Assessment of Primary Hemostasis by PFA-100® Analysis in a Tertiary Care Center

Summary

We evaluated the utility of the PFA-100® platelet function analyzer in identifying disorders in platelet function and/or von Willebrand factor (vWF) in patients with various systemic disorders being followed at a tertiary care center. Closure times were determined with collagen/ ADP (CADP) and collagen/epinephrine (CEPI) cartridges for 305 patients, and abnormal results were further evaluated with platelet aggregometry and vWF analysis. Prolonged CADP and/or CEPI closure times were identified in 114 patients (37.3%), but most were isolated prolonged CEPI closure times predominantly due to aspirin therapy (79 patients). Prolonged CADP closure times were most frequently due to qualitative platelet defects and/or decreased vWF levels. Prolonged CADP closure times were encountered most frequently in patients with sickle cell disease and were associated with a decreased hematocrit. This study demonstrated that the PFA-100® analyzer can accurately assess vWF-dependent platelet function and detect other platelet defects under high shear stress in complex patient populations.

Keywords

Primary hemostasis - platelets - von Willebrand factor

• References

• 1 Sadler JE. von Willebrand factor. J Biol Chem 1991; 266: 22777-80.
• 2 Eberst ME, Berkowitz LR. Hemostasis in renal disease: pathophysiology and management. Am J Med 1994; 96: 168-79.
• 3 Ballard HS, Marcus AJ. Platelet aggregation in portal cirrhosis. Arch Intern Med 1976; 136: 316-9.
• 4 Pareti FI, Gugliotta L, Mannucci L, Guarini A, Mannucci PM. Biochemical and metabolic aspects of platelet dysfunction in chronic myeloproliferative disorders. Thromb Haemost 1982; 47: 84-9.
• 5 Rasi V, Lintula R. Platelet function in the myelodysplastic syndromes. Scand J Haematol 1986; 36 (Suppl. 45) 71-3.
• 6 Perkins HA, MacKenzie MR, Fudenberg HH. Hemostatic defects in dysproteinemias. Blood 1970; 35: 695-707.
• 7 Bracey AW, Wu AH, Aceves J, Chow T, Carlile S, Hoots WK. Platelet dysfunction associated with Wilms tumor and hyaluronic acid. Am J Hematol 1987; 24: 247-57.
• 8 Orlando E, Cortelazzo S, Marchetti M, Sanfratello R, Barbui T. Prolonged bleeding time in patients with lupus anticoagulant. Thromb Haemost 1992; 68: 495-9.
• 9 Rinder MR, Richard RE, Rinder HM. Acquired von Willebrand’s disease: a concise review. Am J Hematol 1997; 54: 139-45.
• 10 Kundu SK, Heilmann EJ, Sio R, Garcia C, Davidson RM, Ostgaard RA. Description of an in vitro platelet function analyzer – PFA-100. Semin Thromb Hemost 1995; 21: 106-12.
• 11 Fressinaud E, Veyradier A, Truchaud F, Martin I, Boyer-Neumann C, Trossaert M, Meyer D. Screening for von Willebrand disease with a new analyzer using high shear stress: a study of 60 cases. Blood 1998; 91: 1325-31.
• 12 Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ. PFA-100 system: a new method for assessment of platelet dysfunction. Semin Thromb Haemost 1998; 24: 195-202.
• 13 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: 35-9.
• 14 Murdock PJ, Woodhams BJ, Matthews KB, Pasi KJ, Goodall AH. von Willebrand factor activity detected in a monoclonal antibody-based ELISA: an alternative to the ristocetin cofactor platelet agglutination assay for diagnostic use. Thromb Haemost 1997; 78: 1272-7.
• 15 Feuring M, Haseroth K, Janson CP, Falkenstein E, Schmidt BMW, Wehling M. Inhibition of platelet aggregation after intake of acetylsalicylic acid detected by a platelet function analyzer (PFA-100). Int J Clin Pharmacol Ther 1999; 37: 584-8.
• 16 Marshall PW, Williams AJ, Dixon RM, Growcott JW, Warburton S, Armstrong J, Moores J. A comparison of the effects of aspirin on bleeding time measured using the Simplate™ method and closure time measured using the PFA-100™ in healthy volunteers. Br J Clin Pharmacol 1997; 44: 151-5.
• 17 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: 213-7.
• 18 Harrison P, Robinson MSC, Mackie IJ, Joseph J, McDonald SJ, Liesner R, Savidge GF, Pasi J, Machin SJ. Performance of the platelet function analyzer PFA-100 in testing abnormalities of primary hemostasis. Blood Coag Fibrinol 1999; 10: 25-31.
• 19 Escolar G, Cases A, Vinas M, Pino M, Calls J, Cirera I, Ordinas A. Evaluation of acquired platelet dysfunctions in uremic and cirrhotic patients using the platelet function analyzer (PFA-100): influence of hematocrit elevation. Haematologica (Pavia) 1999; 84: 614-9.
• 20 Triadou P, Fonty E, Ambrosio AS, Cottat MC, Girot R, Cornu P. Platelet function in sickle cell disease during steady state. Nouv Rev Fr Hematol 1990; 32: 137-42.
• 21 Leichtman DA, Brewer GJ. A plasma inhibitor of ristocetin-induced platelet aggregation in patients with sickle hemoglobinopathies. Am J Hematol 1977; 02: 251-8.
• 22 Bloom AL. von Willebrand factor: Clinical features of inherited and acquired disorders. Mayo Clin Proc 1991; 66: 743-51.
• 23 Rodeghiero F, Castaman G, Dini E. Epidemiological Investigation of the Prevalence of von Willebrand’s Disease. Blood 1987; 69: 454-9.