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(Circulation. 1999;100:1460.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pseudothrombocytopenia After Abciximab (ReoPro) Treatment

Stephan Moll, MD; Imke Poepping, MD; Sven Hauck, MD; Dietrich Gulba, MD; Rainer Dietz, MD

From Franz Volhard Klinik, Humboldt Universität Charité, Berlin, Germany.

Correspondence to Stephan Moll, MD, Franz Volhard Klinik, Wiltbergstraße 50, 13122 Berlin, Germany. E-mail moll@fvk-berlin.de

	Introduction

 
A46-year-old man received a bolus and continuous infusion of abciximab (ReoPro) after PTCA. A platelet count before the procedure was 270 000/µL. Two hours after the bolus, an automated platelet count from EDTA blood was 92 000/µL (Figure 1). The abciximab infusion was stopped. Four hours after the bolus, the platelet count from EDTA blood was 51 000/µL; at the same time, an automated platelet count from citrated blood was 215 000/µL. A peripheral blood film from EDTA blood (Figure 2) showed marked platelet clumping, which was not present on a film from citrated blood. Platelet counts from EDTA blood reached a nadir of 37 000/µL on day 2 and normalized within 2 weeks. No bleeding complications occurred.

View larger version (28K): [in this window] [in a new window]   Figure 1. Time course of automated platelet counts from citrated blood and EDTA blood.

View larger version (95K): [in this window] [in a new window]   Figure 2. Light microscopic image of a peripheral-blood film after Giemsa staining.

Thrombocytopenia is a well-recognized adverse effect of abciximab therapy and may lead to costly and potentially harmful therapeutic interventions (platelet transfusions, immunoglobulin infusions) or discontinuation of potentially beneficial therapy (ie, abciximab). The thrombocytopenia is thought to be due to immune-mediated platelet consumption or platelet removal from the circulation.

Pseudothrombocytopenia, as in the case described, is an important differential diagnosis of thrombocytopenia because, as an ex vivo phenomenon, it is not associated with bleeding complications and does not require discontinuation of abciximab treatment or intervention with platelet transfusions. It is due to the presence of EDTA as an anticoagulant in the blood-drawing tube. Studies of . . . [Full Text of this Article]

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