Surbhi Singh: Platelet Clumps — The Culprit Behind Pseudothrombocytopenia
Surbhi Singh, Consultant Haematopathology at Agilus Diagnostics and Fortis Hospital Gurugram, shared a post on LinkedIn:
“Cellfie Of The Day
*Platelet Clumps — The Culprit Behind Pseudothrombocytopenia
*What you see:
Large platelet aggregates on the peripheral smear, often at the feathered edge or around neutrophils/monocytes.
*Why it matters:
These clumps falsely lower automated platelet counts, leading to pseudothrombocytopenia — a lab artefact, not a true thrombocytopenia.
*Mechanism:
• Most commonly EDTA-dependent platelet agglutination.
• Autoantibodies targeting GP IIb/IIIa become activated in EDTA, causing platelets to clump in vitro.
*Clues on smear:
• Platelet clumps at the tail end.
• Adequate giant platelets or normal platelet morphology.
• Normal RBC and WBC morphology unless concurrent pathology.
*What to do:
• Repeat CBC in citrate anticoagulant.
• Manual smear review to confirm.
• Report corrected platelet count from alternative tube if clumping resolves.”
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