PMC4533439_01
Peripheral blood smears following storage in tubes with one of several anticoagulants. A: Ethylenediaminetetraacetic acid (EDTA); peripheral-blood smear (May-Giemsa stain, 400x magnification) shows platelet clumping at admission. An electronic counting machine was used to generate an estimated platelet count of 1.3 x 104/muL. These findings were also noted similarly after surgery. B: Heparin; peripheral-blood smear (May-Giemsa stain, 400x magnification) shows platelet clumping at admission. An electronic counting machine was used to generate an estimated platelet count of 2.3 x 104/muL. These findings were also noted similarly after surgery. C: EDTA with kanamycin; a peripheral-blood smear (May-Giemsa stain, 400x magnification) showed dissolution of platelet clumping after surgery. An electronic counting machine was used to generate an estimated platelet count of 15.2 x 104/muL. D: Citrate sodium; a peripheral-blood smear (May-Giemsa stain, 400x magnification) showed no platelet clumping after surgery. An electronic counting machine was used to generate an estimated platelet count of 16.9 x 104/muL.
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F1
Because peripheral blood smears revealed platelet clumping (Fig. 1A), we re-examined the hematology following blood collection in tubes that contained heparin. In this case, the platelet counts were 2.3 x 104/muL, and the blood smear still showed platelet clumping (Fig. 1B). Tokyo) was added into the tube (final concentration: 20 mg/mL). Treatment with KM dissociated the EDTA-induced platelet clumping and revealed accurate platelet counts (without KM, 1.3 x 104/muL; with KM, 15.2 x 104/muL) (Fig. 1C). We found lower platelet counts (PTCP) in tubes that contained EDTA or heparin compared to tubes with citrate sodium (Table 1 and Fig. 1A, B, D).
Head computed tomography before (A) and after (B) surgery.
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F2
Since cerebral CT scan revealed old cerebral infarction in right middle cerebral artery territory and left chronic subdural hematoma with severe brain compression and midline shift (Fig. 2A), we performed evacuation of the hematoma through single burr-hole craniostomy. PC transfusion postoperatively. Post-operative CT scans of the head revealed no bleeding (Fig. 2B).