Steroid-Induced Iatrogenic Disease After Treating for Pseudothrombocytopenia

Abstract

Pseudothrombocytopenia, a spontaneous in vitro occurrence after the addition of anticoagulant to blood, causes clumping of platelets resulting in a spurious observation of low platelet counts (<10,000/μL) without any associated hemorrhagic manifestations. We describe a 46-year-old male patient who was diagnosed with immune thrombocytopenic purpura (ITP) based on a reported platelet count of 22,000/μL. He was prescribed high-dose glucocorticoid therapy, up to 60 mg of prednisolone daily for over a year. After repeated hospital admissions, he came under our care as an emergency admission for nonketotic hyperosmolar hyperglycemia. He was diabetic, osteopenic, and had been treated for tuberculosis, all likely consequences of prolonged glucocorticoid therapy. In the presence of persistent platelet counts below 10,000/μL, and without associated clinical hematological manifestations of ITP, a smear of citrated blood was examined and a platelet count of 215,000/μL was observed. This case highlights the possible consequences of misdiagnosis of pseudothrombocytopenia. Failure to recognize this phenomenon may lead to debilitating iatrogenic disease.

Autoimmune Thrombocytopenia Complicated by EDTA- and/or Citrate-Dependent Pseudothrombocytopenia

“…Though the phenomenon per se is harmless, its occurrence may lead to confusion and inadequate interventions including extensive laboratory testing and/or diagnostics, false diagnosis, and consequently false treatment [ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. True thrombocytopenia might also rarely be confused [ 15 ] or associated with PTCP [ 16 , 17 , 18 ].…”

Pseudothrombocytopenia with multiple anticoagulant sample collection tubes

“…It may appear in a newborn of mother with PTCP [ 10 ]. This phenomenon if unrecognized leads to incorrect diagnosis, inappropriate treatment, and debilitating iatrogenic disease [ 11 , 12 ]. EDTA-dependent PTCP is the most common but two (EDTA and citrate), three (EDTA, citrate, and heparin), and even four (EDTA, citrate, heparin, and sodium fluoride) anticoagulant-dependent PTCPs were also described in the literature [ 2 , 8 , 9 ].…”

An atypical IgM class platelet cold agglutinin induces GPVI-dependent aggregation of human platelets

“…Generally, pseudothrombocytopenia does not require clinical monitoring or treatment. However, failure to recognise pseudothrombocytopenia can lead to unnecessary monitoring, inappropriate platelet transfusions and other treatments (4,(16)(17)(18)(19). A higher risk of major bleeding in patients with pseudothrombocytopenia undergoing cardiac surgery under hypothermic conditions, means that timely recognition of this condition is critical in these patients (20)(21)(22)(23).…”