with thymoma and plasmocytoma. Arch Pathol Lab Med 1999; 123: 159-162.

  47. Lazo-Langner A, Piedras J, Romero-Lagarza P, Lome-Maldonado C, Sanchez-Guerrero J, Lopez- Karpovitch X. Platelet satellitism, spurious neutropenia, and cutaneous vasculitis: casual or causal association? Am J Hematol 2002; 70: 246-249.

  48. Onder O, Weinstein A, Hoyer LW. Pseudothrombocytopenia caused by platelet agglutinins that are reactive in blood anticoagulated with chelating agents. Blood 1980; 56: 177-182.

  49. López JA, Andrews RK, Afshar-Kharghan V, Berndt MC. Bernard-Soulier syndrome. Blood 1998; 91: 4397-4418.

  50. Hatzipantelis ES, Tsantali H, Athanassiou-Metaxa M, Avramidou K, Zambul D, Gombakis N. Hereditary giant platelet disorder presented as pseudothrombocytopenia. Eur J Haematol 2001; 67: 330-331.

  51. Behrens WE. Mediterranean macrothrombocytopenia. Blood 1975; 46: 199-208.

  52. Mhawech P, Saleem A. Inherited giant platelet disorders. Classification and literature review. Am J Clin Pathol 2000; 113: 176-190.

  53. Campuzano-Maya G. Trombocitopenia: más importante que encontrarla es saber porqué se presenta. Medicina & Laboratorio 2007; 13: 111- 125.

  54. Lau LG, Chng WJ, Liu TC. Transfusion medicine illustrated. Unnecessary transfusions due to pseudothrombocytopenia. Transfusion 2004; 44: 801.

  55. Kocum TH, Katircibasi TM, Sezgin AT, Atalay H. An unusual cause of mismanagement in an acute myocardial infarction case: pseudothrombocytopenia. Am J Emerg Med 2008; 26: 740 e741-742.

  56. Campuzano-Maya G. Evaluación del paciente con trombocitopenia. Medicina & Laboratorio 2007; 13: 411-435.

  57. Di Giovanni S, De Matteis MA, Ciocca D, Cirella MP, Nanni Costa MP. Pseudothrombocytosis and pseudoleukocytosis in a case of essential mixed cryoglobulinemia (type II). Clin Exp Rheumatol 1986; 4: 143-145.

  58. Zandecki M, Dupriez B, Fenaux P, Jude B, Watel A, Dracon M, et al. Cytological and ultrastructural assessment of free crystals or precipitates associated with pseudoleukocytosis and pseudothrombocytosis in cryoglobulinemia. Nouv Rev Fr Hematol 1989; 31: 397-402.

  59. Pérez-Vila ME, Pedro C, Mellibovsky L, Woessner S, Serrano S, Florensa L. Spurious thrombocytosis associated with cryoglobulinaemia: a case report. Haematologica 2002; 87: ELT39.

  60. Fohlen-Walter A, Jacob C, Lecompte T, Lesesve JF. Laboratory identification of cryoglobulinemia from automated blood cell counts, fresh blood samples, and blood films. Am J Clin Pathol 2002;117: 606-614.

  61. Hutchinson CV, Stelfox P, Rees-Unwin KS. Needle-like cryoglobulin crystals presenting as spurious thrombocytosis. Br J Haematol 2006; 135: 280.

  62. Hagino T, Kaito K, Asai O, Dobashi N, Yano S, Takei Y, et al. [Pseudoleukocytosis and pseudothrombocytosis caused by fragmentation of leukemic cells in tumor lysis syndrome]. Rinsho Ketsueki 2007; 48: 1559-1562.

  63. Lawrence C, Atac B. Hematologic changes in massive burn injury. Crit Care Med 1992; 20: 1284-1288.

  64. Maitra A, Ward PC, Kroft SH, Levinson BS, Jamal S, Fishleder AJ, et al. Cytoplasmic inclusions in leukocytes. An unusual manifestation of cryoglobulinemia. Am J Clin Pathol 2000; 113: 107-112.

  65. Bain BJ. Quantitative changes in blood cells. In: Bain BJ, ed. Blood cells. A practical guide. 4th ed ed. Malden, Massachusetts USA; Blackwell Publishing. 2006: 217-262.

  66. Campuzano-Maya G. Proof of an association between Helicobacter pylori and idiopathic thrombocytopenic purpura in Latin America. Helicobacter 2007; 12: 265-273.

  67. George JN, Rizvi MA. Thrombocytopenia. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, Seligsohn U, eds. William’s haematology. 6th ed ed. New York; McGraw-Hill Book Company. 2001:1495-1539.

  68. Campuzano-Maya G. Estudio del paciente con trombocitopenia. Laboratorio Al Día 1995; 5: 325-350.

  69. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996; 88: 3-40.

  70. Sekhon SS, Roy V. Thrombocytopenia in adults: a practical approach to evaluation and management. South Med J 2006; 99: 491-498; quiz 499-500, 533.

