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Simon Senanu: Not Every Thrombocytopenia Is Real
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Mar 1, 2026, 13:06

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?”

Simon Senanu: Not Every Thrombocytopenia Is Real
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