Transient pseudothrombocytopenia associated with immune heparin-induced thrombocytopenia complicated by pulmonary embolism

Zimrin, Ann B.; Warkentin, Theodore E.

doi:10.1160/th12-12-0908

Cited by 5 publications

(7 citation statements)

References 7 publications

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“…In both cases, platelet aggregation was dependent on the antibodies, resulting in the question of whether the concomitance was reflected by a coincidence or an association [ 17 ]. In contrast, a true association could be demonstrated in two other patients who had heparin-induced thrombocytopenia and PTCP [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…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 ]. Recently, PTCP has also been described in a patient receiving romiplostim for ITP [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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

Salama

2015

Transfus Med Hemother

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Background: Pseudothrombocytopenia (PTCP) is a well-known phenomenon. However, confusion may occur due to unusual characteristics. Case Reports: Two patients with autoimmune thrombocytopenia (ITP) and long-lasting PTCP are described. Initially, only the diagnosis of ITP was confirmed. During observation, discrepancies were recognized between clinical findings and platelet counts. Re-examination resulted in the additional diagnosis of EDTA-dependent PTCP. Subsequently, the latter diagnosis was changed to citrate-dependent PTCP in both cases. Interestingly, PTCP was observed to change again and became recognizable in citrate or heparin, and only during the first 20-30 min following phlebotomy in EDTA specimens. Conclusion: The incidence of concomitant ITP with PTCP might be higher than previously reported, and PTCP may have variable dynamics and characteristics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Salama

2015

Transfus Med Hemother

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“…These basically include viral infections [3,59,79], sepsis [80], thrombotic and cardiovascular disorder, heparin-induced thrombocytopenia (HIT) [41,81,82], auto-immune disorders [39,83], liver diseases [51,84], cancer [85,86], surgical settings [87][88][89], post stem cell transplantation [90,91], treatment with valproic acid [51], insulin, antibiotics [92], or chemotherapeutic agents such as sunitinib [52]. Some authors prefer to use the term "coincidental PTCP" or "concomitant PTCP" rather than expressly associating this condition with a particular disease [43,81]. Several recent cases with therapy based on monoclonal antibodies have also been described, encompassing GpIIbIIIa [93] or immune checkpoint inhibitor such as pembrolizumab [94].…”

Section: Clinical Risk Factorsmentioning

confidence: 99%

Pseudothrombocytopenia—A Review on Causes, Occurrence and Clinical Implications

Lardinois

Favresse

Châtelain

et al. 2021

JCM

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Pseudothrombocytopenia (PTCP), a relative common finding in clinical laboratories, can lead to diagnostic errors, overtreatment, and further (even invasive) unnecessary testing. Clinical consequences with potential life-threatening events (e.g., unnecessary platelet transfusion, inappropriate treatment including splenectomy or corticosteroids) are still observed when PTCP is not readily detected. The phenomenon is even more complex when occurring with different anticoagulants. In this review we present a case of multi-anticoagulant PTCP, where we studied different parameters including temperature, amikacin supplementation, measurement methods, and type of anticoagulant. Prevalence, clinical risk factors, pre-analytical and analytical factors, along with clinical implications, will be discussed. The detection of an anticoagulant-dependent PTCP does not necessarily imply the presence of specific disorders. Conversely, the incidence of PTCP seems higher in patients receiving low molecular weight heparin, during hospitalization, or in men aged 50 years or older. New analytical technologies, such as fluorescence or optical platelet counting, will be soon overturning traditional algorithms and represent valuable diagnostic aids. A practical laboratory approach, based on current knowledge of PTCP, is finally proposed for overcoming spuriously low platelet counts.

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“…The most communicated incorrect diagnosis was the suspicion that the prescribed drug led to falling platelet counts, leading to discontinuation of the regimen [6]. For example, if clinicians suspected heparininduced thrombocytopenia (HIT) in systemically anticoagulated patients, they stopped heparin therapy [7].Another example includes an assumption that ITP was responsible for the marked thrombocytopenia, and so PTCP-patients were regularly but unnecessarily treated with high doses of corticosteroids [4,8]. Finally, in supposed therapy-resistant ITP, treating physicians provided an indication for splenectomy [9,10].…”

Section: Ptcp As a Source Of Misleading Clinical Conclusionmentioning

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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Transient pseudothrombocytopenia associated with immune heparin-induced thrombocytopenia complicated by pulmonary embolism

Cited by 5 publications

References 7 publications

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

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

Pseudothrombocytopenia—A Review on Causes, Occurrence and Clinical Implications

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

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