Validation of flow cytometric analysis of platelet function in patients with a suspected platelet function defect. (1st February 2018)

• Record Type: Journal Article
• Authors: van Asten, I.; Schutgens, R. E. G.; Baaij, M.; Zandstra, J.; Roest, M.; Pasterkamp, G.; Huisman, A.; Korporaal, S. J. A.; Urbanus, R. T.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 16:Number 4(2018)
• Page Start: 689
• Page End: 698
• Publication Date: 2018-02-01
• Subjects: blood platelet disorders -- blood platelets -- flow cytometry -- platelet activation -- platelet function tests; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.13952
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract : Essentials The diagnosis of mild platelet function disorders (PFDs) is challenging. Validation of flow cytometric testing in patients with suspected PFDs is required. Flow cytometry has added value to light transmission aggregometry (LTA) in diagnosis of PFDs. There is fair agreement in diagnosing PFDs between LTA and flow cytometry. Summary: Background: Light transmission aggregometry (LTA) is the most commonly used test for the diagnosis of platelet function disorders (PFDs), but has moderate sensitivity for mild PFDs. Flow cytometry has been recommended for additional diagnostics of PFDs but is not yet standardized as a diagnostic test. We developed a standardized protocol for flow cytometric analysis of platelet function that measures fibrinogen binding and P‐selectin expression as platelet activation markers in response to agonist stimulation. Objectives: To determine the additional value of flow cytometric platelet function testing to standard LTA screening in a cross‐sectional cohort of patients with a suspected PFD. Methods: Platelet function was assessed with flow cytometry and LTA in 107 patients suspected of a PFD in whom von Willebrand disease and coagulation factor deficiencies were excluded. Both tests were compared in terms of agreement and discriminative ability for diagnosing patients with PFDs. Results: Out of 107 patients, 51 patients had an elevated bleeding score; 62.7% of the patients had abnormal platelet function measured with flow cytometry and 54.2% of the patients were abnormal based on LTA. There was fair agreement between LTA and flow cytometry (κ = 0.32). The discriminative ability of flow cytometric analysis in patients with an elevated bleeding score was good (AUC 0.82, 0.74–0.90), but moderate for LTA (AUC 0.70, 0.60–0.80). Both tests combined had a better discriminative ability (AUC 0.87, 0.80–0.94). Conclusion: Flow cytometric analysis of platelet function has added value in diagnostics of PFDs in patients with unexplained bleeding tendency.