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[Pseudothrombocytopenia: case reports and review of the literature]
B Huss1, V Kretschmer, M Schnabel
1Abteilung für Transfusionsmedizin und Gerinnungsphysiologie, Universitätsklinik Marburg, Deutschland.
Background:
Pseudothrombocytopenia (PTP) is an in vitro phenomenon with falsely low platelet counts determined automatically. Usually the thrombocytopenia is noticed accidentally without a corresponding tendency to bleeding. If this phenomenon is not recognized, misinterpretation may bring the patient into a considerable risk by diagnostical and therapeutical mistakes. By own cases and analysis of the literature, causes, appearance. incidence, as well as diagnostic and clinical problems of PTP shall be explained in detail.
Casuistics:
We report on three patients who showed a significant decrease of platelet counts after surgery DIC (disseminated intravascular coagulation) and heparin-induced thrombocytopenia type II (white clot syndrome) were assumed primarily. In all three cases the reason for the low postoperative platelet counts was found to he due to PTP caused by cold agglutinins.
Conclusion:
From the cases described it can he concluded that PTP may develop during postoperative clinical course. Due to the broad differential diagnostic spectrum in the postoperative situation. PTP is hardly considered. Therefore, there is a greater chance of misinterpretation and therapeutic mistakes. In case of low platelet counts PTP should always be excluded, even when thrombocytopenia seems to be explicable differently.
Insights
Pseudothrombocytopenia (PTP) is a lab error causing falsely low platelet counts. It can occur post-surgery and mimic serious conditions, necessitating careful exclusion to prevent diagnostic and therapeutic mistakes.
Area of Science:
- Hematology
- Clinical Pathology
Background:
- Pseudothrombocytopenia (PTP) is an in vitro artifact leading to falsely low automated platelet counts.
- Unrecognized PTP can result in significant diagnostic and therapeutic errors.
- Understanding PTP's causes, presentation, and incidence is crucial for accurate patient management.
Observation:
- Three postoperative patients initially suspected of disseminated intravascular coagulation or heparin-induced thrombocytopenia type II presented with decreased platelet counts.
- In these cases, pseudothrombocytopenia induced by cold agglutinins was identified as the cause of the low platelet counts.
Findings:
- Pseudothrombocytopenia can manifest during the postoperative period.
- The broad differential diagnosis in postoperative patients often leads to PTP being overlooked.
- Cold agglutinins are identified as a cause of pseudothrombocytopenia in postoperative settings.
Implications:
- PTP must be considered in the differential diagnosis of thrombocytopenia, especially postoperatively.
- Failure to exclude PTP can lead to misdiagnosis and inappropriate treatments.
- Systematic exclusion of PTP is essential for all patients with low platelet counts, even when other causes seem apparent.