Open Journal of Pediatrics, 2011, 1, 39-40 OJPed
doi:10.4236/ojped.2011.13011 Published Online September 2011 (http://www.SciRP.org/journal/ojped/).
Published Online September 2011 in SciRes. http://www.scirp.org/journal/OJPed
Transplacental transmission of EDTA dependent
pseudothrombocytopenia in a neonate
Ali Bay1*, Ercan Sivasli1, Safak Taviloglu1, Goksel Leblebisatan2, Enes Coskun1, Unal Uluca1
1Department of Pediatric s , Gaziantep University, Gaziant ep, Turkey;
2Gaziantep Children Hospital, Gaziantep, Turkey.
Received 22 April 2011; revised 2 June 2011; accepted 25 July 2011.
Verifying platelet counts can prevent unwarranted
diagnostic tests and transfusions. In case of throm-
bocytopenia, if the clinical picture and history do not
suggest bleeding tendency, one should always per-
form peripheral blood smear by directly obtaining
blood by finger puncture before doing any further
tests. If the peripheral blood smear exhibits platelet
clumps, pseudothrombocytopenia should always be
remembered. In this case, we present a neonate with
a diagnosis of transplacental transmission of EDTA-
Keywords: Thrombocytopenia; Pseudothrombocytopenia;
Pseudothrombocytopenia or spurious thrombocytopenia
is an in vitro laboratory finding usually associated with
the use of ethylenediamine tetraacetic acid (EDTA) in
blood collection tubes . It is due to platelet clumping
when blood is anticoagulated with EDTA. EDTA while
binding calcium ions releases glycoprotein IIb (GpIIb)
epytope by interacting with the glycoprotein IIb-IIIa
(GpIIb-IIIa) molecule on the platelet membrane [2,3]. If
the patient has autoantibodies (usually IgG type immu-
noglobulins) against these epytopes, they cause clump-
ing of these platelets by binding to the epytopes on their
surfaces. These thrombocyte clumps are considered as
leukocyte by the automated blood counters due to their
volumes and so the platelet counts are estimated as low.
We describe a case of transient congenital pseudoth-
rombocytopenia in a baby born to a mother with pseu-
2. CASE REPORT
A 28 year old woman was found to have persistent
thrombocytopenia by routine electronic blood counting.
There was no history of bleeding tendency though her
first childbirth was via C/S. In her second pregnancy, the
automatic platelet count on EDTA-anticoagulated sam-
ple was 33.000/mm³; her peripheral blood smear exhib-
ited multiple platelet clumps. Her blood was collected in
heparin anticoagulated tube and her platelet count was
184.000/mm³. She was diagnosed as EDTA dependant
pseudothrombocytopenia. She delivered her baby via
C/S without complications.
The laboratory analyses of newborn show that throm-
bocytopenia with a level of platelet count 56.000/mm³.
She had no bleeding tendency. In her blood smear, sev-
eral large platelet clumps were detected. We considered
that this low platelet count might be due to EDTA-in-
duced aggregation of the platelets. Therefore, we meas-
ured platelet count of his blood samples obtained by
venipuncture in different test tubes, each containing so-
dium citrate or standard heparin. Platelet counts of blood
samples in test tubes containing sodium citrate or hepa-
rin were found to be 154.000/mm3 and 161.000/mm3,
respectively. So the baby was considered to have pseudo
thrombocytopenia and discharged from the hospital.
Finally, du ring her last follow up visit, she was 6 month s
old and the baby’s platelet count was normal, even in the
presence of EDTA. Repeat counts performed over the
following months showed persistence of pseudothrom-
bocytopenia in th e mother.
The prevalence rate of EDTA-dependent pseudothrom-
bocytopenia was reported as 0.07% to 0.20% in the lit-
erature. . It is almost always discovered during rou-
tine hematologic tests. Pseudothrombocytopenia is seen
in patients whose blood is taken into EDTA containing
tubes. The incidence of autoantibodies causing clumping
of platelets due to the presence of EDTA is 1/1000 in
humans . These autoantibodies are either present life-
long time or may be temporary secondary to the pres-
ence of infections or use of drugs. These autoantibodies
A. Bay et al. / Open Journal of Pediatrics, 2011, 1, 39-40
can cross the placenta and cause thrombocytopenia in
neonate . This case documents transplacental trans-
mission of the plasmatic factor probably an IgG, respon-
sible for pseudthrombocytopenia. If there is thrombocy-
topenia, a peripheral blood smear with blood counts,
taken into tubes containing citrate or heparin as antico-
agulant should be performed.
In case of low thrombocyte level which ob tained with
an electronic counter peripheral smear should be prepar-
ed from both patient’s fingertip and blood sample with
EDTA. Also platelet count should be repeated with an-
other anticoagulant like citrate or heparin instead of
EDTA. Repeated thrombocyte counts with other antico-
agulants are usually found normal in range. Thrombo-
cytes sometimes surround in leucocytes (thrombocyte
satellism) which form a cluster. These clusters can not be
counted correctly by electronic blood counter instru-
ments. So this should be ruled out when thrombocyto-
penia is detected. It should be kept in mind that low
thrombocyte counts can be obtained due to aggregation
of thrombocyte when blood samples are taken improp-
erly (insufficient mix of anticoagulant and blood sample,
difficulty in venous access). When low platelet counts
are found from the blood samples of patients whom have
been difficulties in venous access, peripheral blood
smear should be done and examined under microscope.
MPV (mean platelet volume) is also measured in full
blood count instruments beside thrombocyte count. In
patients with low platelet levels; if MPV value is high
the differential diagnosis should include acute ITP, Ber-
nard-Soulier syndrome and also one should always re-
member the possibility of formation of thrombocyte
clusters and further investigation should be performed
according to these causes .
One has to decide if thrombocytopenia is real or
pseudo before making further diagnostic tests, a periph-
eral smear should always be done with complete blood
 Onder, O., Weinstein, W. and Hoyer, L.W. (1980) Pseu-
do-thrombocytopenia caused by platelet agglutinins that
are reactive in blood anticoagulated with chelating agents.
Blood, 56, 177-182.
 Said, S.M., Hahn, J., Schleyer, E., Müller, M., Fiedler,
G.M., Buerke, M. and Prondzinsky, R. (2007) Glycopro-
tein IIb/IIIa inhibitor-induced thrombocytopenia: Diag-
nosis and treatment. Clinical Research in Cardiology, 96,
 Van der Meer, W., Allebes, W., Simon, A., Van Berkel, Y.
and De Keijzer, M.H. (2002) Pseudothrombocytopenia: A
report of a new method to count platelets in a patient
with EDTA-and temperature-independent antibodies of
the IgM type. European Journal of Haematology, 69,
 Zandecki, M., Genevieve, F., Gerard, J. and Godon, A.
(2007) Spurious counts and spurious results on haema-
tology analysers: A review. Part I: Platelets. International
Journal of Laboratory Hematology, 29, 4-20.
 Chiurazzi, F., Villa, M.R. and Rotoli, B. (1999) Trans-
placental transmission of EDTA-dependent pseudothrom-
bocytopenia. Haematologica, 84, 664.
 Akbayram, S., Dogan, M., Akgun, C., Caksen, H. and
Oner, A.F. (2010) EDTA-dependent pseudothrombocy-
topenia in a child. Clinical and Applied Thrombosis He-
mostasis, 7 June 2010 (ahead of print).
opyright © 2011 SciRes. OJPed