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British Journal of Anaesthesia, 2000, Vol. 84, No. 5 640-642
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Report

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

N. J. Wilkes1, N. A. Smith1 and S. V. Mallett1

1 Department of Anaesthesia, Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK

N. J. Wilkes, Department of Anaesthesia, Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK

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 61x109 litre–1, but he had no history of bleeding problems. Previous platelet counts demonstrated results ranging from 16x109 litre–1 to 254x109 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 pseudothrombocyto- penia. We present the perioperative implications of this in vitro phenomenon and methods of detecting the functional and numerical integrity of circulating platelets.


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