To help determine the cause of or potential for excessive bleeding and/or to diagnose a platelet function disorder; to monitor and evaluate platelet function; to monitor the presence and effectiveness of anti-platelet medications
When you bruise easily or experience excessive or prolonged bleeding from minor cuts, nose or gums, or excessive menstrual bleeding; when you are taking medications that can alter platelet function; prior to or during certain surgeries; if you have a family member with a history of excessive bleeding
A blood sample drawn from a vein in your arm
You may be instructed to refrain from taking drugs that can affect the results of these tests, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or any over-the-counter medications that contain drugs such as these, anti-histamines, and certain antibiotics. The most common NSAIDs include ibuprofen, naproxen and COX-2 inhibitors. However, do not stop taking your medications unless instructed to do so by your healthcare practitioner.
Platelets (also known as thrombocytes) are small, round cellular fragments that are vital for normal blood clotting. Platelet function tests indirectly evaluate how well a person's platelets work in helping to stop bleeding within the body.
Platelets are produced in the bone marrow and circulate in the blood. When there is an injury to a blood vessel and bleeding begins, platelets are the first elements to help to stop bleeding. They do so in three ways. They:
These reactions result in the formation of a loose platelet plug in a process called primary hemostasis. At the same time, activated platelets support the coagulation cascade, a series of steps that involves the sequential activation of proteins called clotting factors. This is called secondary hemostasis and the two processes result in the formation of a stable clot that remains in place until the injury has healed.
If there are insufficient platelets or if they are not functioning normally in any of the three main ways, a stable clot may not form and a person may be at an increased risk of excessive bleeding. The number of platelets in blood can be determined with a platelet count and can help diagnose disorders having to do with too many or too few platelets. However, the overall ability of platelets to function properly in the body is more difficult to measure.
Platelet function tests are a group of assays that use specialized equipment to measure the ability of platelets to aggregate and promote clotting in a sample of blood. There are a variety of tests available but no one test that identifies all problems with platelet function. Also, there is no widespread agreement on which test(s) is best for each circumstance.
In addition to evaluating people for excessive bleeding, platelet function tests may be used in other situations. There are situations in which it is desirable to decrease the ability of platelets to aggregate, as in for people who are at an increased risk of developing a dangerous blood clot or at increased risk for heart attacks. These people may be prescribed medications that reduce platelet activation or reduce their ability to aggregate. People on these types of anti-platelet medications, such as low-dose aspirin or clopidogrel, may have platelet function tests done as a way of monitoring their treatment. However, there is currently no consensus among medical experts on the usefulness of platelet function tests in anti-platelet therapy.
In the past, the primary screen for platelet dysfunction was the bleeding time or the standardized bleeding time. This was the only test that directly measured platelet function within the body. It involves making two small, shallow, standardized cuts on the inner forearm and measuring the amount of time for bleeding to stop. The bleeding time procedure has fallen from favor in recent years. Many hospitals no longer offer it and several national organizations have issued position statements against its routine use. The bleeding time is not sensitive or specific and it does not necessarily reflect the risk or severity of surgical bleeding. It is poorly reproducible, can be affected by aspirin use and by the skill of the person performing the test, and frequently leaves small, thin scars on the forearm.
Closure time assays
This test measures the time required for the platelets in a sample of blood to plug a small hole in a tiny tube after being exposed to various activating substances. This is called the closure time. Prolonged closure times indicate lower platelet function but do not identify the cause. This test may be abnormal if the platelet count is low, if platelet function is reduced, if other proteins needed for platelet function are reduced, or if anti-platelet medications are present. This type of assay can be used to screen for von Willebrand disease and some platelet function disorders, but it will not detect all platelet function disorders, particularly the milder forms. This test is relatively simple to perform and is available in many healthcare facilities. Further testing would need to be performed in order to identify the exact cause of any abnormal results.
