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Tangella AV, Peta RK, Yadlapalli DC, Raghunadha Rao D, M MS. Ethylene Diamine Tetra Acetate-Induced Pseudo Thrombocytopenia (EDTA-PTCP) in an Adolescent: A Case Report. Cureus 2023; 15:e38545. [PMID: 37273366 PMCID: PMC10239273 DOI: 10.7759/cureus.38545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Ethylene diamine tetra acetate-induced pseudo thrombocytopenia (EDTA-PTCP) is a fictitious laboratory condition that is associated with platelet clumping, leading to falsely low platelet counts. This fictitious occurrence can lead to expensive, time-consuming, and invasive diagnostic procedures. It may also result in the application of unnecessary therapies, although it is not linked to any hemorrhagic symptoms or platelet malfunction. This emphasizes the necessity of verifying laboratory results from automated analyzers in every patient with thrombocytopenia with a peripheral smear, particularly when they are out of proportion when compared to the clinical features. When using hematology analyzers, EDTA-induced pseudo thrombocytopenia can be missed. In cases of isolated thrombocytopenia, this can be easily avoided by performing a simple visual peripheral blood smear check, hence making it an important differential for thrombocytopenia on an automatic analyzer report, which has to be ruled out. Here, we present the case of an adolescent who presented to us with low platelet counts and was diagnosed with EDTA-PTCP after proper evaluation.
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Affiliation(s)
- Adarsh Vardhan Tangella
- Internal Medicine, Andhra Medical College, Visakhapatnam, IND
- Internal Medicine, King George Hospital, Visakhapatnam, IND
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2
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Chiba Y, Otsuka Y, Lefor AK, Sanui M. Efficacy of point-of-care thromboelastography 6s to evaluate platelet function in a patient with pseudothrombocytopenia undergoing cardiopulmonary bypass: a case report. JA Clin Rep 2022; 8:8. [PMID: 35076782 PMCID: PMC8789975 DOI: 10.1186/s40981-022-00496-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pseudothrombocytopenia is a phenomenon caused by in vitro platelet aggregation induced by anticoagulants contained in blood sampling tubes. Thromboelastography (TEG) 6s is a common point-of-care viscoelastic test to assess intraoperative coagulation status, which may reduce the need for blood transfusions. The reliability and usefulness of TEG6s for patients with pseudothrombocytopenia has not been established. CASE PRESENTATION We present a patient with pseudothrombocytopenia, who underwent suprarenal abdominal aortic aneurysm repair under cardiopulmonary bypass. At the beginning of surgery, TEG6s with citrated blood sampling showed that the results were unaffected by the disease. After completion of the aortic repair and the administration of protamine, maximum amplitude of TEG6s and adequate hemostasis were achieved without platelet transfusions, while standard laboratory tests showed thrombocytopenia. CONCLUSIONS In the present patient who underwent cardiopulmonary bypass, TEG6s may have contributed to a reliable and useful assessment of coagulation and hemostatic status avoiding unnecessary platelet transfusions.
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Affiliation(s)
- Yoshihiko Chiba
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma, Omiya, Saitama-City, Saitama, 330-8503, Japan
| | - Yuji Otsuka
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma, Omiya, Saitama-City, Saitama, 330-8503, Japan.
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 1-3311, Yakushiji, Shimotsuke-city, Tochigi, 329-0498, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma, Omiya, Saitama-City, Saitama, 330-8503, Japan
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Shrestha GS, Basnet B, Nepal G, Lamichhane R, Gaire P, Shrestha R, Thapalia S. EDTA-dependent pseudo thrombocytopenia mimicking dengue fever-associated persistent thrombocytopenia: A case report. Clin Case Rep 2021; 9:e04999. [PMID: 34721861 PMCID: PMC8538016 DOI: 10.1002/ccr3.4999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 11/08/2022] Open
Abstract
No hemorrhagic manifestations, presence of platelet clumps on the peripheral blood smear, normal manual count, and normal autoanalyzer count after collecting blood in citrate vial help confirm the diagnosis of EDTA-dependent thrombocytopenia.
