EVALUATION OF PRIMARY HAEMOSTASIS WITH PLATELET FUNCTION ANALYSER PFA-10
Abstract
Background. Laboratory evaluation is indicated when a disorder of primary haemostasis is suspected by a personal or family history of easy bruising, nose bleeds, menorrhagia or postoperative bleeding, especially following dental extraction or tonsillectomy. The traditional procedures to diagnose defect in primary haemostasis are bleeding time, measurement of von Willebrand factor and platelet aggregometry. The most widely used screening test is bleeding time. Despite attempts at standardisation, the bleeding time remains poorly reproducible and is relatively insensitive to platelet function defects. Recently, a new test method, the platelet function analyser (PFA-100) has been introduced for the investigation of primary haemostasis. PFA-100 measures the ability of platelets activated in a high-shear environment to occlude an aperture in membrane treated with collagen and epinephrine and/or collagen and ADP. The time taken for flow across the membrane to stop (closure time) is recorded.
Conclusions. This article highlights the benefits and limitations of the clinical utility of the PFA-100. Because of its simplicity and excellent sensitivity the PFA-100 is useful mainly as a screening test for von Willebrand disease, hereditary and acquired platelet-dysfunctions including acetylsalicylic acidinduced abnormalities. Recently the PFA-100 has been shown to be of value in monitoring antiplatelet therapy and in monitoring desmopressin treatment in von Willebrand disease.
Downloads
References
Marchant KK, Corcoran G. The laboratory diagnosis of platelet disorders. An algorithmic approach. Arch Pathol Lab Med 2002; 126: 133–46.
Mattix H, Singh AK. Is the bleeding time predictive of bleeding prior to a percutaneous renal biopsy? Curr Opin Nephrol Hypertens 1999; 8: 715–8.
Lehman CM, Blaylock RC, Alexander DP, Rodgers GM. Discontinuation of the bleeding time test without detectable adverse clinical impact. Clin Chem 2001; 47: 1204–11.
Mammen EF, Comp PC, Gosselin R et al. PFA-100 system: a new method for assessment of platelet dysfunction. Semin Thromb Hemost 1998; 24: 195– 202.
Kundu SK, Heilmann EJ, Sio R et al. Description of an in-vitro platelet function analyser: PFA-100. Semin Thromb Hemost 1995; 21: Suppl 2: 106–12.
Mammen EF, Alshameeri RS, Comp PC. Preliminary data from a field trial of the PFA-100 system. Semin Thromb Hemost 1995; 21: Suppl 2: 113–20.
Wuillemin WA, Gasser KM, Zeerleder SS, Lammle B. Evaluation of platelet function analyser (PFA-100) in patients with a bleeding tendency. Swiss Med Wkly 2002; 132: 443–8.
Harrison P, Robinson MSC, Mackie IJ et al. Performance of the platelet function analyser PFA-100 in testing abnormalities of primary haemostasis. Blood Coagul Fibrinolysis 1999; 10: 25–31.
Heilmann JE, Kundu KS, Sio R et al. Comparison of four commercial citrate blood collection systems for platelet function analysis by the PFA-100™ system. Thromb Res 1997; 87: 159–64.
Wuillemin WA, Gasser KM, Zeerleder SS, Lammle B. Evaluation of platelet function analyser (PFA-100) in patients with a bleeding tendency. Swiss Med Wkly 2002; 132: 443–8.
Favaloro EJ. Utility of the PFA-100 for assessing bleeding disorders and monitoring therapy. A review of analytical variables, benefits and limitations. Hemophilia 2001; 7: 170–9.
Favaloro EJ. Clinical application of the PFA-100. Curr Opin Hematol 2002; 9: 407–15.
Jilma B. Platelet function analyser (PFA-100): a tool to quantify congenital or acquired platelet dysfunction. J Lab Clin Med 2001; 138: 152–63.
Francis J, Francis D, Larson L, Helms E, Garcia M. Can the platelet function analyser (PFA)-100 test substitute for the template bleeding time in routine clinical practice? Platelets 1999; 10: 132–6.
Escolar G, Cases A, Vinas M, Pino M, Calls J, Cirera I, Ordinas A. Evaluation of acquired platelet dysfunctions in uremic and cirrotic patients using the platelet function analyser (PFA-100TM): influence of hematocrit elevation. Haematologica 1999; 84; 614–9.
Kottke-Marchant K, Powers JB, Brooks L, Kundu S, Christie DJ. The effect of antiplatelet drugs, heparin, and preanalytical variables on platelet function detected by the platelet function analyser (PFA-100). Clin Appl Thromb Hemost 1999; 5: 122–30.
Carcao MD, Blanchette VS, Stephens D et al. Assessment of thrombocytopenic disorders using the platelet function analyser (PFA-100). Br J Haematol 2002; 117: 961–4.
Fressinaud E, Veyradier A, Truchaud F et al. Screening for von Willebrand disease with a new analyser using high shear stress: a study of 60 cases. Blood 1998; 91: 1325–31.
Ortel TL, James AH, Thames EH et al. Assessment of primary hemostasis by PFA-100 analysis in a tertiary care center. Thromb Haemost 2000; 84: 93–7.
Von Pape K, Aland E, Bohner J. Platelet function analysis with PFA-100 in patients medicated with acetylsalicylic acid strongly depends on concentration of sodium citrate used for anticoagulation of blood sample. Thromb Res 2000; 98: 295–9.
Homoncik M, Jilma B, Hergovich N et al. Monitoring of aspirin (ASA) pharmacodynamics with the platelet function analyser PFA-100. Thromb Haemost 2000; 83: 316–21.
Zupan IP, Šabovič M, Salobir B, Ponikvar JB, Černelč P. Utility of in vitro closure time test for evaluating platelet-related primary hemostasis in dialysis patients. Am J Kidney Dis 2003, 42; 746–51.
Homoncik M, Blann AD, Hollenstein U, Prenerstorfer T, Eichler HG, Jilma B. Systemic inflamation increase shear stress-induced platelet plug formation measured by PFA-100. Br J Haematol 2000; 111: 1250–2.
Fressinaud E, Veyradier A, Sigaud M, Boyer-Neumann C, Le Boterff C, Meyer C. Therapeutic monitoring of von Willebrand disease: interest and limits of a platelet function analyser at high shear rates. Br J Haematol 1999; 106: 777–83.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
