Pseudothrombocytopenia: incidence and strategy for resolution in clinical
            laboratory

Prates, Romário Farias; Viana, Robson C.; Oliveira, Márcio Vasconcelos; Souza, Cláudio Lima

doi:10.5935/1676-2444.20170061

Cited by 3 publications

(6 citation statements)

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“…Pseudothrombocytopenia is suspected if clinical manifestations do not correlate with low platelet counts 12 . Pseudo thrombocytopenia (PTCP) is immune mediated, time and temperature dependentspurious low platelet counts, commonly observed in laboratory practices, as an in vitro phenomenon 7 . The potential etiological factors could bepre-analytical errors such as poor mixing of sample, time lapse betweensample collection and processing, use of different anticoagulants such as Ethylinediamine tetra acetic acid (EDTA), sodium citrate, heparin, large size platelets and platelet satellitism 17 .…”

Section: Introductionmentioning

confidence: 99%

EDTA related Pseudothrombocytopenia (PTCP) Incidence and Resolution of Clinically Threatened Artifact

Amir¹,

Latif²,

Mohammad³

et al. 2023

PJMHS

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Background: EDTA related pseudothrombocytopenia (PTCP) is immune mediated, time and temperature dependent spurious low platelet counts commonly observed in laboratory practices, as an in vitro phenomenon. Microscopic evaluation of every sample is not possible due to immense workload hence PTCP is overlooked mostly due to immense work load .Vortex mixer is practically feasible tool often used in laboratories to obtain the accurate platelet counts of the suspected samples by using same EDTA anticoagulated samples. Aim: To evaluate the frequency of EDTA related pseudothrombocytopenia in OPD of tertiary care centre and analyze the vortexing for resolution of PTCP. Methodology: This was case control study conducted in clinical pathology department of JPMC in collaboration with ICU from November 2022 to January 2023. Total 3000 samples of CBC were analyzed. 150 patients with platelet count less than 150µl , with abnormal histograms and platelet clumps on smear were enrolled as cases of PTCP. 150 healthy individuals with match age and gender recruited as controls. Sample was subjected to vortex for 2 min at 3000rpm Samples were reanalyze ,clumps dissolution recheck by smear. Results : Prevalence of isolated thrombocytopenia was 33%, with 15% cases of EDTA related PTCP, platelet clumps seen in all PTCP cases on smear, 87% clumps were resolved completely with significantly increased platelet counts post vortexing with p value <0.05. Conclusion: Vortexing has proved as a promising, rapid and a cost effective method to deal with PTCP, save patient from needless investigations and invasive procedures. Keywords: Thrombocytopenia, Pseudothrombocytopenia, Ethylene diamine tetra acetic acid, Vortex, Platelet histograms,

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Section: Introductionmentioning

confidence: 99%

EDTA related Pseudothrombocytopenia (PTCP) Incidence and Resolution of Clinically Threatened Artifact

Amir¹,

Latif²,

Mohammad³

et al. 2023

PJMHS

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“…None of the mentioned guidelines describe how to quantify aggregation, and not all guidelines have a precise definition of aggregation. Accordingly, previous studies of PTCP from hematology instruments have used various or unspecified definitions of aggregation, raising the concern that the studies may not be comparable 6–10 …”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, previous studies of PTCP from hematology instruments have used various or unspecified definitions of aggregation, raising the concern that the studies may not be comparable. [6][7][8][9][10] The aim of this study was to investigate the diagnostic accuracy of the flag PLT-Clumps from the WNR/WDF and the PLT-F channels from Sysmex XN. Furthermore, we aimed to study how different cutoffs for investigation for PTCP and different definitions of platelet aggregation affected the diagnostic accuracy.…”

mentioning

confidence: 99%

The diagnostic accuracy of Sysmex XN for identification of pseudothrombocytopenia using various thresholds for definition of platelet aggregation

