Simon Senanu: Not Every Thrombocytopenia Is Real
Simon Senanu, Medical Laboratory Scientist at Perkins Medical Centre, shared a post on LinkedIn։
“Platelets: Low Count – Or Lab Artifact?
A platelet count of 42 ×10⁹/L appears.
- Before you transfuse.
- Before you call hematology.
- Before you label it DIC.
Pause.
Not every thrombocytopenia is real.
The Most Common Culprit: EDTA Clumping
Platelets are measured in EDTA (purple-top) tubes.
In some patients, EDTA causes platelets to clump in vitro.
The analyzer:
- Misses the clumps
- Excludes them
- Reports a falsely low count
Clues:
No bleeding
- Previously normal counts
- Analyzer flag: ‘platelet clumps’
- Smear shows aggregates
Fix:
- Repeat in a citrate (blue-top) tube.
- Never transfuse until confirmed.
Other Pre-Analytical Causes
- Underfilled tube
- Microclots
- Delayed processing
Always ask:
‘Was the sample adequate?’
If It’s Real – Think Mechanism
- Decreased production
Chemotherapy, marrow failure causing gradual drop
- Increased destruction
ITP, sepsis, DIC, severe malaria causing acute fall
- Sequestration
Splenomegaly, portal hypertension causing moderate thrombocytopenia
DIC rarely presents with isolated low platelets.
Check PT, aPTT, fibrinogen, D-dimer.
Pattern matters more than the number.
The Peripheral Smear Still Matters
Automation counts particles.
Microscopy confirms biology.
A smear reveals:
- Clumping
- Giant platelets
- Schistocytes
- True pathology
If you skip the smear, you skip context.
Clinical Takeaway
A low platelet count is a signal – not a diagnosis.
Before you act:
- Confirm it’s real
- Check the sample
- Review the smear
- Assess the patient
Because sometimes the problem isn’t thrombocytopenia.
It’s the tube.
How many ‘low platelets’ are actually just the tube?
In your setting, what’s the most common cause of true thrombocytopenia – sepsis, ITP, DIC… or malaria?”
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