Donna Kaiser asks, “Is the use of acid-citrate-dextrose (ACD) tubes acceptable for patients who present with platelet satellitosis? We have several patients that continue to clump in sodium citrate tubes, mostly oncology patients. I have heard of using ACD as the anticoagulant to resolve the issue. If this is true, which ACD tube is acceptable and what would the conversion factor be?
Hello, Donna, and thank you for your question. Platelet satellitosis most often appears in EDTA tubes, however like you, I have seen it in citrate tubes. In those instances, I have gone to heparin tubes, which introduce no correction factor and provide for an accurate platelet count, though they cannot be used to make Wright stain films. I’ve had no experience with ACD tubes, though, in a discussion with Dan Southern of Western Carolina University, we speculate that since citrate is the anticoagulant, the same problem may appear in ACD. The ACD tubes that are distributed by Becton-Dickinson appear to be glass only, I find no plastic ACD tubes in their catalogue. I’d like to hear from others about ACD or other approaches to managing satellitosis, which causes spurious thrombocytopenia, risking a clinical misinterpretation.