The platelet count has a primary role in the diagnosis and treatment of idiopathic thrombocytopenic purpura (ITP). This study analysed the accuracy of ITP patient platelet counts determined by Abbott CD-Sapphire (impedance/optical) and Bayer Advia 120 (optical) analyses, compared with a reference immunoplatelet method. Instrument platelet estimates showed broad equivalence in the higher range of observed values, but significant discrepancies against the immunoplatelet count were seen when platelet counts were <10 x 10(9)/l. CD-Sapphire mean platelet volume (MPV) results revealed increased (>12 fl) platelet volumes in eight of eight ITP patients with counts of <20 x 10(9)/l compared with 6/6 and 5/13 patients with platelet counts of 20-50 and >50 x 10(9)/l. In contrast, Bayer Advia MPV values showed no relationship with the platelet count. Increased reticulated platelets were associated with an increasing CD-Sapphire MPV (R(2) = 0.61) and a decreasing platelet count. High (>40%) reticulated platelet values were seen in 9/9 patients with immunoplatelet counts of <20 x 10(9)/l compared with 0/19 patients with platelet counts above 20 x 10(9)/l. There may be a need for caution in the interpretation of platelet counts in ITP patients obtained with conventional instrument methods, and therapeutic decisions should ideally be validated by reference immunoplatelet procedures.

Our study showed a progressive modification of pathogen inactivated platelet concentrates observed up to 7 days. The persistence of the secretory pool and the presence of the platelet membrane fibrinogen receptor suggest the persistence of a potential hemostatic efficacy. Clinical studies are necessary to directly correlate this type of analysis to 24 h recovery or survival of transfused platelets in humans.

Hemodialysis patients on maintenance erythropoietin need an adequate supply of iron to optimize therapy and achieve and maintain target levels of hemoglobin. Evaluation of iron stores and early detection of iron deficiency are essential for management of erythropoiesis in chronic renal failure, but there is still no single biochemical or hematological parameter that is sensitive or specific enough to completely describe the distribution of iron in the body. Serum transferrin receptor (sTfR) is a marker of iron that is available for erythropoiesis. We selected 2 clinical cases in which hemodialysis patients were receiving maintenance erythropoietin. To suggest how sTfR can be used in its double diagnostic meaning according to the clinical context of the patient, sTfR was evaluated in one case as a marker of iron deficiency and in the other as a marker of erythropoiesis. The association of sTfR with hematological parameters of iron-deficient erythropoiesis (reticulocyte hemoglobin content, percentage of hypochromic erythrocytes, ratio of reticulocyte hemoglobin content to hemoglobin content) and parameters of stimulated erythropoiesis (absolute reticulocyte count, immature reticulocyte fraction) increases the accuracy of sTfR in its double diagnostic power.

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