All reviews of published articles are made public. This includes manuscript files, peer review comments, author rebuttals and revised materials. Note: This was optional for articles submitted before 13 February 2023.
Peer reviewers are encouraged (but not required) to provide their names to the authors when submitting their peer review. If they agree to provide their name, then their personal profile page will reflect a public acknowledgment that they performed a review (even if the article is rejected). If the article is accepted, then reviewers who provided their name will be associated with the article itself.
Dear Dr Zhang,
Congratulations! The last version of your manuscript is accepted.
Best regards
Dear Dr Yan,
Please check the latest suggestions for adjustments between results and discussion and resubmit your manuscript, as the reviewer suggested.
Best regards
There appear many discussions in the result part. Please, just report the findings in the result part and move the explanations to discussion part.
No comments
No comment
After the reviewers' comprehensive review of the manuscript, I am forwarding it for further adjustments and corrections, as recommended by Reviewer 1. Please note the specific details regarding the basic report, experimental design, and the validity of the findings.
Sincerely
1. This work will benefit from review for its English by someone fluent in written English
2. In the title, the word “evaluation” is not important. Comparison integrates the evaluation process.
3. It is better to avoid abbreviations from the title
4. At the beginning of abstract, the authors mentioned that EDTA-PTCP is a “fictitious” condition. It is not clear why the authors used the word “fictitious”, given that the condition is real laboratory finding.
5. Line 28: the purpose statement is not correct. The purpose of the study is to compare different analyzers with respect to identification of pseudo-thrombocytopenia
6. Conclusion and recommendation are lacking in the abstract. From line 42 onwards, it can be titled as conclusion.
7. Would be better if the mechanism how EDTA causes PTCP was briefly described in the background.
8. Line 89: start on new line
9. The statistical tests used for fig 2 and 3 are not indicated
1. Time dependence of EDTA-PTCP should be reflected in the title of your study, as it is a major part of your finding. It just appeared in the method and result part.
2. The research question is not well-defined and the gaps are not clearly indicated. We know that for patients with thrombocytopenia, peripheral smear examination is undertaken to see if there are platelet clumps. This is also how you selected your study participants. In light of this, you should present the gaps in the existing practice and how your study fills this gap. This has to be clearly described at the final part of your introduction.
3. While selecting the 32 PTCP samples, on top of the presence of platelet clumping, repeating CBC using different anticoagulant affirms the presence of EDTA-PTCP. I think this was not done in this study. Which analyzer and channel was used to select the 32 patients?
4. How do the authors explain the sufficiency of the sample size to infer the finding?
5. Can we report the magnitude of EDTA-PTCP (EDTA-PTCP among patients with thrombocytopenia) in the study area?
6. Under the section “Clinical Features of EDTA-PTCP Patients”, no clinical feature of the patients was mentioned. It was all about laboratory findings.
7. Platelet clump was seen in both EDTA and citrated sample. Then, how can we say that the PTCP is EDTA-induced? EDTA induced PTCP is due to EDTA dependent antibodies that react with platelet glycoprotein IIb/IIIa.
8. Does figure 1 represents all the 32 cases?
9. In the discussion part, the authors repeatedly stated the “dissociative” effect of different analyzers, which appears to be totally new idea. What effect would the mentioned analyzers have on platelet clumping is not clear. Possible explanation for the variability of counts in different analyzers and channels was not discussed.
10. Except the principle of cell counting, the analyzers don’t have direct effect on “dissociation” and “disaggregation” of clumps. How do these cell counting principles, be it, optical, impedance, or fluorescence could favor or disfavor identification of PTCP?
1. Clear explanation is required whether the included samples are really with EDTA-PTCP. This has to be diagnosed by the presence of thrombocytopenia on automated analyzer, platelet clumping under microscopy, and correction by using alternative anticoagulants like sodium citrate.
2. Similar setting has to be used for this experiment. EDTA-PTCP should be diagnosed using the corresponding analyzer and channel before evaluating each analyzer and channel or time dependence.
3. Peripheral blood smear examination is a better method to detect EDTA-PTCP. However, the authors mentioned in the conclusion that this method is time consuming and not accessible in China, which is a bit bold to conclude.
4. In the conclusion, the connotation is that some analyzers and channels better correct PTCP by disaggregating platelet clump. I couldn’t comprehend this.
No comment
The authors demonstrated how to identify EDTA-PTCP and addressed ways to correct the issue. However, they focused solely on correcting low platelet counts using hematology analyzers, neglecting to compare their results with simpler alternatives, such as using kanamycin to deaggregate platelet clumps.
This manuscript does not present new information, as several reports have already shown that the Mindray analyzer with PLT-O can deaggregate platelet clumps. The key issue is determining whether the corrected results are accurate.
Moreover, the manuscript contains redundant results that could be effectively presented with just two figures.
The experimental design does not address a clear knowledge gap, particularly in demonstrating the accuracy of the analyzer's results. The authors attempted to use sodium citrate tubes as a standard method to correct platelet clumping, but this approach resolved only 70% of the clumps (from the other literatures).
These comparative studies do not provide new knowledge, as similar reports already exist. To generate novel data, the authors should focus on accurately determining platelet counts. For example, they could compare methods such as using kanamycin for deaggregation and confirming the results by counting platelets on a blood smear.
There is some bias in the selection of the area for the blood smear in Figure 1. For example, platelet clumps are more commonly seen at the edges of the slide. The authors should ensure that the same area is used consistently when demonstrating platelet clumps.
All text and materials provided via this peer-review history page are made available under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.