This is a young female who presented with localized pain and swelling following a scorpion sting. However, patient developed signs of DIC (alongside impaired coagulopathy tests), 24 hours after the reported sting.  

Automated blood counts at this time showed moderate microcytic hypochromic anemia (Hb: 6.3g/dL, MCV: 72 fL) and a platelet count of 497,000 /µL.  

This high platelet count is not compatible with the suspected diagnosis of DIC, prompting the need for a peripheral smear evaluation. Peripheral smear revealed numerous microspherocytes and a low manual platelet count of 60,000/ µL. These findings confirmed that the spurious elevation of platelet count in this case was a result of the inability of automated analyzers to discriminate between platelets and comparable sized microspherocytes.  

Learning points 

• Though most scorpion stings present as a local tissue reaction characterized by mild to moderate burning pain, minimal swelling and erythema, significant envenomations amounting to systemic symptoms can be caused by a number of species possessing potent venom. These species include Centruroides (Southwestern United States), Hemiscorpius lepturus (Middle East) and Buthus (India) amongst others.  
• Toxin-induced alteration in the coagulation system due to release of cytokines and inflammatory mediators has been implicated as a causative factor for DIC induced by scorpion stings.  
• Careful monitoring and repeat laboratory testing is of utmost importance to diagnose potential disastrous complications like DIC in a patient presenting with a scorpion sting. 
• Automated analyzers may reveal falsely normal or elevated platelet count in DIC owing to the presence of frequent schistocytes or microspherocytes, being counted as platelets, thus emphasizing the importance of correlation between peripheral smear and automated CBC results.