  71. Levine SP. Thrombocytosis. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B, eds. Wintrobe’s clinical hematology. 11th ed. Philadelphia, PA, USA; Lipincott Williams & Wilkins. 2004: 1591-1601.

  72. Heath HW, Pearson HA. Thrombocytosis in pediatric outpatients. J Pediatr 1989; 114: 805-807.

  73. Campuzano-Maya G. Trombocitosis. Medicina & Laboratorio 1997; 7: 367-375.

  74. Bessman JD, Gilmer PR, Gardner FH. Use of mean platelet volume improves detection of platelet disorders. Blood Cells 1985; 11: 127-135.

  75. Bessman JD, Williams LJ, Gilmer PR, Jr. Mean platelet volume. The inverse relation of platelet size and count in normal subjects, and an artifact of other particles. Am J Clin Pathol 1981; 76: 289-293.

  76. Bain BJ. Morphology of blood cells. In: Bain BJ, ed. Blood cells. A practical guide. 4th ed ed. Malden,Massachusetts USA; Blackwell Publishing. 2006:61-174.

  77. Vukelja SJ, Krishnan J, Diehl LF. Mean platelet volume improves upon the megathrombocyte index but cannot replace the blood film examination in the evaluation of thrombocytopenia. Am J Hematol 1993; 44: 89-94.

  78. Bessman JD, Gilmer PR, Jr., Gardner FH. Improved classification of anemias by MCV and RDW. Am J Clin Pathol 1983; 80: 322-326.

  79. Derry JM, Kerns JA, Weinberg KI, Ochs HD, Volpini V, Estivill X, et al. WASP gene mutations in Wiskott-Aldrich syndrome and X-linked thrombocytopenia. Hum Mol Genet 1995; 4: 1127-1135.

  80. Ochs HD, Notarangelo LD. Structure and function of the Wiskott-Aldrich syndrome protein. Curr Opin Hematol 2005; 12: 284-291.

  81. Thrasher AJ, Burns S, Lorenzi R, Jones GE. The Wiskott-Aldrich syndrome: disordered actin dynamics in haematopoietic cells. Immunol Rev 2000; 178: 118-128.

  82. Ochs HD, Thrasher AJ. The Wiskott-Aldrich syndrome. J Allergy Clin Immunol 2006; 117: 725- 738; quiz 739.

  83. FitzPatrick DR, Strain L, Thomas AE, Barr DG, Todd A, Smith NM, et al. Neurogenic chronic idiopathic intestinal pseudo-obstruction, patent ductus arteriosus, and thrombocytopenia segregating as an X linked recessive disorder. J Med Genet 1997; 34: 666-669.

  84. Notarangelo LD, Miao CH, Ochs HD. Wiskott-Aldrich syndrome. Curr Opin Hematol 2008; 15: 30-36.

  85. Sullivan KE, Mullen CA, Blaese RM, Winkelstein JA. A multiinstitutional survey of the Wiskott-Aldrich syndrome. J Pediatr 1994; 125: 876-885.

  86. Campuzano-Maya G. Semiología del hemograma. Laboratorio Al Día 1995; 5: 161-174.

  87. Haddad E, Cramer E, Riviere C, Rameau P, Louache F, Guichard J, et al. The thrombocytopenia of Wiskott Aldrich syndrome is not related to a defect in proplatelet formation. Blood 1999; 94: 509-518.

  88. Qasim W, Gilmour KC, Heath S, Ashton E, Cranston T, Thomas A, et al. Protein assays for diagnosis of Wiskott-Aldrich syndrome and X-linked thrombocytopenia. Br J Haematol 2001; 113: 861-865.

  89. Knox-Macaulay HH, Bashawri L, Davies KE. X linked recessive thrombocytopenia. J Med Genet 1993; 30: 968-969.

  90. Freson K, Devriendt K, Matthijs G, Van Hoof A, De Vos R, Thys C, et al. Platelet characteristics in patients with X-linked macrothrombocytopenia because of a novel GATA1 mutation. Blood 2001;98: 85-92.

  91. Heiss NS, Knight SW, Vulliamy TJ, Klauck SM, Wiemann S, Mason PJ, et al. X-linked dyskeratosis congenita is caused by mutations in a highly conserved gene with putative nucleolar functions. Nat Genet 1998; 19: 32-38.

  92. Bernard J, Soulier J. Sur une nouvelle variété de dystrophie thrombocytaire-hémorragipare congénitale. Semin Hop Paris 1948; 24: 3217.

  93. Gröttum KA, Solum NO. Congenital thrombocytopenia with giant platelets: a defect in the platelet membrane. Br J Haematol 1969; 16: 277-290.

  94. Caen JP, Nurden AT, Jeanneau C, Michel H, Tobelem G, Levy-Toledano S, et al. Bernard-Soulier syndrome: a new platelet glycoprotein abnormality. Its relationship with platelet adhesion to subendothelium and with the factor VIII von Willebrand protein. J Lab Clin Med 1976; 87: 586-596.

