Pseudothrombocytopenia in a patient undergoing splenectomy of an accessory spleen. Case report.
OBJECTIVE
Coagulation tests (CBC and prothrombin time) were initially conceived as a mean of screening and following rare congenital coagulopathies; the CBC provides the number of platelets per cubic milliliter. The objective of this report was to present the case of a patient who presented with an extremely low number of platelets when her blood was analyzed in an EDTA-containing tube and its numbers were normal when the blood was analyzed with citrate, alerting for the risk of erroneously administering blood products.


METHODS
This is the case of a 40-year-old female patient, ASA II. In 2001 she presented with thrombocytopenia and was referred to a hematologist in Manaus, in the state of Amazonas, Brazil and underwent splenectomy that same year with a diagnosis of idiopathic thrombocytopenic purpura. Since her CBCs continued to show thrombocytopenia, an abdominal ultrasound was done and showed a spherical hypoechoic image, with an echotexture similar to the spleen, measuring 2.0 x 1.7 cm, with well-defined contents (accessory spleen), and a splenectomy was indicated. One hour into the surgery, blood samples were drawn for CBC and chemistry: Hb = 11.3 g x dL(-1); Ht = 33.4%; Platelets = 35,000 microL(-1); PT = 15.2 (86.0% Activity) (INR = 1.09). Due to the minimal blood loss in the surgical field, a new test with citrate was requested to determine the platelet count (results: 138,000 platelets).


CONCLUSIONS
The anomalous result of an isolated exam without corresponding clinical signs should not guide the treatment. All exams have a defined percentage of errors and the search for those technical errors can avoid the use of the wrong treatment.
Yamada
Eduardo Jorge
EJ
Hospital Universitário Getúlio Vargas (HUGV) da Universidade Federal do Amazonas (UFAM), Manaus, AM. duyamada@bol.com.br
Souto
Anne Francy Pereira
AF
de Souza
Ellen da Encarnação Onety
Eda E
Nunes
Cid Amorim
CA
Dias
Cremilda Pinheiro
CP
D000328:Adult; D005260:Female; D006801:Humans; D013154:Spleen / Q000002:abnormalities* / Q000601:surgery*; D013156:Splenectomy; D013921:Thrombocytopenia / Q000150:complications*