Methods employed for distinguishing true thrombocytopenia

Methods employed for distinguishing true thrombocytopenia from PTCP include using other anticoagulants (sodium citrate, oxalate, and heparin), elevating the temperature of a blood sample to 37°C, examining a blood sample containing EDTA as soon as possible, examining a blood smear under a microscope, and adding kanamycin or amikacin to a blood sample collected with EDTA. Automated platelet clump count is also available for screening EDTA-dependent PTCP. Misclassification of PTCP leads to unnecessary diagnostic tests and treatment. In Case 1, we conducted an unnecessary platelet transfusion and delayed surgery on the patient, which could have led to complications after the transfusion, making the patient anxious. Additional aggressive treatments, such as splenectomy, steroid therapy, and bone marrow biopsy have also been reported. When a patient with a low platelet count but without any hematology disease, family history, and bleeding tendency manifestation is identified, PTCP should also be considered. When EDTA-dependent PTCP is suspected, a blood sample of the patient with tubes containing other anticoagulants can be re-evaluated. Later on, the simple, inexpensive, and diagnostic method of peripheral blood smear examination can be employed to confirm platelet clumping (Fig. 3).
Introduction Degenerative sagittal imbalance is either flexible or fixed. An anterior release and posterior instrumentation can be used to correct the deformity of patients with flexible degenerative sagittal imbalance, whereas pedicle subtraction osteotomy (PSO), commonly applied for treating ankylosing spondylitis, iatrogenic flat-back deformity, and posttraumatic kyphosis, is used for correcting the sagittal alignment of patients with fixed degenerative sagittal imbalance. PSO is theoretically performed on L4, which is always the apex of lumbar lordosis, in a normal population. However, most spine surgeons prefer L3 as the osteotomy site, because wedge resection is easier to perform on L3 than on L4. The procedure involves resecting the vertebral wedge from the spine, widening from the anterior Merimepodib of the vertebral body through the pedicles and toward the posterior elements of the spine. The degree of correction should be measured preoperatively to avoid inadequate sagittal-balance restoration after osteotomy. Among the various methods used for calculating the degree of correction, the full-balance-integrated (FBI) technique is relatively simple and effective. In this technique, the projected C7 plumb line falling on the S1 plateau is evaluated preoperatively to determine the degree of correction. Sagittal imbalance is sometimes accompanied with coronal imbalance. For the concurrent restoration of sagittal balance and correction of coronal imbalance, an asymmetrical PSO can be used. Coronal imbalance can be corrected during wedge closure through the removal of a large portion of the wedge-shaped bone on the convex side and a small portion of the vertebral body on the concave side.
Case report The patient was a 56-year-old female who experienced mild back pain, which radiated to her legs, as well as intermittent claudication for 5 years. The symptoms became more pronounced on sitting and walking, and conservative therapy was ineffective in relieving pain. Preoperative whole-spine X-ray scans revealed lumbar kyphoscoliosis (Cobb angle: 10.2°) and positive sagittal balance [sagittal vertical axis (SVA): 7.6 cm] (Figs. 1 and 2). A magnetic resonance imaging scan of the lumbar spine revealed hypertrophy of the facet joints and the ligamentum flavum, as well as disk herniations at L3–L4 and L4–L5 (Fig. 3). Asymmetrical PSO was performed and convex-sided posterolateral wedge osteotomy was applied to correct the kyphoscoliosis and to restore sagittal balance. Before performing the asymmetrical PSO, the angle for correcting lumbar kyphosis was calculated according to the FBI technique. First, a new projected C7 plumb line should pass through the S1 plateau. A 15° angle (angle of C7 translation) was obtained by measuring the angle between a line connecting the center of L4 with the center of C7, and another line connecting the center of L4 with a projected C7 plumb line that fell vertically on the S1 plateau. Second, the angle of femur obliquity was calculated to be 5° by measuring the inclination of the femoral axis to the vertical. Third, the pelvic-tilt compensation angle was 5° because the patient\'s pelvic tilt was 23.5° (between 15° and 25°) (Fig. 4). Hence, the summation of the correction angle was 25°, which lies within the range of the degree of correction provided by the PSO.