Viscoelastometry (or Thromboelastometry)
Blood clots have to be strong to stop bleeding and prevent new bleeding until healing can occur. This type of testing is designed to determine the strength of a blood clot as it forms. It is most often performed in larger hospitals, either in the operating room as a point-of-care test or in the clinical laboratory.
Endpoint bead or endpoint platelet aggregation assays
These assays determine the number of coated beads or platelets that aggregate after substances are added to activate platelets in a sample of blood. They provide a single measure of aggregation (an endpoint) rather than a measure of aggregation over time. More platelets aggregating or sticking to beads indicates better platelet function. These tests may be abnormal if the platelet count is low, if platelet function is reduced, or if anti-platelet medications are present.
Platelet count ratio
The number of platelets are measured in an initial sample. A substance is added to the sample to activate the platelets and cause them to aggregate. The number of platelets is measured again – only those that have not aggregated will be counted the second time. The difference between the first measurement and the second measurement is an indication of platelet function.
Many different substances can activate a platelet, including proteins in the wound, factors released from other activated platelets, and factors produced by the coagulation system that aids platelets in forming a strong plug to stop bleeding. Many different platelet abnormalities have been described due to problems with one or more of these activating systems. Platelet aggregometry consists of 4 to 8 separate tests. In each test, a different platelet activating substance (agonist) is added to blood, followed by measurement of platelet aggregation over several minutes. When complete, the entire panel of tests is reviewed and interpreted to determine if there is any evidence of abnormal platelet function. Platelet aggregation testing is the gold standard in platelet function testing and can diagnose a variety of inherited and acquired platelet function disorders. It is typically performed at academic medical centers or large hospitals due to the complexity of the testing and interpretation.
Similar to platelet aggregometry, lumiaggregometry simultaneously measures the release of certain organic agents from platelet granules (little sacs within the platelet) utilizing a luminescence technique. This technique measures the amount of light emitted when activating substances are added, that results in the conversion of ADP (adenosine diphosphate) to ATP (adenosine triphosphate). This measurement reflects any abnormalities that may be present in platelet granules, a problem with patients with 'storage pool defects' that are often seen in grey platelet syndrome, Hermansky-Pudlak syndrome, and Chediak-Higashi syndrome.
Platelets can be evaluated for functional defects using flow cytometry. This test uses lasers to determine proteins that are present on the platelet surface and how they change when the platelet is activated. Platelet flow cytometry is a highly specialized procedure available only in a few university hospital and reference laboratories to diagnose inherited platelet function disorders.
A blood sample is drawn though a needle from a vein in the arm. Due to critical time constraints related to platelet activation/ function, you may be sent directly to the laboratory performing the tests. If you have a history of excessive bleeding, you should inform the healthcare practitioner drawing your blood.
In general, no test preparation is needed. However, you may be instructed to refrain from taking drugs that can affect the results of these tests, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or any over-the-counter medications that contain drugs such as these. The most common NSAIDs include ibuprofen, naproxen, and COX-2 inhibitors. (See MedlinePlus Drugs & Supplements for more information on drugs, drug ingredients, and brand names.) However, do not stop taking your medications unless instructed to do so by your healthcare practitioner.
Various platelet function tests are used to evaluate the ability of platelets to clump together and begin to form a clot. They may be used for a variety of reasons. Examples of some of the situations in which they may be used include:
Platelet function testing may include one or more of the following:
For a more detailed explanation of these tests, read the "What is being tested?" section.
Some other tests that may be done in conjunction with or as follow up to platelet function tests to evaluate platelet disorders include complete blood count (CBC), platelet count, PT, PTT, D-dimer, and von Willebrand factor (vWF).
One or more platelet function tests are ordered whenever a healthcare practitioner wants to evaluate platelet function. This may be:
The interpretation of results of the various types of platelet function tests depends on why the tests were performed.