  95. Bernard J. History of congenital hemorrhagic thrombocytopathic dystrophy. Blood Cells 1983; 9: 179-193.

  96. Kunishima S, Kamiya T, Saito H. Genetic abnormalities of Bernard-Soulier syndrome. Int J Hematol 2002; 76: 319-327.

  97. Nichols WL, Kaese SE, Gastineau DA, Otteman LA, Bowie EJ. Bernard-Soulier syndrome: whole blood diagnostic assays of platelets. Mayo Clin Proc 1989; 64: 522-530.

  98. Kunishima S, Yamada T, Hamaguchi M, Saito H. Bernard-Soulier syndrome due to GPIX W127X mutation in Japan is frequently misdiagnosed as idiopathic thrombocytopenic purpura. Int J Hematol 2006; 83: 366-367.

  99. Noris P, Spedini P, Belletti S, Magrini U, Balduini CL. Thrombocytopenia, giant platelets, and leukocyte inclusion bodies (May-Hegglin anomaly): clinical and laboratory findings. Am J Med 1998; 104: 355-360.

  100. McBane RD, Elliott MA, White JG, Charlesworth JE, Costopoulos MG, Owen WG, et al. Fechtner syndrome: physiologic analysis of macrothrombocytopenia. Blood Coagul Fibrinolysis 2000; 11: 243-247.

  101. Redman R, Shunkwiler SM, Harris NS, Kedar A, Clapp WL. Sebastian syndrome with abnormal platelet response to ristocetin. Lab Hematol 2008;14: 19-23.

  102. Standen GR, Saunders J, Michael J, Bloom AL. Epstein’s syndrome: case report and survey of the literature. Postgrad Med J 1987; 63: 573-575.

  103. Nurden AT, Nurden P. The gray platelet syndrome: clinical spectrum of the disease. Blood Rev 2007; 21: 21-36.

  104. Favier R, Jondeau K, Boutard P, Grossfeld P, Reinert P, Jones C, et al. Paris-Trousseau syndrome : clinical, hematological, molecular data of ten new cases. Thromb Haemost 2003; 90: 893-897.

  105. Okita JR, Frojmovic MM, Kristopeit S, Wong T, Kunicki TJ. Montreal platelet syndrome: a defect in calcium-activated neutral proteinase (calpain). Blood 1989; 74: 715-721.

  106. Smith TP, Dodds WJ, Tartaglia AP. Thrombasthenic-thrombopathic thrombocytopenia with giant, “swiss-cheese” platelets. A case report. Ann Intern Med 1973; 79: 828-834.

  107. Rees DC, Iolascon A, Carella M, O’Marcaigh A S, Kendra JR, Jowitt SN, et al. Stomatocytic haemolysis and macrothrombocytopenia (Mediterranean stomatocytosis/macrothrombocytopenia) is the haematological presentation of phytosterolaemia. Br J Haematol 2005; 130: 297-309.

  108. Ntaios G, Papadopoulos A, Chatzinikolaou A, Saouli Z, Karalazou P, Kaiafa G, et al. Increased values of mean platelet volume and platelet size deviation width may provide a safe positive diagnosis of idiopathic thrombocytopenic purpura. Acta Haematol 2008; 119: 173-177.

  109. Bessman JD. Platelet size in thrombocytosis. Acta Haematol 1984; 71: 144.

  110. Small BM, Bettigole RE. Diagnosis of myeloproliferative disease by analysis of the platelet volume distribution. Am J Clin Pathol 1981; 76: 685-691.

  111. Biddle DA, Neto TG, Nguyen AN. Platelet storage pool deficiency of alpha and delta granules. Arch Pathol Lab Med 2001; 125: 1125-1126.

  112. Drouin A, Favier R, Masse JM, Debili N, Schmitt A, Elbim C, et al. Newly recognized cellular abnormalities in the gray platelet syndrome. Blood 2001; 98: 1382-1391.

  113. Stavem P, Berg K. A macromolecular serum component acting on platelets in the presence of EDTA- -platelet stain preventing factor? Scand J Haematol 1973; 10: 202-208.

  114. Mattson JC, Peterson DM, McCarron S, Stathopoulos N. The Bernard-Soulier platelet: II. A comparative study of changes in platelet morphology and cytoskeletal architecture following contact activation. Scan Electron Microsc 1984: 1941-1950.

  115. Cockbill SR, Burmester HB, Heptinstall S. Pseudo grey platelet syndrome--grey platelets due to degranulation in blood collected into EDTA. Eur J Haematol 1988; 41: 326-333.

  116. Gokalp A, Oguz A, Turkay S, Icagasioglu D, Canturk NZ. May-Hegglin anomaly (a presentation of a family). Turk J Pediatr 1989; 31: 167-171.

  117. Fajardo LF, Rao S. Platelet enlargement in malaria. Mil Med 1971; 136: 463-464.




2020     |     www.medigraphic.com