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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
YAMADA, Eduardo Jorge et al. Pseudothrombocytopenia in a patient undergoing splenectomy of an accessory spleen: case report. Rev. Bras. Anestesiol. [online]. 2008, vol.58, n.5, pp. 485-491. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942008000500007.
BACKGROUND AND OBJECTIVES: 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. CASE REPORT: 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 × 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.dL-1; Ht = 33.4%; Platelets = 35,000.µL-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.
Keywords : BLOOD [transfusion]; COMPLEMENTARY EXAMS [platelet count]; COMPLEMENTARY EXAMS [pseudothrombocytopenia].