You are called by the CCU nurses. They are concerned that one of a post primary angioplasty patient’s blood results has returned with platelets of 12 × 109 /L. Bloods taken at the time of procedure revealed platelets of 179 × 109 /L. The patient has no signs of bleeding and all other blood results, including haemoglobin, are stable and consistent. They have been loaded with aspirin 300 mg, prasugrel 60 mg, heparin 8000 units, and abciximab as a weight-adjusted bolus and current infusion for 12 hours. They had not previously received these agents. GP 2b/3a was recommended as the patient had a highly thrombotic right coronary artery occlusion with evidence of microvascular distal embolization and required a long length of drug-eluting stent.
What do you advise?
A. This is likely to be a spurious result; continue with the current treatments but repeat the blood result urgently and watch for bleedingInadequate platelet inhibition or platelet replacement will increase the chances of early stent thrombosis and should be avoided. This clinical scenario suggests an early immune-mediated response to abciximab with thrombocytopenia. The platelet count should gradually recover on stopping the agent, but the platelets should not be replaced unless there were signs of significant bleeding. Heparin-induced thrombocytopenia usually occurs after a few days with repeated exposure. Pseudo-thrombocytopenia (clumping) is possible and would be obvious on a blood film, but this should be excluded rather than assumed.