CLUMPING PLATELETS

[AnthonyHeard]

The Curious Case of the Clumping Platelets

The first time I heard the phrase CLUMPING PLATELETS was on January 26th this year when following my routine (as if anything can ever be routine in ITP) 3 month blood test on January 15th. I got a telephone call from my specialist advising that I would have to get another blood test as the one taken was inconclusive. They could not get a definite platelet count because my platelets had clumped.

So what exactly is PLATELET CLUMPING and why does it occur ? Well thanks to Shirley at the ITP Support Association and her getting me an explanation from Professor George my mind was put at ease and my natural curiosity satisfied.

The way I understand it is that when a blood test is done a chemical is routinely used in the test tube on the blood sample. The chemical used in most cases is EDTA (Ethylenediaminetetraacetic acid (say that quickly after a few glasses of wine ). Sometimes, as happened in my case this January platelets clump in the test tube when EDTA is used.

The blood sample can be tested using a different chemical to get a platelet count if EDTA produces CLUMPING PLATELETS. So when I subsequently had yet another blood test on February 24th I had 3 samples taken, one to be tested with EDTA, the second to be tested in CITRATE (an alternative chemical) and thirdly another to be tested using Lithium Heparin (yet another chemical). The results came back satisfactory this time with a platelet count of 139 and amazingly they did NOT CLUMP this time in the EDTA.

So yet another curious episode in what after all is a curious condition called ITP.

Has CLUMPING PLATELETS happened to anyone else ? If so please do tell us ......I look forward to your thoughts/comments fellow ITP voyagers !!!!!

[Robert1959]

Yes this happened to me on a number of occasions as well when my platelets were very low so I had to be retested in Citrate.

[Dawnwarry]

I had clumping platelets just before an operation about 8 years ago but they said they thought the count was high enough not to retest so the op went ahead.

[Timy]

Hello it happens to me many times.. it was always frustrating when they take my blood samples at the medical clinic.. today i took two samples. One with the machine i think they used edtaand i got 65, but when they tried to manual it using micriscope (blood smear) i got 244..

[SkylurA]

Platelet clumping can occur if the tube is not well-mixed or mixed quickly enough. If it is not inverted 8 to 10 times or inverted quickly enough to mix the blood with the anticoagulant, then platelet clumping may happen. This is likely what happened with your sample.

Platelet clumping can also be more likely to occur if the sample is refrigerated instead of kept at room temp.

Lastly, platelet clumping can occur in an EDTA sample due to blood that coagulates quickly.

If you have abnormally high or low platelet count, then a citrated platelet may be ordered so the provider knows the number is accurate.

If this is a routine occurrence, then any doctor ordering your bloodwork should know about this so they can order a citrated platelet straight out the gate, so you do not have to be redrawn.

[Dawnwarry]

I have a vague recollection of this happening to me years ago with the consultant (prior to an operation) asking for another blood test as there was clumping in the original one.

[B-A-Dreamer]

The first time I became aware of platelets was in 2000 when I was recalled to hospital because a platelet count had come back at 10 and the doctor didn't believe it. The result said that the lab had looked for clumping but not found any. Since then, on various occasions when platelets were below 20 they have repeated testing with citrate but they continue to disbelieve the results, talk about clumping, and then retest with citrate. I don't know why they can't just do it once with citrate but I presume that's more expensive initially so they end up with everything costing more because of wasted EDTA tests.

[Linbrom]

Hi Anthony, I now know all about clumping platelets. Earlier this year I was undergoing radiotherapy and having weekly blood tests because of my ITP . A count in the low 20’s sent the treatment team into a blind panic and said they needed to repeat the test at once. I told them to leave it with me and I immediately contacted my haematology nurse specialist. I went to my regular haematology unit and they did the citrate test . Of course they immediately came back up to a safe level.When it happened again with no clumping my haematologist later concluded that I had pseudo thrombocytopenia caused by the treatment and adjusted my Romiplostim dose for the duration of the treatment as a precaution. Now all is returned to my normal levels. It is helpful to be aware of all these factors like clumping because understandably not all medical professionals understand ITP and are really concerned when they see low figures. ( another one is giant platelets which confuse the automatic test system but can clearly seen on a manually examined film)Throughout my entire 13 year ITP journey I have learnt a lot and explained the condition to countless medics who we’re grateful for my knowledge. I should add that the ITP Support Association had been my guardian angel