title: A case report of sudden thrombocytopenia detected only by in vitro analysis.
abstract: We experienced an unexpected thrombocytopenia detected only in vitro during radical prostatectomy for a 66-year-old patient. Thrombocytopenia with platelet aggregation was observed in a blood sample obtained using a heparinized syringe (not by ethylene diamine tetra-acetic acid tube). Although we could not exclude platelet agglutination in vivo, no thrombosis or coagulation disorder was observed. We changed the anti-coagulant in the arterial catheter carrier fluid (saline) from heparin to argatroban, and continued with the operation. No embolic complications were observed during the perioperative period. Although pseudothrombocytopenia or heparin-induced thrombocytopenia was highly suspected in the present case, we were not able to confirm which of the two developed. Multi-directional attention and care may be required for perioperative unexpected thrombocytopenia.
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan. satko1110@yahoo.co.jp.
authors.forename: Satoko
authors.initials: S
authors.lastname: Noguchi
authors.affiliation: Department of Operation Center, Hirosaki University Medicine Hospital, Hirosaki, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kitayama
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
authors.forename: Hidetomo
authors.initials: H
authors.lastname: Niwa
authors.affiliation: Department of Blood Transfusion, Hirosaki University Medicine Hospital, Hirosaki, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Tamai
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D010974:Platelet Aggregation; D013921:Thrombocytopenia / Q000139:chemically induced / Q000175:diagnosis*
chemical_list: D006493:Heparin
keywords: Heparin; Platelet aggregation; Pseudothrombocytopenia