Псевдотромбоцитопения - способы коррекции в трудных случаях

[Dr.Vad]

Замена ЭДТА на цитрат или гепарин - наиболее простое решение, но что можно сделать, если и это не помогает?: добавление аминогликозидного антибиотика (канамицин, гентамицин) в пробирку перед взятием крови может помочь:

Clin Chem Lab Med. 1999 Nov-Dec;37(11-12):1063-6.
Accurate platelet counting in an insidious case of pseudothrombocytopenia.
Lombarts AJ, Zijlstra JJ, Peters RH, Thomasson CG, Franck PF.
Department of Clinical Chemistry, Leyenburg Hospital, The Hague, The Netherlands.

Anticoagulant-induced aggregation of platelets leads to pseudothrombocytopenia. Blood cell counters generally trigger alarms to alert the user. We describe an insidious case of pseudothrombocytopenia, where the complete absence of Coulter counter alarms both in ethylenediaminetetraacetic acid blood and in citrate or acid citrate dextrose blood samples was compounded by the fact that the massive aggregates were exclusively found at the edges of the blood smear. Non-recognition of pseudothrombocytopenia can have serious diagnostic and therapeutic consequences. While the anti-aggregant mixture citrate-theophylline-adenosine-dipyridamole completely failed in preventing pseudothrombocytopenia, addition of iloprost to anticoagulants only partially prevented the aggregation. Only the prior addition of gentamicin to any anticoagulant used resulted in a complete prevention of pseudothrombocytopenia and enabled to count accurately the platelets.
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EDTA-dependent pseudothrombocytopenia confirmed by supplementation of kanamycin; a case report.
Ahn HL, Jo YI, Choi YS, Lee JY, Lee HW, Kim SR, Sim J, Lee W, Jin CJ.
Korean J Intern Med. 2002 Mar;17(1):65-8.
[Ссылки доступны только зарегистрированным пользователям ]
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Br J Haematol. 1997 Dec;99(4):817-23.
Aminoglycosides prevent and dissociate the aggregation of platelets in patients with EDTA-dependent pseudothrombocytopenia.
Sakurai S, Shiojima I, Tanigawa T, Nakahara K.
Department of Central Laboratory, Tokyo University Hospital, Japan.

Although EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is of practical importance because failure to recognize this clinical entity may result in misdiagnosis and subsequent mismanagement of the patients, the pathophysiological nature of EDTA-PTCP remains unknown. To develop an effective way to evaluate the platelet counts in patients with EDTA-PTCP, we introduced aminoglycosides-supplemented anticoagulating agents. When kanamycin was pre-supplemented with EDTA for anticoagulating blood samples from EDTA-PTCP patients there was no significant change in the platelet counts and the morphology of blood cells after 150 min of incubation at room temperature. Furthermore, when kanamycin was added to EDTA-anticoagulated blood samples from EDTA-PTCP patients within 30 min after blood withdrawal, rapid dissociation of platelets without apparent morphological changes of blood cells was observed, and complete blood cell counts as well as the histogram patterns were almost the same as those examined immediately after blood sampling. The dissociation of aggregated platelets was also detected when other antibiotics were used, although it was associated with some extent of morphological changes of blood cells. These findings indicate that the supplementation of aminoglycosides either before or after blood sampling is a useful method for the diagnosis EDTA-PTCP and for the evaluation of platelet counts in patients with EDTA-PTCP.