In the investigation of excessive bleeding or the potential for bleeding during surgery, abnormal results may indicate the presence of a platelet disorder. Testing for coagulation factor deficiencies or abnormalities (bleeding disorder tests) in addition to clinical evaluation is often necessary to identify an inherited disorder or acquired condition as the cause of the dysfunction. Often, family studies may be required to determine if the abnormality is inherited or acquired.
Examples of inherited platelet function disorders include:
Acquired platelet dysfunction – those that are not inherited – may be due to chronic conditions such as:
Some acquired platelet disorders that are temporary include:
When a person is on an anti-platelet medication, such as aspirin, the results of testing reflect the platelet response to the medication.
Platelet function testing is not a perfect reflection of the clotting process in the body (in vivo). A person with normal platelet function test results may still experience excessive bleeding or inappropriate clotting during and after a surgery.
Most samples for platelet function testing are only stable for a very short period of time. Testing choices are often limited to what is locally available.
There are several drugs that can affect the results of platelet function tests. Some of these include:
Many people will never need to have platelet function testing performed. It is generally only indicated when someone is experiencing bleeding, on specific medications, or having certain surgeries. The tests are not indicated for general screening.
Typically, a hospital or laboratory will offer one or more tests but not a wide variety. Since the sample must be tested promptly, your healthcare practitioner will choose from what is available. Rarely, if a healthcare practitioner wanted a particular type of test done, then it might be necessary for you to go to a clinic, hospital, or another city where that test is performed.
It could. While some conditions associated with platelet dysfunction are inherited, others are acquired and may occur at any point in your life. Platelet dysfunction that is due to a chronic disease may persist but can generally be managed. Dysfunction due to medication will typically resolve once the medication is discontinued.
Sources Used in Current Review
2017 review performed by Nicole Ziegler, MT (ASCP) and the Editorial Review Board.
Kottke-Marchant, Kandice (©2016) An Algorithmic Approach to Hemostasis Testing Second Edition: College of American Pathologists (CAP) Press, Northfield, IL. Pp 17-32, 99-120
Chandler, W.L. Emergency assessment of hemostasis in the bleeding patient. Int J Lab Hematol. 2013; 35:339-343. Available online at http://onlinelibrary.wiley.com/doi/10.1111/ijlh.12071/pdf. Accessed on 4/27/17 Accessed on 6/2/2017.
Harrison, P and Lordkipanidze, M. Testing Platelet Function. Hematol Onc Clin N Am. 2013; 27:411-441.
Breet NJ, van Werkum, JW, Bouman HJ, et al. Comparison of six major platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. JAMA 2010; 303(8): 849-56. Available online at https://www.ncbi.nlm.nih.gov/pubmed/20179285. Abstract accessed 6/2/2017.
Breet NJ, van Werkum JW, Bouman HJ, et al. High on-aspirin platelet reactivity as measured with aggregation-based, cyclooxygenase-1 inhibition sensitive platelet function tests is associated with the occurrence of atherothrombotic events. J Thromb Haemost 2010;8(10):2140-8. Available online at http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2010.04017.x/abstract. Accessed 4/27/17.
Paniccia R, Priora R, Alessandrello A, et al. Platelet function tests: a comparative review. Vascul Health Risk Manage 2015; 11:133-148.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.
Bleeding Time. AccessMed Health Information Library [On-line information]. Available online at http://www.hendrickhealth.org/healthy/000209.htm.
Elstrom, R. (2001 October 28, Updated). Platelet aggregation test. MedlinePlus Health Information, Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003669.htm.
Menta, S. (1999 Spring). The Coagulation Cascade. Physiology Disorders Evaluation, College of Medicine, Univ of Florida [On-line information]. Available online at http://www.medinfo.ufl.edu/year2/coag/title.html.
Platelet Function Analyzer (PFA)-100 – FAQ. Florida Hospital Cancer Institute, Clinical and Research Laboratories [On-line information]. Available online at http://www.fhci-labs.com/researchlabs/clinicallabs/hemostasisandthrombosis/faq/pfa-faq.htm.
