Determination and Treatment of Disorders of Primary Haemostasis

V. Kretschmer; M. Weippert-Kretschmer

doi:10.1055/s-0038-1660415

Hämostaseologie, Table of Contents

Hamostaseologie 1999; 19(04): 168-175
DOI: 10.1055/s-0038-1660415

Schwerpunktthema/Main Topic

Schattauer GmbH

Determination and Treatment of Disorders of Primary Haemostasis

Experience with Routine Application of the In Vitro Bleeding Test

V. Kretschmer

¹Department of Transfusion Medicine and Haemostaseology, University Hospital, Marburg

,

M. Weippert-Kretschmer

¹Department of Transfusion Medicine and Haemostaseology, University Hospital, Marburg

› Author Affiliations

Abstract

Summary

Perioperative bleeding complications due to disorders of primary haemostasis are often underestimated. Routine determination of primary haemostasis is still problematic. The in vivo bleeding time (BT) shows low sensitivity and high variability. In this contribution the results and experiences with the IVBT having been obtained in various studies and during 10 years of routine use are reported. Patients and Methods: Blood donors before and after ASA ingestion, patients with thrombocytopenia as well as congenital and acquired platelet function disorders. Monitoring of desmopressin efficacy. IVBT with Thrombostat 4000 (tests with CaCl₂ = TST-CaCl₂ and ADP = TST-ADP) and PFA-100 (test cartridges with epinephrine = PFA-EPI and ADP = PFA-ADP). Results and Conclusions: IVBT becomes abnormal with platelet counts <100,000/μl. With platelet counts <50,000/μl the results are mostly outside the methodical range. IVBT proved clearly superior to BT in von Willebrand syndrome (vWS). All 16 patients with vWS were detected by PFA-EPI, whereas with BT 7 of 10 patients with moderate and 1 of 6 patients with mild forms of vWS were spotted. The majority of acquired and congenital platelet function disorders with relevant bleeding tendency were detectable by IVBT. Sometimes diagnostic problems arose in case of storage pool defect. Four to 12 h after ingestion of a single dose of 100 mg ASA the TST-CaCl₂ became abnormal in all cases, the PFA-EPI only in 80%. However, the ASA sensitivity of TST-CaCl₂ proved even too high when looking for perioperative bleeding complications in an urological study. Therefore, the lower ASS sensitivity of the PFA-100 seems to be rather advantageous for the estimation of a real bleeding risk. The good efficacy of desmopressin in the majority of cases with mild thrombocytopenia, congenital and acquired platelet function disorders and even ASS-induced platelet dysfunction could be proven by means of the IVBT. Thus IVBT may help to increase the reliability of the therapy. However, the IVBT with the PFA-100 is not yet fully developed. Nevertheless, routine use can be recommended when special methodical guidelines are followed.

Keywords

Primary haemostasis - platelet function - von Willebrand syndrome - acetylsalicylic acid - platelet disorder - bleeding time - desmopressin

