Transient EDTA-dependent pseudothrombocytopenia in a patient with sepsis

Abstract

Ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia (EDTA-PTCP) is the phenomenon of a spurious low platelet count due to antiplatelet antibodies that cause platelet clumping in blood anticoagulated with EDTA. We describe a case of EDTA-PTCP that appeared transiently with the development of sepsis. A 50-year-old man underwent Bentall's aortic root replacement for acute aortic dissection with aortic insufficiency. Postoperatively the patient suffered paralytic ileus followed by methicillin-resistant Staphylococcus aureus enteritis and septicemia with endotoxemia. EDTA-PTCP appeared with the development of sepsis, and disappeared with its resolution. To avoid incorrect diagnoses and inappropriate treatment, EDTA-PTCP should always be considered as a possible cause of reported low platelet counts, even in patients with sepsis.

Ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia associated with neuroendocrine carcinoma: A case report

“…EDTA-PTCP occurs due to anti-platelet autoantibodies that cause platelet clumping in the presence of EDTA (4,8). These antibodies, usually IgG but also IgM and IgA, recognize platelet antigens on the platelet membrane modified by EDTA (1,9), which results in platelet agglutination.…”

“…EDTA-PTCP has been identified in healthy subjects and patients with various conditions, including gastrectomy, autoimmune diseases, liver diseases, cardiovascular diseases and viral infections (4,5,(10)(11)(12)(13)(14). EDTA-PTCP has also been reported in association with neoplastic diseases, including breast cancer and multiple myeloma (6,7).…”

“…It has been suggested that damaged platelets in a variety of diseases may expose cryptic antigens and induce the synthesis of anti-platelet antibodies (4,15). Platelet-associated autoantibodies against glycoprotein (GP) Ia/ IIa, Ib/IX or IIB/IIIA have been detected in these patients (4,7). However, the clinical relevance of EDTA-dependent antiplatelet autoantibodies remains uncertain.…”

EDTA-dependent pseudothrombocytopenia in a patient with the prediagnosis of idiopathic thrombocytopenic purpura

“…Bunun sebebi düşük sı-caklık ve EDTA'lı ortamda trombositlerin kümeleşme-sine neden olan antitrombosit antikorlarının varlığıdır [1,8]. Günümüzde trombositopeni tanısı konulan hastaların önemli bir kısmı gerçekte EDTA-PTP olgularıdır [6].…”

“…Psödotrombositopenilerin en yaygın formu olan EDTA-PTP'nin görülme sıklığı 1/1000 olarak tahmin edilmektedir. Sodyum sitrat ve heparin gibi antikoagülanlara bağlı ortaya çıkan psödotrombositopeniler ise daha nadirdir [3,6]. Psödotrombositopeni hasta kişilerde görü-lebildiği gibi sağlıklı kişilerde de görülebilir [7].…”