Kottke-Marchant, K. and Aller, R. (2003 January). Toward multi-functional analyzers. College of American Pathologists, January 2003 Survey of instruments [On-line information]. Available online at http://www.cap.org/apps/docs/cap_today/surveys/coagSurvIntro.html.
Corcoran, G. and Kottke-Marchant, K. (2002 June). Chasing after the causes of platelet disorders. College of American Pathologists, Feature Story [On-line article]. Available online at http://www.cap.org/apps/docs/cap_today/feature_stories/platelet_disorders_feature.html.
What is Idiopathic Thrombocytopenic Purpura? NHLBI, Diseases and Conditions Index [On-line information]. Available online at http://www.nhlbi.nih.gov/health/dci/Diseases/Itp/ITP_WhatIs.html.
What is von Willebrand Disease? NHLBI, Diseases and Conditions Index [On-line information]. Available online at http://www.nhlbi.nih.gov/health/dci/Diseases/vWD/vWD_WhatIs.html.
Von Willebrand Disease. NHF [On-line information]. Available online at http://www.hemophilia.org/bdi/bdi_types3.htm.
Hemostasis. Merck Manual of Diagnosis and Therapy [On-line information]. Available online at http://www.merck.com/mrkshared/mmanual/section11/chapter131/131b.jsp.
Bleeding Disorders. The Merck Manual of Medical Information-Home Edition, Section 14. Blood Disorders, Chapter 155 [On-line information]. Available online at http://www.merck.com/mrkshared/mmanual_home/sec14/155.jsp.
Cortese Hassett, A. (2002). Platelet Function Testing. Transfusion Medicine Update, The Institute for Transfusion Medicine, Issue #5 [On-line information]. Available online at http://www.itxm.org/TMU2002/Issue5.htm.
Lee, D. (2000 July 24). Platelet Aggregometry. Stanford Interventional Cardiology [On-line information]. Previously available online at http://cvmed.stanford.edu/interventional/aggregometry.htm.
Coagulation Test Panels. Clinical and Research Laboratories, Florida Hospital Cancer Institute [On-line information]. Available online at http://www.fhci-labs.com/researchlabs/clinicallabs/hemostasisandthrombosis/panels.htm.
Carville, D. and Guyer, K. (2000 September). Hemostasis testing: past, present, and Future. IVD Technology Magazine, medical devicelink [On-line article]. Available online at http://www.devicelink.com/ivdt/archive/00/09/005.html.
Locke, J. (2001 October). Issues in Platelet Function Testing. Clinical Laboratory Strategies [On-line AACC Newsletter]. Prepublication version available from Jalane at [email protected]
Wuillemin, W., et.al. (2002). Evaluation of a Platelet Function Analyser (PFA-100Ò) in patients with a bleeding tendency. Swiss Med Wkly 132:443-448 [On-line journal]. PDF available for download at http://www.smw.ch/pdf200x/2002/31/smw-10039.PDF.
SE Lind. The bleeding time does not predict surgical bleeding. Blood, Jun 1991; 77: 2547 - 2552.
RPC RODGERS, J LEVIN, and SE LIND. Bleeding Time Revisited Blood, May 1992; 79: 2495 - 2497.
Hankey, G. and Eikelboom, J. (2004 February 28) Aspirin resistance. BMJ 2004;328:477-479 [On-line journal]. Available online at http://bmj.bmjjournals.com/cgi/content/full/328/7438/477.
Peterson, P. (2005 October). Aspirin Resistance: Fact and Fiction. Medscape Conference Coverage, based on selected sessions at the: Pathology Today: American Society for Clinical Pathology 2005 Annual Meeting [On-line CME/CMLE]. Available online at http://www.medscape.com/viewarticle/518858.
Eikelboom, J. et. al. (2005 July 11). Aspirin Resistance and Its Implications in Clinical Practice. Medscape General Medicine 2005;7(3):76 [On-line information]. Available online at http://www.medscape.com/viewarticle/506101.
