Psuedothrombocytopenia, the presence of platelet clumping on the peripheral blood film, is usually considered to rule out the diagnosis of immune thrombocytopenia (ITP) or other causes of increased platelet destruction and to be a laboratory artifact of no clinical significance. We report a case of concurrent psuedothrombocytopenia and ITP. While the examination of the peripheral blood film remains a critical element of the diagnostic approach to thrombocytopenia, this case emphasizes the importance of confirming the relevance of morphologic findings by additional testing.