Spurious thrombocytopenia produced by the interaction of rheumatoid factor with antiplatelet antibody

A patient had spurious thrombocytopenia resulting from a mechanism not previously described. Whereas in prior reports the in vitro phenomenon of platelet clumping has been effected by either EDTA-dependent or temperature-dependent antibodies capable of direct platelet agglutination, neither the IgG nor the IgM fractions of this patient's serum demonstrated such activity. However, agglutination was produced by incubating allogeneic platelets with the IgG fraction followed by a room temperature incubation with the rheumatoid factor-positive IgM fraction. The data support a new mechanism for spurious thrombocytopenia resulting from the interaction of a cold-reactive rheumatoid factor with antiplatelet antibody.