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Coronary artery bypass grafting in a patient with pseudothrombocytopenia: case report
Mehmet Kaplan1, Cagri Düzyol, Ali Kemal Gur
1Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. mehmetkaplan@superonline.com
Insights
Pseudothrombocytopenia, a condition causing low platelet counts, can be misdiagnosed. This case highlights how correct diagnosis allows safe coronary artery bypass grafting surgery.
Area of Science:
- Cardiology
- Hematology
- Clinical Pathology
Background:
- Coronary artery disease necessitates surgical intervention like coronary artery bypass grafting.
- Preoperative assessment is crucial for identifying potential surgical risks, including low platelet counts.
Observation:
- A patient scheduled for coronary artery bypass grafting presented with severe thrombocytopenia (6000/mm3) on initial testing.
- Further hematological evaluation revealed platelet aggregation in non-heparinized blood, consistent with pseudothrombocytopenia.
- The patient's platelet count normalized in heparinized blood, confirming the pseudothrombocytopenia diagnosis.
Findings:
- Pseudothrombocytopenia, often triggered by ethylenediaminetetraacetic acid (EDTA) in blood collection tubes, can mimic true thrombocytopenia.
- Accurate diagnosis through specific blood handling techniques is essential for appropriate patient management.
- The patient successfully underwent coronary artery bypass grafting surgery without complications after the correct diagnosis.
Implications:
- Pseudothrombocytopenia should be considered in patients with unexplained low platelet counts, especially before surgery.
- Correctly diagnosing pseudothrombocytopenia prevents unnecessary surgical delays and allows for safe operative management.
- This case underscores the importance of meticulous laboratory evaluation in cardiovascular surgery patients.
Abstract:
A 53-year-old female patient with coronary arterial disease who had been diagnosed with conventional coronary angiography was scheduled to undergo elective coronary artery bypass grafting surgery. Preoperative routine evaluations of the whole blood count revealed severe thrombocytopenia (6000/mm3). The patient received a consultation by the internal medicine clinic. With an initial diagnosis of pseudothrombocytopenia, the patient's operation was delayed, and she was referred to a hematology clinic for further diagnosis. The thrombocyte count in heparinized whole blood was in the normal range. A smear of a fresh, nonheparinized blood sample revealed thrombocytes in aggregations of 5 to 14, which confirmed the diagnosis. The patient underwent operation with cardiopulmonary bypass with normal heparinization, and no unexpected postoperative complications, including bleeding, occurred in the early postoperative period. She had an uneventful recovery and was discharged from the hospital on the seventh postoperative day. Later routine polyclinic control evaluations showed no complications. We think the possibility of pseudothrombocytopenia should be discussed with patients. With the correct diagnosis, such patients can be safely given the chance of operation with no more than the usual risks of coronary bypass surgery.
