Grand Rounds

A Queer Case of Thrombocytopenia in a Child

Govind Kendre, Shruti Mantri, Sunil Hilalpure, Suraj Goyanka, Leo Prince, Murlidharan C
Department of Clinical Hematology, Seth G.S. Medical College, KEM Hospital, Mumbai, India

Address for Correspondence: Dr. Govind Kendre, Department of Clinical Hematology, Seth G.S. Medical College, Parel, Mumbai, India. Email:

Clinical Problem:
A 3-years-old male child was hospitalized for right-sided pneumonia. Complete blood count (CBC) showed hemoglobin 13.5 gm/dl, total leucocyte count- 6800 cells/cumm and thrombocytopenia with a platelet count of < 20,000 cells/cumm on two occasions. There was no history of easy bruisability, petechiae, ecchymosis or bleeding from any site. There was no history of bleeding disorders in family members. Physical examination was normal. CBC by an automated counter in the hematology lab showed hemoglobin of 13 gm%, total leucocyte counts of 10,500 cells/cumm and platelet counts of 10,000 cells/cumm. A peripheral smear examination showed multiple aggregates of platelets (Figure 1). All previous CBCs were done using ethylenediaminetetraacetic acid (EDTA) as an anticoagulant. When the CBC was repeated with sodium citrate as an anticoagulant, the platelet count was found to be 2,35,000 cells /cumm.

Figure 1. Peripheral blood smear (Giemsa stain) (1000x): showing platelet clumps.

Why did the child have thromobocytopenia on EDTA samples?

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