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Background: The phenomena of platelet phagocytosis and platelet satellitism (PS) are rare in vitro observations, with an estimated occurrence of 0.008%. These phenomena can be identified in blood smears utilizing ethylenediaminetetraacetic acid (EDTA) as an anticoagulant, manifesting as neutrophils engulfing platelets and platelets clustering around neutrophils to form satellite-like structures. These occurrences may result in pseudothrombocytopenia (PTCP), potentially complicating clinical diagnosis and treatment decisions.
Methods: This particular case study involved measuring whole blood samples from a pregnant woman and her neonate using EDTA-K2 and sodium citrate anticoagulants. Blood smears were prepared and stained with Wright's stain to observe the morphology and count of platelets and leukocytes under oil immersion microscopy. Moreover, we investigate the potential pathophysiological mechanisms underlying these phenomena in both the mother and the infant.
Results: The platelet counts in EDTA-K2 anticoagulated samples from both the mother and the neonate were significantly lower than those in sodium citrate anticoagulated samples. On EDTA-K2 blood smears, neutrophils engulfing platelets and the platelet satellitism phenomenon were observed, with a high proportion of phagocytic cells, whereas the sodium citrate-treated whole blood samples showed no evidence of phagocytosis or platelet sat-ellitism.
Conclusions: The manifestation of EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) extends beyond aggregation and may include engulfment and adhesion. Sodium citrate anticoagulant can partly correct the low blood cell counts resulting from EDTA-PTCP. Furthermore, EDTA-PTCP can be maternally transmitted to neonates, causing neonatal pseudothrombocytopenia. To the best of our knowledge, this case constitutes an exceptionally rare occurrence of concurrent platelet phagocytosis and PS phenomena in both the mother and the infant.
DOI: 10.7754/Clin.Lab.2025.250755
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