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A 5 3-year-old female patien t is seen for evaluation prior to a plan ned den tal extrac-tion . She has sys tem ic lupus erythematosus and has been noted to be thrombocyto-penic on recen t laboratory evaluation by her rheumatologist. The peripheral smear is shown below.
What is the mechanism of this patient's thrombocytopenia?
- Autoantibodies related to EDTA anticoagulant
- Antiphospholipid antibodies
- Antinuclear antibodies
- Warm autoantibodies
Medicine
A. The blood smear shows numerous platelets surrounding granulocytes, that is, platelet satellitism, a cause of pseudothrombocytopenia. This scenario is an in vitro phenomenon probably related to interactions between platelet glycoprotein lib/lila complex and the neutrophil Fe receptor, caused by the anticoagulant EDTA contained in some blood collection containers. Platelet satellitism is less common than platelet clumping, also related to pseudothrombocytopenia (N Engl J Med. 1998;338:591).
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