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EDTA-induced platelet aggregation can be avoided by a new anticoagulant also suitable for automated complete blood
U Lippi1, M Schinella, M Nicoli
1Laboratorio di Chimica Clinica e di Ematologia, Ospedale Civile Maggiore, Verona, Italy.
Abstract:
In vitro EDTA-induced platelet aggregation is a fairly rare event but can have serious clinical consequences producing pseudothrombocytopenia and pseudoleukocytosis. Sixteen specimens with previously recognized EDTA-induced platelet aggregation were collected in a new anticoagulant-antiaggregant mixture containing trisodium citrate 17 mmol/l, pyridoxal 5'-phosphate 11.3 mmol/l and Tris 24.76 mmol/l (CPT mixture) and analyzed at various times after venepuncture with four hematological instruments: Coulter Counter S-Plus STKR, Technicon H6000, Technicon H1 and Ortho ELT-8. In CPT-anticoagulated specimens the signals and instrumental flags of platelet clumping were absent, and the platelet number correlated very well with a microscopic count from a finger stick drawn into Unopette. The complete blood count was very similar in "normal" hematological specimens either collected in K3. EDTA or in CPT, although Technicon H1 and Ortho3 ELT-8 required a suitable calibration for MCV and hematocrit in the latter mixture. Mean platelet volume was stable for up to 24 h only in CPT-collected specimens, if it was measured on a Coulter Counter S-Plus STKR. In routine hematological practice CPT can be an alternative anticoagulant to K3. EDTA, most suitable for automated complete blood count and useful in avoiding EDTA-induced platelet clumping.
Insights
A new CPT mixture effectively prevents EDTA-induced platelet clumping, offering a reliable alternative anticoagulant for automated complete blood counts and improving platelet count accuracy.
Area of Science:
- Hematology
- Clinical Pathology
Background:
- EDTA-induced platelet aggregation is a rare but clinically significant issue causing pseudothrombocytopenia and pseudoleukocytosis.
- Accurate platelet counts are crucial for patient diagnosis and treatment.
Purpose of the Study:
- To evaluate a novel anticoagulant-antiaggregant mixture (CPT) as an alternative to K3EDTA for preventing in vitro platelet aggregation.
- To assess the performance of the CPT mixture across multiple hematological instruments.
Main Methods:
- Sixteen specimens with known EDTA-induced platelet aggregation were collected in the CPT mixture.
- Specimens were analyzed using Coulter Counter S-Plus STKR, Technicon H6000, Technicon H1, and Ortho ELT-8 hematological instruments.
- Platelet counts were compared with microscopic counts.
Main Results:
- The CPT mixture eliminated platelet clumping signals and flags on all tested instruments.
- Platelet counts in CPT-anticoagulated specimens showed excellent correlation with microscopic counts.
- Complete blood counts were comparable between K3EDTA and CPT, with minor calibration needs for specific instruments.
- Mean platelet volume remained stable for up to 24 hours in CPT specimens analyzed on a Coulter Counter S-Plus STKR.
Conclusions:
- The CPT mixture is a viable alternative anticoagulant to K3EDTA for routine hematology.
- CPT effectively prevents EDTA-induced platelet clumping, ensuring more accurate automated complete blood counts.
- This mixture enhances the reliability of platelet enumeration in automated systems.