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Affiliation(s)
| | - Babin Basnet
- Bhimphedi Primary Health Care CenterBhimphediNepal
| | | | - Rajan Lamichhane
- Department of Internal MedicineTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Prabin Gaire
- Department of PathologyTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Rayana Shrestha
- Department of Internal MedicineTribhuvan University Institute of MedicineMaharajgunjNepal
| | - Sabin Thapalia
- Department of Internal MedicineTribhuvan University Institute of MedicineMaharajgunjNepal
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Pseudothrombocytopenia Inducing Nonindicated Platelet Transfusion after Cardiac Surgery. Case Rep Med 2021; 2021:3695407. [PMID: 33747091 PMCID: PMC7954639 DOI: 10.1155/2021/3695407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Pseudothrombocytopenia (PTCP) is an in vitro phenomenon of low platelet count caused by the agglutination of platelets, leading to false low platelet counts in automated cell counting. Typically, ethylenediaminetetraacetic acid (EDTA) mediates this platelet clumping. PTCP has little clinical significance, but misdiagnosis may lead to unnecessary diagnostic tests and treatment. In this case report, we present a 65-year-old Caucasian female suffering from multiple complications during and after cardiac surgery. During her postoperative stay at the ICU, she was diagnosed with thrombocytopenia and an inadequate response to platelet supplementation.
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Lardinois B, Favresse J, Chatelain B, Lippi G, Mullier F. Pseudothrombocytopenia-A Review on Causes, Occurrence and Clinical Implications. J Clin Med 2021; 10:594. [PMID: 33557431 PMCID: PMC7915523 DOI: 10.3390/jcm10040594] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pseudothrombocytopenia (PTCP), a relative common finding in clinical laboratories, can lead to diagnostic errors, overtreatment, and further (even invasive) unnecessary testing. Clinical consequences with potential life-threatening events (e.g., unnecessary platelet transfusion, inappropriate treatment including splenectomy or corticosteroids) are still observed when PTCP is not readily detected. The phenomenon is even more complex when occurring with different anticoagulants. In this review we present a case of multi-anticoagulant PTCP, where we studied different parameters including temperature, amikacin supplementation, measurement methods, and type of anticoagulant. Prevalence, clinical risk factors, pre-analytical and analytical factors, along with clinical implications, will be discussed. The detection of an anticoagulant-dependent PTCP does not necessarily imply the presence of specific disorders. Conversely, the incidence of PTCP seems higher in patients receiving low molecular weight heparin, during hospitalization, or in men aged 50 years or older. New analytical technologies, such as fluorescence or optical platelet counting, will be soon overturning traditional algorithms and represent valuable diagnostic aids. A practical laboratory approach, based on current knowledge of PTCP, is finally proposed for overcoming spuriously low platelet counts.
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Affiliation(s)
- Benjamin Lardinois
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| | - Julien Favresse
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| | - Bernard Chatelain
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy;
| | - François Mullier
- Namur Thrombosis and Hemostasis Center (NTHC), CHU UCL Namur, Université Catholique de Louvain, 5530 Yvoir, Belgium; (B.L.); (J.F.); (B.C.)
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Tantanate C. Vortex mixing to alleviate pseudothrombocytopenia in a blood specimen with platelet satellitism and platelet clumps. Clin Chem Lab Med 2020; 59:e189-e191. [PMID: 33554527 DOI: 10.1515/cclm-2020-1432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/05/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Chaicharoen Tantanate
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
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Akbayram HT, Pekpak E. A Rare Cause of Thrombocytopenia: Pseudothrombocytopenia. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pseudothrombocytopenia is caused by in vitro platelet clumping in anticoagulated blood. Electronic blood count shows a low platelet count in subjects with normal platelet levels. The situation may be mistaken with true thrombocytopenia and may lead to incorrect diagnosis and treatment. Microscopic examination of the peripheral blood smear is of key importance to confirm the diagnosis. The aim of this case report was to draw attention to pseudotyhrombocytopenia, which is one of the possible causes of thrombocytopenia.
