EVALUATION OF SODIUM CITRATE ANTICOAGULANT FOR THE RESOLUTION OF EDTA-DEPENDENT PSEUDO THROMBOCYTOPENIA

Authors

  • Fatima Sharif Department of Haematology, Shifa International Hospital, Islamabad-Pakistan https://orcid.org/0000-0002-3366-9830
  • Ayesha Junaid Department of Haematology, Shifa International Hospital, Islamabad-Pakistan
  • Khadija Ashraf Department of Haematology, Shifa International Hospital, Islamabad-Pakistan
  • Maira Ijaz Department of Haematology, Shifa International Hospital, Islamabad-Pakistan
  • Maria Saeed Department of Haematology, Shifa International Hospital, Islamabad-Pakistan
  • Tuba Farhat Department of Haematology, Shifa International Hospital, Islamabad-Pakistan
  • Noor Rehman Department of Haematology, Shifa International Hospital, Islamabad-Pakistan
  • Mujeeb ur Rehman Department of Haematology, Shifa International Hospital, Islamabad-Pakistan https://orcid.org/0009-0000-6371-3719

DOI:

https://doi.org/10.55519/JAMC-04-12300

Keywords:

Platelets, pseudothrombocytopenia, EDTA, sodium citrate, diagnosis

Abstract

Background: EDTA-dependent pseudo thrombocytopenia (EDTA-PTCP) refers to a falsely low platelet count occurring in the presence of ethylene diamine tetra-acetic acid (EDTA) anticoagulant during blood sample collection, which results in the formation of platelet clumps in vitro. This phenomenon has significant clinical implications, including unnecessary administration of platelets. Our study aims to evaluate the efficacy of sodium citrate anticoagulant for the resolution of EDTA-PTCP. Methods: This retrospective study was conducted in the haematology laboratory of Shifa International Hospital (SIH), Pakistan. Patients with pseudo thrombocytopenia (i.e. platelet count less than 150,000/ul with platelet clumps seen on peripheral smear) were included in this study if they had blood samples drawn in both EDTA and sodium citrate tubes less than 48 hours apart. Data was analyzed using IBM® SPSS Software Version 22. Results: A total of 151 study participants were included in this study. The mean age was 48.95±20.69 years and the majority were female (52.3%). Wilcoxon signed-rank test showed that there was a statistically significant difference in platelet count measured in both tubes (Z = -3.223, p=0.001). Overall, blood samples processed in sodium citrate tubes showed lower platelet count than EDTA samples. Sodium citrate anticoagulant was able to correct EDTA-PTCP in 47 (31.1%) of the cases. Conclusion: Sodium citrate anticoagulant was only able to resolve one-third of our EDTA-PTCP cases. Our findings do not support the use of sodium citrate as a suitable alternative for correction of EDTA-PTCP. ated.

Author Biographies

Fatima Sharif, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Ayesha Junaid, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Khadija Ashraf, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Maira Ijaz, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Maria Saeed, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Tuba Farhat, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Noor Rehman, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

Mujeeb ur Rehman, Department of Haematology, Shifa International Hospital, Islamabad-Pakistan

 

References

Zandecki M, Genevieve F, Gerard J, Godon A. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. Int J Lab Hematol 2007;29(1):4–20.

Lin J, Luo Y, Yao S, Yan M, Li J, Ouyang W, et al. Discovery and Correction of Spurious Low Platelet Counts due to EDTA-Dependent Pseudothrombocytopenia. J Clin Lab Anal 2015;29(5):419–26.

Silvestri F, Virgolini L, Savignano C, Zaja F, Velisig M, Baccarani M. Incidence and diagnosis of EDTA-dependent pseudothrombocytopenia in a consecutive outpatient population referred for isolated thrombocytopenia. Vox Sang 1995;68(1):35–9.

Bartels PC, Schoorl M, Lombarts AJ. Screening for EDTA-dependent deviations in platelet counts and abnormalities in platelet distribution histograms in pseudothrombocytopenia. Scand J Clin Lab Invest 1997;57(7):629–36.

