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Pseudothrombocytopenia, beyond a laboratory phenomenon: study of 192 cases

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Abstract

The platelet antibodies that cause pseudothrombocytopenia (PTCP) act only in vitro and do not produce clinical bleeding. Most studies on PTCP have focused on improving differential diagnosis with true thrombocytopenia but studies on the characteristics of patients with PTCP are limited. In this study, we aimed to evaluate the clinical and biological characteristics of 192 patients with PTCP. In addition to general variables, we evaluated automated and microscopic platelet counts, platelet clumps, platelet diameters, immature platelet fraction (IPF), and platelet antibodies. Adult women accounted for the largest subgroup of patients (n=82; 42.7%) and 67 patients (34.9%) were grouped into families. Forty-four patients (22.9%) had one or more associated autoimmune disorders (ADs); 39 relatives of these patients (19.8%) had ADs and 45 relatives (23.4%) had immune thrombocytopenia (ITP) or unspecified thrombocytopenia. Platelet cryptantibodies and/or autoantibodies were positive in 56 patients (30.1%). Most patients (n=169; 80%) had automated platelet counts >80×109/L. In all patients, microscopic platelet counts were ≥150×109/L. The platelet clump index (% increase in microscopic platelet count compared to automatic count) ranged from 30 to >7000%. Platelet diameters and IPF parameters were significantly greater in the PTCP versus healthy controls (p<0.001). A total of 17 patients (8.8%) had had previous ITP or the PTCP evolved into ITP. Our data suggest that PTCP should be considered a situation of autoimmunity; the assessment of platelet clumps has a high diagnostic value; the close association between ITP and PTCP suggests that these conditions could be different phases of the same process.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

The authors wish to thank Bradley Londres for professional language editing.

Author information

Authors and Affiliations

  1. Platelet Pathology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Núria Pujol-Moix, Ignacio Español & Alfons Soler

  2. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain

    Núria Pujol-Moix & Ignacio Español

  3. Immunohematology Laboratory, Banc de Sang i Teixits de Catalunya, Barcelona, Spain

    Eduardo Muñiz-Díaz

  4. Hematology Department, Hospital Clínico Universitario Virgen de la Arrixaca., Murcia, Spain

    Ignacio Español

  5. Thrombosis and Haemostasis Research, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain

    Sergi Mojal & Juan Carlos Souto

  6. Hematology Department, Hospital Universitari Parc Taulí. Sabadell, Barcelona, Spain

    Alfons Soler

  7. Unitat d’Hemostàsia i Trombosi., Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Juan Carlos Souto

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  1. Núria Pujol-Moix
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Contributions

N. Pujol-Moix and E. Muñiz-Diaz designed and coordinated de study. N. Pujol-Moix wrote the article. N. Pujol-Moix, J. C. Souto, I. Español, and A. Soler collected the clinical and laboratory data (automated platelet counts and indices, microscopic platelet counts and analyses on blood smears). E. Muñiz-Diaz performed the analyses of platelet antibodies. S. Mojal performed the statistical analyses. All authors critically reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Núria Pujol-Moix.

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-The authors have no relevant financial or non-financial interests to disclose.

-The study was conducted in accordance with the ethical standards of the Declaration of Helsinki and was approved by the Institutional Review Board of the Hospital de la Santa Creu i Sant Pau.

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Pujol-Moix, N., Muñiz-Díaz, E., Español, I. et al. Pseudothrombocytopenia, beyond a laboratory phenomenon: study of 192 cases. Ann Hematol 102, 1363–1374 (2023). https://doi.org/10.1007/s00277-023-05192-8

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