Novel method to dissociate platelet clumps in EDTA-dependent pseudothrombocytopenia based on the pathophysiological mechanism

Chae, Hyojin; Kim, Myungshin; Lim, Jihyang; Oh, Eun‐Jee; Kim, Yonggoo; Han, Kyungja

doi:10.1515/cclm-2011-0892

Cited by 31 publications

(33 citation statements)

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“…EDTA-PCTP can occur both in the normal subjects and the patients with various diseases, such as autoimmune diseases, tumor, infections and so on [6][7][8][9][10][11]. The mechanism is not completely clear, but autoimmune antibody is considered to be a key factor [12,13]. In vitro, the cryptic platelet antigen on the membrane of platelets can be exposed to the autoimmune antibody when EDTA exists.…”

Section: Discussionmentioning

confidence: 99%

Transient appearance of EDTA dependent pseudothrombocytopenia in a patient with 2019 novel coronavirus pneumonia

et al. 2020

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EDTA dependent pseudothrombocytopenia (EDTA-PCTP) is a phenomenon that characterized by a spurious decrease of platelets in vitro due to the aggregation of platelets in EDTA anticoagulant blood samples. We report the first case of a transient appearance of EDTA-PCTP in a patient with 2019 novel coronavirus pneumonia . A 59-year-old woman was admitted to the isolated ward for severe type of 2019 novel coronavirus pneumonia. At the time of admission, her platelet count was in a normal range. Two days later, her platelet count decreased gradually without any signs or symptoms of bleeding. Since the peripheral blood smear showed a platelet aggregation, a blood sample anticoagulanted with citrate was tested and the number of platelet was normal. The phenomenon disappeared after 17 days when the patient was cured. This case emphasized the importance of peripheral blood smear and clinical manifestation, especially in the differential diagnosis of thrombocytopenia.

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Section: Discussionmentioning

confidence: 99%

Transient appearance of EDTA dependent pseudothrombocytopenia in a patient with 2019 novel coronavirus pneumonia

et al. 2020

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“…[1,2] According to previous studies, EDTA can dissociate the Ca 2+ -dependent platelet membrane glycoprotein (GP) IIb/IIIa heterodimer by its chelating calcium. [10–13] Meanwhile, these antiplatelet autoantibodies, mainly in the form of immunoglobulin (Ig) M, IgG, or IgA subsets, [14,15] recognize the exposure of the epitopes on GPIIb/IIIa leading to platelet clumps. In addition, agglutination appears to occur more readily at cold temperature rather than at 37°C.…”

Section: Discussionmentioning

confidence: 99%

Transient appearance of EDTA-dependent pseudothrombocytopenia in a postoperative patient with sepsis

Shi

Lin²,

He³

et al. 2017

Medicine

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Rationale:Ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia (EDTA-PTCP) is a rare phenomenon characterized by spuriously low platelet counts when EDTA reacts with harvested blood. However, to the best of our knowledge, only two cases involving EDTA-PTCP in postoperative patients with sepsis have been reported. Here, we describe a case of EDTA-PTCP that appeared transiently in a postoperative patient with sepsis.Patient Concerns:A 68-year-old female patient underwent laparoscopic tension-free hernioplasty for incisional hernia. Postoperatively, the patient developed very low platelet counts. The number of platelets in this patient had not improved following treatment with fresh-frozen plasma and platelet transfusions.Diagnoses:The diagnosis of EDTA-PTCP was confirmed from the discovery of platelet aggregation in peripheral blood smears.Interventions:We used sodium citrate-anticoagulated blood samples for platelet counting.Outcomes:The patient's platelet counts returned to normal with the use of sodium citrate-anticoagulated blood samples. Furthermore, the phenomenon of EDTA-PTCP disappeared when the patient was cured.Lessons:The phenomenon of low platelet counts in postoperative patients with sepsis should be considered as possible EDTA-PTCP. In addition, peripheral blood smears and the use of sodium citrate anticoagulant are effective and valuable methods that can help identify EDTA-PTCP.

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“…3,5,11,12 Recently it has been proposed that EDTA-induced platelet clumps can be dissociated by a mixture of calcium chloride for re-association of glycoprotein (GP) IIb/IIIa complex and sodium heparin for maintaining anticoagulation to correctly estimate platelet counts. 5,13 The addition of an aminoglycoside antibiotic (e.g kanamycin) has similarly been used to count platelets in cases of PTCP. 5,14 Schrezenmeir et al proposed that the phenomenon of in vitro-platelet aggregation should be collectively called anticoagulant induced PTCP and Gschwandtner et al referred it as a 'laboratory disease'.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of EDTA induced pseudothrombocytopenia and the effect of alternative anticoagulants

Shrestha

Karki

2014

J Pathol Nep

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Background: Artifactual Thrombocytopenia is a condition in which there is falsely lowered platelet in patients who have thrombocytopenia but the absence of petechiae or echymoses. Pseudothrombocytopenia is also an artifactual thrombocytopenia caused by anticoagulant dependent agglutinins. The aim of this study was to compare the platelet count in pseudothrombocytopenia in EDTA anticoagulated samples and other alternative anticoagulants. Materials and methods:This study was performed in the department of hemotology hematology, Institute of medicine. All cases during study period were evaluated by EDTA-anticoagulated whole blood samples but criteria for selecting pseudothrombocytopenia patients was unexpectedly low platelet counts with clumping/aggregate on peripheral blood smear. Additional samples were collected in sodium citrate and heparin for examined.Results: A total of 50 patients aged between 18 to 90 years were found to have pseudothrombocytopenia. Platelet counts in samples anticoagulated with EDTA ranged from 20x109/l to 149x109/l and samples from same patients anticoagulated with citrate ranged from 41x109 /l to 312x109 /l and heparin showed platelet count ranging from 29x10 9 /l to 210x109 /l. The mean platelet count in EDTA-anticoagulated blood of individuals with pseudothrombocytopenia was 104x109/l whereas the mean platelet count in citrate and heparin-anticoagulated samples was 151x109/land123x109/l respectively. Platelet counts decreased dramatically in the EDTA samples in contrast to the samples anticoagulated with citrate or heparin post four hours of collection.Conclusion: Peripheral blood smears should be examined for platelet clumping/aggregates in cases with low platelet count not correlating with clinical presentation or in isolated thrombocytopenia flagged in hematology analyser. Alternative anticoagulants should be used for correct estimation of platelet count.

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Novel method to dissociate platelet clumps in EDTA-dependent pseudothrombocytopenia based on the pathophysiological mechanism

Abstract: The novel method is an easily applicable and efficient measure that allows dissociation of platelet clumps, based on the pathophysiological mechanism of EDTA-PTCP.

Cited by 31 publications

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Transient appearance of EDTA dependent pseudothrombocytopenia in a patient with 2019 novel coronavirus pneumonia

Transient appearance of EDTA dependent pseudothrombocytopenia in a patient with 2019 novel coronavirus pneumonia

Transient appearance of EDTA-dependent pseudothrombocytopenia in a postoperative patient with sepsis

Evaluation of EDTA induced pseudothrombocytopenia and the effect of alternative anticoagulants

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