Anticoagulant-induced pseudothrombocytopenia in a patient presenting for coronary artery bypass grafting

Abstract

A 73-yr-old man with severe ischaemic heart disease presented for coronary artery bypass grafting. His preoperative platelet count, obtained from an ethylene diamine tetraacetic acid (EDTA) sampling bottle, was 61 x 109 litre-1, but he had no history of bleeding problems. Previous platelet counts demonstrated results ranging from 16 x 109 litre-1 to 254 x 109 litre-1 with variable degrees of in vitro platelet clumping. Preoperative thrombelastography reflected a normal coagulation profile. The laboratory findings and the absence of a history of haemorrhagic complications suggested a diagnosis of EDTA-dependent pseudothrombocytopenia. We present the perioperative implications of this in vitro phenomenon and methods of detecting the functional and numerical integrity of circulating platelets.