Evaluation of Amikacin Mediated Platelet Aggregate Dissociation in Multi-Anticoagulant-Dependent Pseudothrombocytopenia (PTCP).

Anticoagulant-dependent pseudothrombocytopenia (PTCP) is an in vitro artifact that leads to falsely low platelet counts. To evaluate the efficacy of Amikacin in reversing platelet (PLT) clumping induced by various anticoagulants, including EDTA, heparin, and sodium citrate. we collected 26 blood samples demonstrating EDTA-dependent pseudothrombocytopenia. Amikacin solution (50 μL of 50 mg/L) was added to 500 μL of whole blood from each sample. Complete blood count (CBC) analysis was performed at 5, 30, 60, 240 min, and 24 h post-treatment. Additionally, five samples exhibiting PLT aggregation dependent on multiple anticoagulants (EDTA, heparin, and sodium citrate) were treated with Amikacin, and PLT counts were compared across the different anticoagulant tubes. For the Amikacin-treated EDTA tubes, differential leukocyte counts (DLC) were analyzed and compared with untreated controls, with validation by flow cytometry. Amikacin treatment significantly increased PLT counts in EDTA-dependent samples compared with untreated controls (p < 0.001), with the maximum effect observed at 240 min. In samples with multi-anticoagulant dependency, PLT counts in heparin- and sodium citrate-anticoagulated tubes remained significantly lower than those in EDTA tubes after Amikacin treatment (p < 0.01). Furthermore, in Amikacin-treated EDTA blood, the proportions of neutrophils and basophils were significantly increased (p < 0.0001), whereas the proportions of lymphocytes and monocytes decreased (p < 0.01). Amikacin effectively reverses EDTA-dependent PLT clumping within 240 min, but only partially resolves aggregation induced by heparin or sodium citrate. Moreover, the use of Amikacin in EDTA-anticoagulated blood compromises the accuracy of CBC differential counts, rendering such samples unsuitable for routine hematological analysis.