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EDTA-Dependent pseudothrombocytopenia / EDTA-Iliskili Yalana Trombositopeni.

Ethylenediaminetetraacetic acid-dependent pseudo-thrombocytopenia (EDTA-DP) occurs rarely, with an incidence rate of 0.09%-0.21%. EDTA-DP may lead to misdiagnosis since low platelet count may determine by outomated blood counter in which EDTA as anticoagulant is used (1), (2). It is diagnosed via microscopic detection of platelet aggregates in a peripheral blood smear. Additionally, in vitro clumping of the platelets occurs due to auto-antibodies that develop against platelet surface antigens (1). Although automatic blood analyzers are widely used, peripheral blood smear is the hematological gold standard for definitive diagnosis. When the thrombocyte number is low the morphology and appearance of platelets must be confirmed via a peripheral blood smear. As such, laboratory errors and excessive expenditure of time can be. avoided.

A 7-year old boy was referred to our hospital due to thrombocytopenia The patient's platelet count was determined by a different laboratory to be between 1.0 x [10.sup.9]/L and 15 x [10.sup.9]A. History of familial or acquired hemorrhagic disorders, lymphadenopathy, drug intake, blood transfusion, systemic disease, and recent viral infection was negative. Physical examination was normal. Laboratory findings were as follows: platelet count: 13 x [10.sup.9]/L; hemoglobin: 1.2.2 g/dL; white blood cell count: 14,8 x [10.sup.9]/L; mean platelet volume: 8.8 FL. Aggregation of platelets was observed via microscopic examination of the peripheral blood smear (Figure 1A and 1B). Direct Coombs' test, and cold agglutinin, serum immunoglobulins, antinuclear antibody, total protein, and lipid levels were normal. Using sodium citrate, the patient's platelet count was 249 x [10.sup.9]/L (Figure 2)

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

We considered that EDTA-DP induced platelet agglutination in vitro, resulting in the observed decrease in the platelet count, and therefore diagnosed the patients as EDTA-DP. The patient was not given any treatment. During 4 months of outpatient follow-up the patient's platelet count varied between 200 and 409 x109/L. Written informed consent was obtained.

EDTA-DP may be erroneously diagnosed due to a false low platelet count measured in an automated blood analyzer in which EDTA was used as anticoagulant. Aggregation of platelets in EDTA-DP is prevented by other anticoagulants, such as sodium citrate or heparin (3). The presented patient was referred to our clinic due to thrombocytopenia. The patient's peripheral blood smear had not been evaluated prior to presentation to our facility EDTA-DP was diagnosed when clustered platelets were separately seen on the peripheric blood smear in our hematology clinic. Nowadays, automatic blood count device has been used. But still, peripheric blood semear is the gold standart for hematologists for definitive diagnosis. When thrombocytopenia is detected, peripheric blood smear should be performed from the finger tip and examined to see whether or not it is a real or pseuclothrombocytopenia.

Conflict of Interest Statement

None of the authors has any conflicts of interest, including specific financial interests, relationships, and/or affiliations, relevant to the subject matter .or materials included.

Address for Correspondence: Aysenur BAHADIR, M.D.,

Karadeniz Teknik Universitesi, Tip Fakultesi, Pediatrik Hematoloji Bi1im Dalt, Trabzon, Turkey Rhone: +90 462 377 57 76 E-mail: aysenurkbr@yahoo.com

Received/Gelis tarihi: July 4, 2011

Accepted/Kabul tarihi: August 15, 2011.

References

(1.) Yoneyama A, Nakahara K, EDTA-dependent pseudothrom-bocytopenia-differentiation from true thrombocytopenia. Nippon Rinsho 2003; 61(4): 569-574

(2.) Carrillo-Esper R, Contreras-Dominguez V, Pseudothrom-bocytopenia induced by ethylenediaminetetraacetic acid in burned patients. Cir Cir 2004; 72 (4): 335-338

(3.) Celkan T, Toptan H, Dogru 0, Spurious thrombocytopenia. Turk Arch Ped 2009; 44 (2): 73-74

Ayenur Bahadir, Erol Erduran, Beril Dilber, Nalan Uctincti

Karadeniz Technical University, School of Medicine, Department of Pediatric Hematology, Trabzon, Turkey
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Title Annotation:Images in Hematology; ethylenediaminetetraacetic acid
Author:Bahadir, Aysenur; Erduran, Erol; Dilber, Beril; Ucuncu, Nalan
Publication:Turkish Journal of Hematology
Article Type:Report
Geographic Code:7TURK
Date:Sep 1, 2012
Words:606
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