Keywords: thrombocytes, thrombocytopenia, blood platelet disorders
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Affiliation(s)
| | - Esra Pekpak
- Pediatrik Hematoloji Bilim Dalı, Gaziantep Üniversitesi, Tıp Fakültesi
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Abstract
Abstract
Anticoagulation with ethylenediaminetetraacetic acid (EDTA) is a necessary pre-requisite for automated blood cell counting. With a prevalence of 0.01–1%, EDTA anticoagulation is accompanied by time- and temperature-dependent in vitro aggregation of platelets, resulting in false low counts. To avoid wrong clinical conclusions, spontaneous anticoagulant-induced platelet agglutination should therefore be recognized during analysis. This might be a challenge for the routine laboratory.
The actual knowledge of this rare but clinically important laboratory artefact will be summarized and reviewed in the following, based on our own experiences and the available literature. This includes pathophysiological and epidemiological aspects, valuable information regarding the detection and prevention of a PTCP, and the possibilities for determination of the correct platelet count.
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Mannuß S. Influence of different methods and anticoagulants on platelet parameter measurement. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Platelets are the smallest and perhaps the most versatile components of human blood. Besides their role in coagulation and the maintenance of vascular integrity, they are involved in many physiological processes, ranging from immune response and leukocyte recruitment to the production of antimicrobial peptides and immune-suppressive factors like TGF-β. These versatile abilities make platelets interesting for researchers from different disciplines. However, beside profound investigation into platelets’ physiological role, there is a need for correct, standardized and thus reproducible quantification of platelet parameters. Mean platelet volume (MPV) is a widespread prognostic marker for several conditions, such as, acute coronary syndrome, chronic kidney disease and liver cirrhosis. Platelet activation is regarded as a marker for inflammatory processes, for example in autoimmune diseases such as type-1 diabetes, systemic lupus erythematosus and rheumatoid arthritis. The monitoring of platelet function is relevant for patients receiving antiplatelet medication. Platelet parameter measurement is affected by the choice of in vitro anticoagulant, the measurement technology and the time delay after sampling. This review focuses on the pre-analytical variability that arises as a result of the use of different in vitro anticoagulants and analyzer technologies when determining platelet parameters, since, even approximately 180 years after the discovery of platelets, there is still no standardized procedure.
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Affiliation(s)
- Steffen Mannuß
- Klinikum der Stadt Ludwigshafen , Institut für Labordiagnostik, Hygiene und Transfusionsmedizin , Ludwigshafen , Germany
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Mannuß S, Schuff-Werner P, Dreißiger K, Burstein C. Inhibition of agonist-induced platelet aggregation by magnesium sulfate warrants its use as an alternative in vitro anticoagulant in pseudothrombocytopenia. Platelets 2019; 31:680-684. [DOI: 10.1080/09537104.2019.1663804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Steffen Mannuß
- Institute of Clinical Chemistry and Laboratory Medicine, Rostock University Medical Center, Rostock, Germany
- Medizinisch-Diagnostische Institute (MVZ), Berlin, Germany
| | - Peter Schuff-Werner
- Institute of Clinical Chemistry and Laboratory Medicine, Rostock University Medical Center, Rostock, Germany
- Medizinisch-Diagnostische Institute (MVZ), Berlin, Germany
| | - Katrin Dreißiger
- Institute of Clinical Chemistry and Laboratory Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christine Burstein
- Institute of Clinical Chemistry and Laboratory Medicine, Rostock University Medical Center, Rostock, Germany
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In-Hospital Onset of Pseudothrombocytopenia Days before Surgery. Case Rep Anesthesiol 2019; 2018:4726036. [PMID: 30693112 PMCID: PMC6333016 DOI: 10.1155/2018/4726036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022] Open
Abstract
Automated cell counters often produce spuriously low platelet counts due to laboratory artifacts. These in vitro phenomena may lead to erroneous treatments, surgical delays, and unnecessary platelet transfusions. An overlooked case of newly developed anticoagulant-induced platelet aggregation diagnosed in a preoperative visit is discussed and diagnostic clues are presented.
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