|
|
|
Indian Pediatr 2018;55: 529 |
 |
Pseudothrombocytopenia in Type 1 Diabetes
|
|
Balasubramaniyan Muthuvel and Devi Dayal*
Department of Pediatrics, Advanced Pediatrics Center,
PGIMER, Chandigarh, India.
Email: [email protected]
|
|
A 5-yr-old girl diagnosed with Type 1 diabetes (T1D) since 1½ yr of age,
and treated elsewhere with premixed insulins presented to our emergency
department with complaints of vomiting, abdominal pain and altered
sensorium for 1 day. She was treated for moderate diabetic ketoacidosis
based on high blood glucose, positive urine ketones and metabolic
acidosis (pH 7.107, HCO3 11.4 mEq/L). Her blood counts showed hemoglobin
of 10.7 g/dL, platelet count of 86×10
9/L
and total leucocyte count of 6×109/L.
A repeat platelet count was 64×109/L,
and peripheral smear suggested clumping of platelets. There were no
bleeding manifestations. Suspecting ethylene diamine tetra-acetic acid
(EDTA) dependent pseudothrombocytopenia (PTCP), the sample was repeated
in EDTA, heparin, and citrate vials which showed platelet counts of
78×109/L, 408×109/L
and 416×109/L, respectively.
A diagnosis of EDTA - dependent PTCP was made and further workup for
etiology of thrombocytopenia was withheld. The child was discharged
after switching to basal bolus insulin regimen for a better glycemic
control.
PTCP is a relatively uncommon laboratory phenomenon
with estimated prevalence of 0.1%-0.3% in adults (1). Of the three
types, namely EDTA-, heparin- and citrate-induced, the EDTA-PTCP is the
most common [1,2]. The PTCP results from in vitro agglutination
of platelets caused by IgG or IgM autoantibodies predominantly directed
against epitopes on platelet surface glycoprotein (GP) IIb or IIIa [2].
EDTA induces a conformational change in GP IIb/IIIa, exposing these
epitopes and resulting in platelet agglutination at low temperature [2].
This phenomenon is probably related to naturally occurring antibodies
that cross react with platelet cryptoantigen exposed due to the effects
of EDTA [2].
PTCP is an extremely rare condition in children and
is described in association with autoimmune, neoplastic, chronic
inflammatory and infectious diseases [3]. We could not find any previous
reports of its occurrence in children with T1D; although, true
thrombocytopenia of autoimmune and viral etiologies has been described
in T1D [4]. There is a single report of an adult with T1D who developed
PTCP after change in insulin therapy from premixed to basal bolus
regimen [5]. However, he showed PCTP in both EDTA and heparinized
samples unlike with only EDTA as in our patient [5]. Additionally, there
was no recent change in insulin regimen in our patient. Thrombocytopenia
without a bleeding diathesis should alert the attending physician to
possibility of PTCP.
References
1. Froom P, Barak M. Prevalence and course of
pseudothrombocytopenia in outpatients. Clin Chem Lab Med. 2011;49:111-4.
2. Saigo K, Sakota Y, Masuda Y. EDTA-dependent
pseudothrombocytopenia: Clinical aspects and laboratory tests. Rinsho
Byori. 2005;53:646-53.
3. Vaidya P, Venkataraman R. Pseudothrombocytopenia
in a child with dengue. Indian J Pediatr. 2014;81:1395-6.
4. Khadwal A, Devidayal, Deepthi N, Kumar A. Severe
thrombocytopenia in a child with type 1 diabetes. Pediatr Endocrinol
Diabetes Metab. 2008;14:125-6.
5. Beyan C, Kaptan K, Ifran A. Pseudothrombocytopenia after changing
insulin therapy in a case with insulin-dependent diabetes mellitus: A
first case report. Am J Hematol. 2010;85:909-10.
|
|
|
 |
|
