A routine pre-operative sample from an asymptomatic 30-year-old woman shows a platelet count of 60,000 per microliter. She has no history of bleeding. Peripheral smear shows platelet clumping. What is the next best step?

• A Start corticosteroids empirically
• B Transfuse platelets before surgery
• C Proceed directly to bone marrow examination
• D Repeat the platelet count using a citrate-anticoagulated tube ✓

Explanation

EDTA-dependent pseudothrombocytopenia is caused by IgG or IgM antibodies that react with platelet glycoprotein IIb/IIIa exposed by EDTA, producing ex vivo platelet clumping that automated counters read as thrombocytopenia. The patient is asymptomatic and the smear shows clumps, which is diagnostic. Repeating the count in a citrate or heparinized tube, or with a finger-prick sample, yields a true count and avoids unnecessary workup and treatment. No real thrombocytopenia exists, so no therapy is needed.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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