The Case Report of a Patient Undergoing Hemodialysis with Platelet Cold Agglutinin

The presence of platelet cold agglutinins is a rare phenomenon that causes K-EDTA independent pseudo thrombocytopenia at laboratory temperature. If the peripheral blood smear is not examined, this phenomenon can cause a misdiagnosis of thrombocytopenia.

The present study examined the platelet count of a 52-year-old man undergoing hemodialysis in the laboratory for the presence of cold agglutinins. The patient's blood sample was collected using K3-EDTA and sodium citrate anticoagulant. The number of platelets was counted at different times and temperatures with a cell counter machine. Peripheral blood smear was examined at the same time as the platelet count by the device. No sign of bleeding was observed in the patient.

At the time of sampling, platelet count was 164x109/L, but it decreased drastically after storage at laboratory temperature. Moreover, at the end of the peripheral blood smear, a large number of platelet clumps were observed.

Platelet cold agglutination is a rare phenomenon that can lead to laboratory error by inducing pseudo thrombocytopenia. This issue has to be taken into consideration in cases of severe thrombocytopenia without clinical symptoms. Since cold antibodies do not affect in-vivo platelet function, such cases do not show any clinical symptoms; however, it has to be considered in situations such as surgeries performed in hypothermic conditions.