Clinical Chemistry
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Clinical Chemistry 47: 2071-a, 2001;
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(Clinical Chemistry. 2001;47:2071.)
© 2001 American Association for Clinical Chemistry, Inc.

Letters

Laboratory Screening for Abnormalities of Primary Hemostasis

What’s Next?

Giuseppe Lippi1a and Massimo Franchini2

1 Istituto di, Chimica e Microscopia Clinica, Dipartimento di, Scienze Morfologiche e Biomediche, Università degli Studi di Verona, 37134 Verona, Italy

2 Servizio di, Immunoematologia e Trasfusione, Ospedale Policlinico G.B. Rossi, Azienda Ospedaliera, 37134 Verona, Italy

aAddress correspondence to this author at: Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Biomediche e Morfologiche, Università degli Studi di Verona, Ospedale Policlinico, Piazzale Scuro 10, 37134 Verona, Italy. Fax 39-045-8201889; e-mail ulippi{at}tin.it.


To the Editor:

The diagnostic approach to abnormalities of primary hemostasis is still a major challenge for clinical laboratories. In clinical practice, the investigation of unexplained bleeding ideally uses easy, reliable, and inexpensive screening tests, eventually followed by second-line analyses (1). Because of a lack of reliable alternatives, the bleeding time (BT) test has been widely used for decades. However, the BT test is relatively insensitive and nonspecific with respect to identifying abnormalities of primary hemostasis. The diagnostic efficiency of the BT test for prediction of abnormal perioperative bleeding has been critically questioned (2)(3)(4)(5), suggesting the need for alternatives.

The interaction of citrated whole blood with biochemically active membranes coated with physiologic agonists (collagen and adenosine diphosphate or collagen and epinephrine) can be used to trigger platelet activation under high shear rates and generate a stable platelet plug. Abnormal prolongation of clot development can be automatically recorded by the PFA-100® Analyzer (Dade), which reflects potential qualitative and quantitative abnormalities of platelet function. The clinical usefulness of this test has been studied in some clinical settings, including evaluation of uremia, the laboratory approach to the diagnosis of von Willebrand disorder and platelet dysfunction, and the monitoring of therapy with antiplatelet drugs (6)(7)(8). The within- and day-to-day (total) imprecision (CV) of the test are reportedly <10% (8). The test may be especially useful in children (9) because the analysis does not require the active cooperation of the patient and uses <2 mL of blood. We agree with Lehman et al. (5) on the limited clinical impact of discontinuing the BT test, and we believe that automated, in vitro analyzers can be useful for the identification of some defects of primary hemostasis. The PFA-100 analysis has replaced the BT test in the evaluation of disorders of primary hemostasis in our laboratory (9).


References

  1. Triplett DA. Coagulation and bleeding disorders: review and update. Clin Chem 2000;46:1260-1269.[Abstract/Free Full Text]
  2. Rodgers RP, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost 1990;16:1-20.[Web of Science][Medline] [Order article via Infotrieve]
  3. Lind SE. The bleeding time does not predict surgical bleeding. Blood 1991;77:2547-2552.[Free Full Text]
  4. Peterson P, Hayes TE, Arkin CF, Bovill EG, Fairweather RB, Rock WA, Jr, et al. The preoperative bleeding time test lacks clinical benefit: College of American Pathologists’ and American Society of Clinical Pathologists’ position article. Arch Surg 1998;133:134-139.[Abstract/Free Full Text]
  5. Lehman CM, Blaylock RC, Alexander DP, Rodgers GM. Discontinuation of the bleeding time test without detectable adverse clinical impact. Clin Chem 2001;47:1204-1211.[Abstract/Free Full Text]
  6. Cattaneo M, Federici AB, Lecchi A, Agati B, Lombardi R, Stabile F, Bucciarelli P. Evaluation of the PFA-100 system in the diagnosis and therapeutic monitoring of patients with von Willebrand disease. Thromb Haemost 1999;82:35-39.[Web of Science][Medline] [Order article via Infotrieve]
  7. Cattaneo M, Lecchi A, Agati B, Lombardi R, Zighetti ML. Evaluation of platelet function with the PFA-100 system in patients with congenital defects of platelet secretion. Thromb Res 1999;96:213-217.[Web of Science][Medline] [Order article via Infotrieve]
  8. Mammen EF, Alshameeri RS, Comp PC. Preliminary data from a field trial of the PFA-100 system. Semin Thromb Hemost 1995;21(Suppl 2):113-121.
  9. Lippi G, Manzato F, Franchini M, Brocco G, Florenziani G, Guidi G. Establishment of reference values for the PFA-100 platelet function analyzer in pediatrics. Clin Exp Med 2001;:169-170.




This Article
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