Unnecessary transfusions due to pseudothrombocytopenia

Abstract

A 60-year-old woman, with no significant past medical history, presented with syncope secondary to complete heart block. Emergency cardiac pacing was performed with clinical improvement. The initial complete blood count was normal: WBCs, 12.03 ¥ 10 9 per L; Hb level, 13.8 g per dL; and PLTs, 250 ¥ 10 9 per L. Two days later she became hypotensive. An urgent 2-D echocardiogram revealed a moderate-sized pericardial effusion. A complete blood count then showed a PLT count of 84 ¥ 10 9 per L.After transfusing 6 units of PLT concentrates, the PLT count increased to 142 ¥ 10 9 per L. A pericardiocentesis was performed with improvement of clinical status. Three days later, a repeat complete blood count revealed a PLT count of 8 ¥ 10 9 per L. The patient was supported with further PLT transfusions, and a marrow examination was planned. The case was also referred to the hematology team. A review of the peripheral blood films disclosed severe PLT clumping in both samples taken in EDTA (left panel) and citrate (right panel, both, original magnification ¥ 400) tubes. The marrow examination was cancelled and the patient was discharged well.Pseudothrombocytopenia is an uncommon in vitro phenomenon caused by antibody-mediated PLT agglutination, which can be EDTA-or citrate-dependent or, even rarer (<0.02% of all blood counts), both. It does not pose any hemorrhagic risk, and its only clinical importance resides in its lack of recognition, which potentially could lead to inappropriate PLT transfusion, additional testing, and delays in diagnostic or therapeutic procedures. To avoid these, it is imperative that a peripheral blood film be examined and a complete blood count repeated using a different anticoagulant in an asymptomatic patient who gives unexpected low PLT counts, as illustrated in this case.

EDTA-induced pseudothrombocytopenia in association with bladder cancer

“…This phenomenon can cause unnecessary surgical interventions and platelet transfusions if not kept in mind 7 8. In some cases it may cause failure or delay in receiving required therapies, especially surgical interventions, as patients are considered thrombocytopenic.…”

EDTA-Dependent Pseudothrombocytopenia and Unnecessary Transfusion in a Patient with Crimean-Congo Haemorrhagic Fever

“…Psödotrombositopeni kanama riskini veya felç riskini artırmaz; trombosit transfüz-yonu gerektirmez. Ancak akla gelmediğinde splenektomiye kadar giden gereksiz girişimlere ve transfüzyonlara neden olabilmektedir (6)(7)(8). Bazı durumlarda da hastaların gerekli tedavileri alamamasına neden olur (7).…”

“…Psödotrombositopeni, pek çok hastalıkta görülebilirse de en sık EDTA'ya bağlı olarak bildirilmiştir (4,8). EDTA, kan tüplerinde antikoagülan olarak bulunur.…”

The Prevalence and Biochemical Profiles of EDTA-Dependent Pseudothrombocytopenia in a Generally Healthy Population

“…Clinically, EDTA-PTCP does not pose any hemorrhagic risk; however, failure to recognize this artifact could lead to unnecessary bone marrow aspiration and inappropriate therapy such as platelet transfusion, corticosteroid, or even splenectomy [6]. To rule out EDTA-PTCP in patients with thrombocytopenia, several approaches have been proposed to prevent platelet clumping, e.g.…”