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What causes low platelet count associated with clumping of platelets?

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Dr. Deepak Kishore Kaltari

General Surgeon

Practicing since :2002

Answered : 3192 Questions

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Posted on Mon, 30 Jun 2014 in General Health
Question: Hi Doctor..am scheduled for (cosmetic) surgery 25 XXXXXXX Pre op bloodwork showed platelet count of 28 and 3 days later 21 with clumping. Nov 2013 CBC showed clumping with normal count. Last week CBC reported the low count- (I am in Caribbean with so so healthcare but surgery slated for USA). Doc did ultrasound on spleen and organs, all normal. A few days ago did bone marrow biopsy results to arrive from usa one week. I do not bruise and I do not bleed. Have high energy and am never fatigued. My weight has ranged betw 98-105 all my life and I've worked out with weights 25 years and distance swim 4x a week. I feel great always. No blood in urine or stool and never get sick. But this is frightening. How and why can this be?
PS Last week CBC also showed high potassium - I stopped eating bananas.
In fact I eat VERY healthy and never drink.
doctor
Answered by Dr. Deepak Kishore Kaltari 41 minutes later
Brief Answer:
Results likely to be due to hemolysis of sample

Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day


Dear Ms

From the inference of report: Fall in Platelet count associated with clumping of platelets with High Potassium level-- Its likely to be due to the blood sample being Hemolysed.
Due to some factors when blood is collected, sometimes the Red blood cells(RBC) get destructed due to mechanical factors. This releases intracellular factors which cause clumping of Platelets: Fall in platelet count
It also releases intracellular(Present inside the cell) Potassium causing rise in Serum Potassium level. Usually when the rise in Potassium is due to Hemolysis the levels are usually greater than 6 MEq/lt. I would also suggest you to Get EKG/ECG done to rule out any cardiac conduction abnormality due to Hyperkalemia(Increased Potassium level).
Normal Ultrasound with Normal findings of spleen is very much reassuring. Spleen is site of destruction of senescent(old ) Red blood cells(RBC).

In the scenario of no history of any bleeding manifestation, its unlikely to be any significant problem.
I would suggest you to wait for bone marrow bipsy report. Norml report will be very reassuring.

Do Get Back to me if you need any further assistance, will be glad to assist you.

Take Care
Best Regards
Dr Deepak Kishore
MBBS,MS,MCH




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Deepak Kishore Kaltari 10 minutes later
Doctor XXXXXXX
Thank you. Very reassuring. My recent EKG showed MI (probably old) with normal sinus rhythm. I don't want to take up too much of your time but truly value your input.

I've attached the EKG and full CBC from last week.
Are finding consistent with what you just wrote?

Best regards,
XXXXXX
doctor
Answered by Dr. Deepak Kishore Kaltari 18 minutes later
Brief Answer:
Its likley to be due to hemolysed sample

Detailed Answer:
Hi
Dear Ms XXXXXX,

The Hyperkalemia and fall in platelet is definitely due to Hemolysed sample and consistent with my earlier reason. Potassium level of 6 , will definitely cause ECG changes like QT interval prolongation , Bradycardia. There are no such changes in your ECG/EKG , there is only slight ST segment elevation consistent with previous cardiac event.

Repeating the CBC will definitely reveal it to be normal.

Rest be assured there is no cause for concern.

Wishing you a happy and healthy life.
All the best for the proposed Surgery.

Take Care
Regards
Deepak
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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