PB2256 DISSOLVED PSEUDO‐THROMBOCYTOPENIA BY USING EVIDENCE‐BASED RESEARCH

Abstract

Background:Platelet clumping is a common laboratory phenomenon that causes pseudo‐thrombocytopenia (PTC), spurious thrombocytopenia due to persistence of antibody or agglutinins. Microscopic examination of the peripheral blood smear is of key importance to confirm the diagnosis and to avoid any inappropriate or dangerous clinical and therapeutic decision. How to dissolve platelet clumping and make sure correct platelet count is an important procedure. Ethylenediaminetetraacetic acid (EDTA) is a well‐known anticoagulant for the hematological tests (CBC). EDTA‐dependent pseudo‐thrombocytopenia is the most common causes of platelet clumping in medical laboratory.Aims:To dissolved platelet clumping ex vivo and correct platelet count in medical laboratory avoid further inappropriate treatment and waste of medical resource.Methods:We drew blood of the patient in three tubes containing three different types of anticoagulants; EDTA, Sodium Citrate and Heparin. The three blood samples were run in fully automated Hematology analyzer (SYSMEX XN‐3000).Three tubes also process in water bath at 37 °C 10 minute and vortex until run automated Hematology analyzer again.Results:54 years old female patient was referred to our lab for investigations as a case of implicated thrombocytopenia. The CBC revealed normal parameters apart from a low platelet count; 35 x10^9/L. A blood smear was ordered and it revealed server platelet clumping. Using different types anticoagulants, EDTA, Citrate, heparin result similar platelet count and still reveal platelet clumping on blood smear. We further pre‐treated warm water bath(37 °C) plus vortex before analysis. Platelet count was counted 138 x10^9/L by automatic hematologic analyzer in pre‐warm blood specimen. The smear also checked by microscopy without phenomenon of platelet clumping.Summary/Conclusion:Platelet cold agglutinin is confirmed by pre‐warm blood specimen which is a rare cause in pseudo‐thrombocytopenia. We used methods of evidence‐based medicine (EBM) to find out patient with cold agglutinins that affect platelet counting.