EDTA - Dependent Pseudothrombocytopenia: Case Report

Öz

EDTA-dependent pseudothrombocytopenia is the mismeasurement of the thrombocyte count in EDTA anticoagulated blood, due to aggregation of these cells. The situation may be mistaken with true thrombocytopenia and may lead to incorrect diagnosis and treatment, and to loss of power and time. The aim of this case report was to draw attention to EDTA-dependent pseudotyhrombocytopenia, which is one of the possible causes of thrombocytopenia. Case; isolated thrombocytopenia was detected in the EDTA blood sample sent to our laboratory, which had been obtained from a patient hospitalized with the diagnosis of epilepsy in the red area of the emergency medicine unit of our hospital. Another blood sample was collected into Na-citrate, in which the thrombocyte count was observed to be within the normal ranges. Furthermore, thrombocyte aggregations were observed in the peripheral blood smears prepared from the sample with EDTA, whereas no aggregation was observed from the sample with citrate.

Anahtar Kelimeler

• EDTA,pseudothrombocytopenia,peripheral blood smear,pseudothrombocytopenia,thrombocytopenia

EDTA’ya Bağlı Psödotrombositopeni: Olgu Sunumu

Öz

EDTA’ya bağlı psödotrombositopeni; EDTA ile antikoagüle edilmiş kanda trombositlerin kümeleşmesi sonucu, normalden düşük olarak saptanması durumudur. Bu durum gerçek trombositopeni ile karışabilmekte, yanlış tanı ve tedavi uygulanmasına, gereksiz işgücü ve zaman kaybına neden olabilmektedir. Bu olgu trombositopeninin olası nedenlerinden biri olan EDTA’ya bağlı psödotrombositopeniye dikkat çekmek amacıyla sunulmuştur. Olgu; hastanemiz acil tıp kırmızı alanında epilepsi tanısı ile yatan hastadan alınıp acil gözetimli hizmet laboratuvarımıza gönderilen EDTA’lı kan numunesinde izole trombosit düşüklüğü tesbit edilmiştir. Hastadan yeniden alınan Na-sitratlı numunede trombosit sayısının referans değerler arasında olduğu tesbit edilmiştir. Ayrıca hem EDTA’lı hem de Na-sitratlı numuneden yapılan periferik yayma örneklerinde EDTA’lı numunede trombosit kümeleri gözlenirken, Sitratlı numunede gözlenmemiştir.

Anahtar Kelimeler

• EDTA,periferik yayma,psödotrombositopeni,trombositopeni

Kaynakça

1. Hillman RS, Ault KA, Rinder HM. Thrombocytopenia In: Hematology in clinical practice. 4th ed. New York: McGraw-Hill; 2005; p. 339–56.
2. Warkentin TE, Kelton JG. Thrombocytopenia. In: Irwin RS, Cerra FB, Rippe JM, eds. Irwin and Rippe’s Intensive Care Medicine, 4th ed, vol II, Philadelphia: Lippincott-Raven, 1999; p. 1338–49.
3. Scaradavou A. HIV-related thrombocytopenia. Blood Rev 2002;16: 73–6.
4. Watson TD, Stark JE, Vesta KS. Pantoprazole-induced thrombocytopenia. Ann Pharmacother 2006; 40:758–61.
5. Ozcelik F, Arslan E, Serdar MA, ve diğ. A useful method for the detection of ethylenediaminetetraacetic acid and cold agglutinin-dependent pseudothrombocytopenia. Am J Med Sci. 2012;344(5):357-62.
6. Said SM1, Hahn J, Schleyer E, ve diğ. Glycoprotein IIb/IIIa inhibitor-induced thrombocytopenia: diagnosis and treatment. Clin Res Cardiol. 2007;96(2):61-9.
7. Van der Meer W, Allebes W, Simon A, ve diğ. Pseudothrombocytopenia: a report of a new method to count platelets in a patient with EDTA- and temperature-independent antibodies of the IgM type. Eur J Haematol. 2002;69(4):243-7.
8. Casonato A, Bertomoro A, Pontara E, ve diğ. EDTA dependent pseudothrombocytopenia caused by antibodies against the cytoadhesive receptor of platelet gpIIBIIIA. J Clin Pathol 1994; 47(7): 625-30.

9. Fiorin F, Steffan A, Pradella P, ve diğ. IgG platelet antibodies in EDTAdependent pseudothrombocytopenia bind to platelet membrane glycoprotein IIb. Am J Clin Pathol 1998; 110(2):178–83.
10. Zandecki M, Genevieve F, Gerard J, ve diğ. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. Int J Lab Hematol 2007;29(1):4-20.
11. Fang C, Chien Y, Yang L ve diğ. EDTA dependent pseudothrombocytopenia. Formosan Journal of Surgery 2015;48( 3):107–109.
12. Shreiner DP, Bell WR. Pseudothrombocytopenia: manifestation of a new type of platelet agglutinin. Blood 1973;42:541–9.
13. Girmann G, Pees H, Shuerlen PG. Pseudothrombocytopenia and mexiletine. Ann Intern Med 1984;100:767.
14. Yoshikawa H. EDTA-dependent pseudothrombocytopenia induced by valproic acid. Neurology. 2003;61(4):579-80.
15. Ozcelik F, Oztosun M, Gülsün M, ve diğ. İdiopatik trombositopenik purpura ön tanılı bir olguda EDTA’ya bağlı psödotrombositopeni. Turkish Journal of Biochemistry 2012; 37(3):336–339.