Lunde

Hjelmtvedt

Amundsen

2022

Int J Lab Hematology

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Introduction:The aim of this study was to investigate the diagnostic accuracy of the flag PLT-Clumps from the WNR/WDF and the PLT-F channels from Sysmex XN and to study how different cut-offs for investigation for pseudothrombocytopenia (PTCP) and the definition of platelet aggregation affected the diagnostic accuracy.Methods: A smear review was performed for samples with platelet count <150 Â 10 9 /L and samples flagged for platelet aggregation by Sysmex XN-20. The samples were investigated for platelet aggregation in 30 fields using 40Â objective. Findings were classified by size and quantity using two definitions of aggregation: the Norwegian quality improvement of laboratory investigations (Noklus) and the Groupe Francophone de'Hematologie Cellulaire (GFHC). The Q-values for the PLT-Clumps flag from the WNR/WFD channel and the PLT-F channel were compared with smear findings.Results: ROC analysis showed that the diagnostic accuracy of the PLT-clumps flags increased with increasing stringency of the definition of platelet aggregation and when only samples with thrombocytopenia were investigated. With the most stringent PTCP definitions, the diagnostic accuracy of the PLT-Clumps flag from PLT-F was very high (AUC 0.97-0.98) and markedly better than for WNR/WDF. Conclusion:The diagnostic accuracy of PLT-F from Sysmex XN-20 for identification of PTCP was very good and superior to the WNDR/WDF channel in samples with platelet count <150 Â 10 9 /L and a moderate to high number of aggregates in the smear. There is a need for a more precise definition of platelet aggregation.

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“…In most European countries, the most common formulation used is K2EDTA. EDTAdependent pseudothrombocytopenia (EDTA-PTCP) is caused by EDTA-depentent antiplatelet IgM and IgG antibodies which recognize cytoadhesive glycoprotein IIb/IIIa receptors on the platelet plasma membrane, and it occurs at room temparature (2). EDTA-PTCP is a rare phenomenon with overall prevalence of 0.1% in the general population and is not sex-or age-dependent.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with infection, autoimmune diseases and malignancy might have an increased risk of EDTA-PTCP. However, it was recorded in a disease-free population as well (2,3). This phenomenon ocurrs only in vitro and is solely a laboratory artifact because with a different antico-agulant used, the patient presented the physiological platelet count (4).…”

Section: Introductionmentioning

confidence: 99%

Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid: A case report

Dobrijević¹,

Kaćanski-Rađenović²,

Katanić³

et al. 2022

Acta fac medic Naissensis

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Introduction: Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid is a rare phenomenon caused by autoantibodies against platelet membrane with overall prevalence of 0.1% in the general population. This phenomenon is an in vitro artifact and with different anticoagulant used, the patient had the physiological platelet count. Case report: This case is a report of a 2-year-old patient, whose initial complete blood count analysis revealed low platelet count (18 x 10 9 /L) without any visible signs of hemorrhage. After detecting multiple platelet clumps in the peripheral blood smear, the complete blood count was repeated using 3.2% sodium-citrate. The analysis of the new specimen revealed the physiological platelet count. Thus, the patient was diagnosed with pseudothrombocytopenia induced by ethylenediaminetetraacetic acid. Conclusion: Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid should always be suspected whenever thrombocytopenia without bleeding tendency is presented. The peripheral blood smear examination is the most convenient and the cheapest diagnostic test for excluding this artifact.

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Pseudothrombocytopenia: incidence and strategy for resolution in clinical laboratory

Cited by 3 publications

References 0 publications

EDTA related Pseudothrombocytopenia (PTCP) Incidence and Resolution of Clinically Threatened Artifact

EDTA related Pseudothrombocytopenia (PTCP) Incidence and Resolution of Clinically Threatened Artifact

The diagnostic accuracy of Sysmex XN for identification of pseudothrombocytopenia using various thresholds for definition of platelet aggregation

Pseudothrombocytopenia induced by ethylenediaminetetraacetic acid: A case report

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