Neutrophil Platelet Satellitism Revisited: Sidedness and Domain of Neutrophil Associated Platelet Aggregates.
Authors: Milani Cannon , Schiffman Fred J. , Quesenberry Peter J. 
Published: October 2019

Abstract
Abstract 4469
Platelet Satellitism surrounding polymorphonuclear neutrophils has been observed almost exclusively in EDTA-treated blood at room temperature. The mechanism underlying this phenomenon is not fully understood. In a PubMed search of the English language medical literature, there are only 44 reported cases involving the phenomenon of Platelet Satellitism.
We report a case of platelet rosetting around neutrophils in a 78-year old woman with incidental thrombocytopenia. Her isolated thrombocytopenia was not mediated by any form of immunosuppression, medications, hypersplenism, intravascular consumption, or diminished platelet production. A diagnosis of Pseudothrombocytopenia was made based upon her peripheral blood smear revealing platelet aggregates displaying sidedness in relation to her neutrophils.
Platelet Satellitism is postulated to represent an immunologic phenomenon caused by the presence of natural antibodies in which the platelets aggregate around polymorphonuclear neutrophils. The reasons behind why certain individuals possess agglutinating antibodies that lead to platelet clumping, and others have antibodies that cause platelet satellitism is unknown. A proposed mechanism is natural antibodies directed against different epitopes on the platelet GPIIb-IIIa complex. The reported frequency of platelet Satellitism is much lower than that of EDTA platelet clumping (approximately 1:30,000 blood counts) according to the reviewed literature.
Platelet Satellitism to polymorphonuclear neutrophils was initially documented by Field and MacLeod in 1963, and has since been reported as an incidental finding in peripheral blood smears when EDTA was used as an anticoagulant. The process by which platelets bind and form rosettes around polymorphonuclear leukocytes is due to activation of EDTA-dependent antiplatelet and antineutrophil IgG autoantibodies directed against the platelet glycoprotein IIb/IIIa complex and Fc receptors of neutrophils. Further, it is theorized that a non-immunologic cause may play in role in which adherence is induced by thrombospondin or the alpha-granule protein of other platelets. In rare instances, platelets may aggregate around monocytes or basophils.
Our retrospective review underscores the importance of recognizing the principle of Pseudothrombocytopenia due to EDTA-induced Platelet Satellitism. This entity is in vitro phenomena which has no clinical bearing in terms of a predisposition to increased mucous membrane bleeding. As in other literature cases, a clear correlation between the presence of IgG antibodies and a specific clinical situation, disease, or use of drugs could not be demonstrated. Therefore, these antibodies, which are present in some normal individuals, might occur naturally. Due to the exposure of certain antigenic structures present on EDTA-modified platelets and neutrophils, they may manifest themselves by triggering the Platelet Satellitism phenomenon.

Disclosures:
No relevant conflicts of interest to declare.