Full Text

References

References
1 Beck K-H, Mohr P, Bleckmann U, Schweer H, Kretschmer V. Desmopressin effect on acetylic-acid impaired platelet function. Semin Thromb Hemost 1995; 21 (Suppl. 02) 32-9.
2 Bergmann F, Drewke E, Budde U. Sensitivity and specifity of the pfa 100^® analyser regarding disorders of hemostasis. Ann Hematol 1997; 74 (Suppl. 02) A54.
3 Budde U, Kußmann J. (Personal communication 1999).
4 De Rossi S, Glick M. Bleeding time: An unrealiable predictor of clinical haemostasis. J Oral Maxillofac Surg 1996; 54: 1119-20.
5 Dietrich G, Kretschmer V, Weber D, Haupt W, Langen B, Huss B. Variables influencing the Thrombostat 4000:Recommended standardization. Semin Thromb Hemost 1995; 21 (Suppl. 02) 11-9.
6 Dietrich G, Weber D, Kretschmer V. The in vitro bleeding test - Standardization of the methodical procedure. Lab med 1993; 17: 317-23.
7 Eistert B, Kirchmair C, Risse M, Glanz H. Thrombozytenfunktionsstörungen als Ursache von Nachblutungen nach Tonsillektomien. HNO 1995; 43 (03) 177-81.
8 Gasser K, Lämmle B, Sulzer I, Wuillemin W.A. PFA-100:Evaluation of a new method and influence of Acetylsalicylic Acid (ASA). Ann Hematol 1999; 78 (Suppl. 01) A74 (Abstract P 160).
9 Hoffmann J, Bonacker G, Kretschmer V, Schulzki T, Heimanns J. IVBT-docu-mented platelet function correlates with flow cytometric data. Transfus Sci 1996; 17: 553-8.
10 Kratzer M.A.A, Beilud S, Cean J.P. Detection of abnormal platelet function with an in vitro model of primary haemostasis. Haemostasis 1985; 15: 363-70.
11 Kratzer M.A.A, Born G.V.R. Simulation of primary haemostasis in vitro. Haemostasis 1985; 15: 347-62.
12 Kretschmer V, Huss B, Bonacker G, Hoffmann J, Bewarder S, Weber S, Schulzki T, Köppler H, Heimanns J. Thrombocytope-nia-adapted in vitro bleeding test assesses platelet function in thrombocytopenic patients. Semin Thromb Hemost 1995; 21 (Suppl. 02) 79-90.
13 Kretschmer V, Huss B, Dietrich G, Heymanns J, Pflüger K-H. Determination of bleeding risk in thrombocytopenic patients receiving platelet substitution. Transfus Sci 1993; 14: 27-34.
14 Kretschmer V, Huss B, Weber S, Bewarder S, Schulzki T, Köppler H, Heimanns J. A contribution to the indications for platelet transfusion and determination of its therapeutic efficacy. Transfus Sci 1994; 15: 361-9.
15 Kretschmer V, Leicht E, Rothmund M, Zeiler T, Karger R. Perioperative therapy and monitoring of acquired von Willebrand disease (vWD) - Case report. Ann Hematol 1999; 78 (Suppl. 01) A60 (Abstract P 102).
16 Kretschmer V, Marsian F, Zeiler T, Weippert-Kretschmer M. ASS sensitivity of the in-vitro-bleeding-test (IVBT) with platelet function analyzer 100 (PFA-100). Ann Hematol 1999; 78 suppl. A76 (Abstract P 165).
17 Kretschmer V, Schikor B, Söhngen D, Dietrich G. In vitro bleeding test - A simple method for the detection of aspirin effects on platelet function. Thromb Res 1989; 56: 593-602.
18 Kretschmer V. Clinical implications of the in vitro bleeding test - A review. Infusionsther Transfusionsmed 1997; 24: 428-34.
19 Kundu S.K, Heilmann E.J, Sio R, Garcia C, Davidson R.M, Ostgaard R.A. Description of an in vitro platelet function analyzer-PFA-100™. Semin Thromb Hemost 1995; 21 (Suppl. 02) 106-12.
20 Papevon K-W, Aland E, Bohner J. Platelet function analysis with PFA-100™ in patients medicated with acetylsalicylic acid depends on concentration of sodium citrate used for anticoagulation of blood samples. Ann Hematol 1999; 78 (Suppl. 01) A59 (Abstract P 099).
21 Peterson P, Hayes T.E, Arkin C.F, Bovili E.G, Fairweather R.B, Rock W.A, Triplett D.A, Brandt J.T. The preoperative bleeding time test lacks clinical benefit. Arch Surg 1998; 133: 134-9.
22 Thommen D, Sulzer I, Buhrfeind E, Naef R, Furlan M, Lämmle B. Messung der Blutungszeit und Untersuchung der Thrombozytenaggregation. Schweiz med Wschr 1988; 118: 1559-67.
23 Ulshöfer B, Dorst V, Kretschmer V, Köhl H, Riedmüller H. Hemostaseological management of urological Operations in patients taking aspirin using the Thrombostat 4000. Semin Thromb Hemost 1995; 21 (Suppl. 02) 52-8.
24 Weippert-Kretschmer M, Witte M, Budde U, Vigli T, Kretschmer V, Scharrer I. The Thrombostat 4000 - A sensitive screening test for the von Willebrand’s disease. Semin Thromb Hemost 1995; 21 (Suppl. 02) 44-51.