Pseudothrombocytopenia associated with multiple myeloma.

Mayo Clin Proc

Department of Internal Medicine, Gundersen Lutheran Medical Center, La Crosse, Wis, USA.

Published: July 2006

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http://dx.doi.org/10.4065/81.7.869DOI Listing

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Article Synopsis
  • Pseudothrombocytopenia (PTCP) is a rare issue where platelet counts appear low due to aggregation, leading to possible misdiagnoses and unsafe clinical decisions if not recognized quickly.
  • The most frequent cause of PTCP is ethylenediaminetetraacetic acid (EDTA), and there are various management strategies documented, though expert guidance is limited.
  • A collaborative group in Croatia developed minimal recommendations to help standardize the detection and reporting of platelet counts from EDTA-induced PTCP, aimed at laboratory professionals and healthcare providers involved in blood sample management.
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Thrombocytopenia is a rare but serious complication of the intravenous glycoprotein IIb/IIIa (GPIIb/IIIa; integrin αIIbβ3) receptor inhibitors (GPIs), abciximab, eptifibatide, and tirofiban. The thrombocytopenia ranges from mild (50 000-100 000 platelets/μL), to severe (20 000 to <50 000/μL), to profound (<20 000/μL). Profound thrombocytopenia appears to occur in <1% of patients receiving their first course of therapy.

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Key Clinical Message: EDTA-dependent pseudothrombocytopenia as well as myelosuppression should be suspected when thrombocytopenia occurs in patients with autoimmune disease during chemotherapy.

Abstract: A patient with pancreatic cancer and ulcerative colitis developed transient ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia with exacerbation of ulcerative colitis during chemotherapy. Unfortunately, pseudothrombocytopenia could not be immediately detected because thrombocytopenia was masked by a reasonable time course of adverse events associated with chemotherapy and ulcerative colitis recurrence.

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Common causes of thrombocytopenia include pseudo-thrombocytopenia, splenomegaly, decreased bone marrow production, and increased platelet destruction or depletion. The main clinical manifestation is bleeding, and thrombosis-related complications are rare. This article reports an 87-year-old woman with severe thrombocytopenia for more than 7 years.

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Ethylene diamine tetra acetate-induced pseudo thrombocytopenia (EDTA-PTCP) is a fictitious laboratory condition that is associated with platelet clumping, leading to falsely low platelet counts. This fictitious occurrence can lead to expensive, time-consuming, and invasive diagnostic procedures. It may also result in the application of unnecessary therapies,although it is not linked to any hemorrhagic symptoms or platelet malfunction.

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