A characteristic flow cytometric pattern with broad forward scatter and narrowed side scatter helps diagnose immune thrombocytopenia (ITP)

Int J Hematol. 2018 Aug;108(2):151-160. doi: 10.1007/s12185-018-2454-y. Epub 2018 Apr 16.


Various disorders cause severe thrombocytopenia, which can lead to critical hemorrhage. Procedures that rapidly support the diagnosis and risk factors for serious bleeding were explored, with a focus on immune thrombocytopenia (ITP). Twenty-five patients with thrombocytopenia, including 13 with newly diagnosed ITP, 3 with chronic ITP, 6 with aplastic anemia (AA), and 3 with other thrombocytopenia (one acute myeloid leukemia, one acute lymphoblastic leukemia, and one hemophagocytic lymphohistiocytosis), were reviewed. In addition to platelet-related parameters obtained by an automated hematology analyzer, flow cytometric analysis of platelets was performed. A characteristic flow cytometric pattern with broad forward scatter and narrowed side scatter, which is specific to ITP, but not other types of thrombocytopenia, was found. CD62P-positive platelets were increased in newly diagnosed ITP cases compared to control (P < 0.0001), AA (P = 0.0032). Moreover, detection of dramatic changes in these parameters on sequential monitoring may suggest internal hemorrhage, even absent skin or visible mucosal bleeding. The bleeding score for visible mucosae had a negative correlation with platelet count and a positive correlation with immature platelet fraction (%), forward scatter, and CD62P. This characteristic flow cytometric pattern makes it possible to distinguish ITP from other thrombocytopenic disorders.

Keywords: Aplastic anemia; Flow cytometry; Immune thrombocytopenia; Platelets.

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Aplastic
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Flow Cytometry / methods*
  • Hemorrhage / diagnosis
  • Hemorrhage / etiology
  • Humans
  • Infant
  • Male
  • Monitoring, Physiologic
  • P-Selectin
  • Platelet Count*
  • Purpura, Thrombocytopenic, Idiopathic / blood
  • Purpura, Thrombocytopenic, Idiopathic / diagnosis*
  • Purpura, Thrombocytopenic, Idiopathic / etiology
  • Retrospective Studies
  • Young Adult


  • P-Selectin
  • SELP protein, human