(2004 September 3). Accumetrics VerifyNow-Aspirin Assay (Formerly Ultegra RPFA-ASA). FDA 510(k) Summary [On-line information]. PDF available for download at http://www.fda.gov/cdrh/pdf4/k042423.pdf.
Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 169-171, 728-729.
Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 235-237.
Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 862-867.
Dugdale, D. and Chen, Y. (Updated 2009 March 02). Platelet aggregation test. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003669.htm. Accessed September 2009.
(Updated 2008 December). Functional Platelet Disorders. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/FxPlateletDisorders.html#. Accessed September 2009.
Ang, L. and Mahmud, E. (2009 January 15). Monitoring Oral Antiplatelet Therapy: Is It Justified? Medscape from Therapeutic Advances in Cardiovascular Disease. [On-line information]. Available online at http://www.medscape.com/viewarticle/584888. Accessed September 2009.
Gurbel, P. et. al. (2007 November 05). Platelet Function Monitoring in Patients With Coronary Artery Disease. Medscape from Journal of the American Journal of Cardiology. [On-line information]. Available online at http://www.medscape.com/viewarticle/564963. Accessed September 2009.
Hughes, S. (2009 March 28). ACC 2009: Evidence Growing for Personalized Antiplatelet Therapy. Medscape from Heartwire [On-line information]. Available online at http://www.medscape.com/viewarticle/590292. Accessed September 2009.
Stasik, C. (2006 August 1). Principles, Indications, and Limitations of the Platelet Function Analyzer. CAP NewsPath [On-line information]. Available online through http://www.cap.org. Accessed September 2009.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson RA and Pincus MR, eds. Philadelphia: 2007, Pp 757-765.
(Published 17 January 2008) Krasopoulos G, Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis. BMJ, doi: 10.1136/bmj.39430.529549.BE, Available online at http://www.bmj.com/cgi/content/full/bmj.39430.529549.BEv1. Accessed September 2009.
Harrison's Principles of Internal Medicine. 16th ed. Kasper D, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. McGraw-Hill, 2005, Pp 676-678.
Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2011, 805-816.
Wintrobe's Clinical Hematology. 12th ed. Greer J, Foerster J, Rodgers G, Paraskevas F, Glader B, Arber D, Means R, eds. Philadelphia, PA: Lippincott Williams & Wilkins: 2009, Pp 1362-1363.
(©2014) Platelet Function Disorders. Written by David Page, Reviewed by Sara J. Israels, M.D. FRCP(C). Canadian Hemophilia Society. Available online at http://www.hemophilia.ca/en/bleeding-disorders/platelet-function-disorders/introduction/. Accessed February 2014.
(August 28, 2012) Sue Hughes. Should Platelet Function Be Measured? New Data. Medscape News. Available online at http://www.medscape.com/viewarticle/769925. Accessed February 2014.
(October 08, 2013) Michael O'Riordan. Platelet-Function Testing Might Benefit Select PCI Patients, Says Expert Panel. Medscape News. Available online at http://www.medscape.com/viewarticle/812254. Accessed February 2014.
Gorelick P, Farooq M. Advances in Our Understanding of "Resistance" to Antiplatelet Agents for Prevention of Ischemic Stroke. Stroke Res Treat. 2013; 2013: 727842. Published online 2013 July 14 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725785/. Accessed February 2014.
(December 07, 2012) Lisa Nainggolan. Pharmacologists Question Aspirin Resistance. Medscape News. Available online at http://www.medscape.com/viewarticle/775844. Accessed February 2014.
Brad S. Karon, MD, PhD and Elizabeth Jaben, MD. Platelet Function, Laboratory Methods for Evaluating Effectiveness of Anti-platelet Therapy. Clinical Laboratory News April 2011: Volume 37, Number 4. Available online at http://www.aacc.org/publications/cln/2011/April/Pages/PlateletFunction.aspx#. Accessed February 2014.