Lardinois B, Favresse J, Chatelain B, Lippi G, Mullier F. Pseudothrombocytopenia—a review on causes, occurrence and clinical implications. J Clin Med 2021;10(4):594.

Bizzaro N, Brandalise M. EDTA-dependent pseudothrombocytopenia: association with antiplatelet and antiphospholipid antibodies. Am J Clin Pathol 1995;103(1):103–7.

Greinacher A, Selleng S. How I evaluate and treat thrombocytopenia in the intensive care unit patient. Blood 2016;128(26):3032–42.

Ceran E, Schlömmer C, Kröckel I, Scheriau G, Angleitner P, Steinlechner B. Pseudothrombocytopenia inducing nonindicated platelet transfusion after cardiac surgery. Case Rep Med 2021;2021:3695407.

Zhong L, Chadha J, Ameri A. A curious case of pseudothrombocytopenia due to in vitro agglutination. Case Rep Hematol 2020;2020:6236350.

Sudha P, Koshy RC. Ethylene diamine tetra aceticacid pseudothrombocytopenia: A must to know entity for Anaesthesiologists. Indian J Anaesth 2013;57(3):309.

Kovacs F, Varga M, Pataki Z, Rigo E. Pseudothrombocytopenia with multiple anticoagulant sample collection tubes. Interv Med Appl Sci 2016;8(4):181–3.

Farid J, Idris M, Khan MA, Gul N, Moeen S, Bashir S. Frequency of pseudothrombocytopenia in outdoor patients: role of trisodium citrate in correcting it. Pak J Physiol 2021;17(3):54–7.

Cap Today. Q & A column, 11/14 - CAP TODAY [Internet]. 2014 [cited 2023 July]. Available from: https://www.captodayonline.com/qa-column-1114/

Weber D, Nakashima M. 198 Platelet count stability in sodium citrate-anticoagulated whole blood samples. Am J Clin Pathol 2018;149(Suppl_1):S84–5.

Oh BJ, Cho D, Kee SJ, Shin MG, Shin JH, Suh SP, et al. Correction Algorithm of Pseudothrombocytopenia due to Platelet Clumping. Korean J Lab Med 2015;2005:373–8.

Waseem N, Hanif B, Jabbar J. Multicoagulant resistant pseudothrombocytopenia. JPMA 2021;71(9):2247–9.

Baccini V, Geneviève F, Jacqmin H, Chatelain B, Giranrd S, Wuilleme S, et al. Platelet counting: ugly traps and good advice. Proposals from the French-Speaking Cellular Hematology Group (GFHC). J Clin Med 2020;9(3):808.

Cho D, Oh BJ, Kim IH, Jeong CH, Ryang DW. Correction of platelet count using a vortex in pseudothrombocytopenia. Korean J Lab Med 2003;2003:151–6.

Scavone M, Bossi E, Podda GM, Cattaneo M. MgSO4 anticoagulant prevents pseudothrombocytopenia by preserving the integrity of the platelet GPIIb-IIIa complex. Br J Haematol 2021;192(6):e144–8.

Choccalingam C, Kanna Nandagopal Radha R, Snigdha N. Estimation of Platelet Counts and Other Hematological Parameters in Pseudothrombocytopenia Using Alternative Anticoagulant: Magnesium Sulfate. Clin Med Insights Blood Disord 2017;10:1179545X17705380.

Bao Y, Wang J, Wang A, Bian J, Jin Y. Correction of spurious low platelet counts by optical fluorescence platelet counting of BC-6800 hematology analyzer in EDTA-dependent pseudo thrombocytopenia patients. Transl Cancer Res 2020;9(1):166.

Bokaei PB, Grabovsky D, Shehata N, Wang C. Impact of amikacin on pseudothrombocytopenia. Acta Haematologica 2017;137(1):27–9.

Tantanate C, Talabthong S, Lamyai P. Kanamycin Supplement for the Disaggregation of Platelet Clumps in EDTA-Dependent Pseudothrombocytopenia Specimens. Lab Med 2022;53(3):e69–73.

Additional Files

Published

2023-12-22