Pseudothrombocytopenia with multiple anticoagulant sample collection tubes

Kovács, Ferenc; Varga, Marina; Pataki, Zsolt; Rigo, Erzsebet

doi:10.1556/1646.8.2016.4.4

Cited by 23 publications

(30 citation statements)

References 12 publications

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“…For example, EDTA, the standard anticoagulant for platelet counting, causes a time-dependent platelet shape change with consecutive spontaneous platelet activation, and, in rare cases, the EDTA-dependent PTCP can lead to misdiagnosis. Since this phenomenon has also been described for citrate and heparin [29,30,32], a reliable alternative for the correct estimation of platelet counts in suspected PTCP is MgSO 4 [34].…”

Section: Discussionmentioning

confidence: 80%

“…The basis of an EDTA-dependent PTCP is auto-antibodies directed against the platelet fibrinogen receptor GpIIb/IIIa, which is unmasked by EDTA [14]. Since such a phenomenon has also been described for other in vitro anticoagulants [29], partial combined incompatibilities occur [30][31][32][33], and the in vitro agglutination does not necessarily lead to a platelet count that defines as thrombocytopenia [34], the correct term should be "anticoagulant-induced platelet agglutination. "…”

Section: In Vitro Anticoagulationmentioning

confidence: 99%

“…A reliable anticoagulant for the correct determination of platelet counts in cases of anticoagulant-induced platelet agglutination is magnesium sulfate (MgSO 4 ) [30,34].…”

Section: In Vitro Anticoagulationmentioning

confidence: 99%

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Influence of different methods and anticoagulants on platelet parameter measurement

Mannuß

2020

Journal of Laboratory Medicine

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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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Section: Discussionmentioning

confidence: 80%

Section: In Vitro Anticoagulationmentioning

confidence: 99%

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Influence of different methods and anticoagulants on platelet parameter measurement

Mannuß

2020

Journal of Laboratory Medicine

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“…Among these 20% of EDTA induced PTP show the agglutination in citrate anticoagulant as well. Oxalate and heparin have also been implicated in PTP (7,9).…”

Section: Discussionmentioning

confidence: 99%

Pseudotrombocytopenia caused by EDTA in obstetrics and perinatology: Case report

Nikolić¹,

Gojnić-Dugalić²,

Dunjic³

et al. 2017

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Clinically, the most important pseudothrombocytopenia is described in pregnant women and also in their newborns if blood sample is taken using EDTA. Case report: Patient, 35 years old pregnant woman, 36 weeks of gestation, was admitted to Gynecological and Obstetrics Clinic in the CCS because of pregnancy monitoring. The EDTA thrombocytes result was 34.0 x 10e9/L and patient was without any symptoms of bleeding tendency. Pseudothrombocytopenia was suspected. We decided to check it by examination of blood smear and incubating EDTA sample on 37°C degrees for an hour. The platelets value on 37°C degrees was 32.0 x 10e9/L. Blood smear showed a platelet aggregation.The platelet count with the Sodium Citrate was 253.0 x 10e9/L,with the Ammonium oxalate 266.0 x 10e9/L and with Mg-sulphate 284.0 x 10e9/L. Newborn was healthy. The Complete Blood Count of newborn revealed normal parameters apart from a low platelet count 49.0 x 10e9/L. A blood smear was ordered and it revealed platelet aggregations. Platelet count of newborn blood sample taken on sodium-citrate was 189.0 x 10e9/L which clearly indicated pseudothrombocytopenia. Conclusions: Although PTP does not require clinical-therapeutic intervention, undiagnosed PTP can lead to therapeutic intervention (unnecessary administration of platelet concentrate) and seriously deteriorate both mother's and child's health. Therefore, the authors suggest examination of blood smear in every case when thrombocytopenia is diagnosed.

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“…Because few examples of spontaneous in vitro platelet aggregation were reported from other anticoagulants such as citrate, oxalate and thrombin inhibitors heparin and hirudin, other observers proposed to rename the phenomenon more correctly as "anticoagulant-induced PTCP" [27][28][29].…”

Section: Pathophysiological Considerationsmentioning

confidence: 99%

Pseudo-thrombocytopenia (PTCP). A challenge in the daily laboratory routine?

Schuff‐Werner

Mansour²,

A³

2020

Journal of Laboratory Medicine

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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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Pseudothrombocytopenia with multiple anticoagulant sample collection tubes

Cited by 23 publications

References 12 publications

Influence of different methods and anticoagulants on platelet parameter measurement

Influence of different methods and anticoagulants on platelet parameter measurement

Pseudotrombocytopenia caused by EDTA in obstetrics and perinatology: Case report

Pseudo-thrombocytopenia (PTCP). A challenge in the daily laboratory routine?

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