Light Transmission Aggregometry and ATP Release for the Diagnostic Assessment of Platelet Function

 

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ABSTRACT

Light transmission aggregometry (LTA) is the gold standard for the study of patients with defects of platelet function. Use of LTA in clinical practice for predicting the risk of thrombosis or monitoring the pharmacologic effects of antiplatelet agents should be discouraged, because not only is the monitoring of treatment with antiplatelet agents (with any laboratory test) not indicated at present, but also the lack of standardization of the technique for LTA makes it additionally unsuitable for this purpose. The need for standardization of LTA has recently been emphasized by the results of four surveys, which showed that there is a wide variation in the methodology used worldwide. A modification of the traditional LTA is the lumiaggregometer, which measures platelet secretion in parallel with platelet aggregation. This technique is probably preferable to traditional LTA in the diagnostic workup of patients with inherited defects of platelet function, because it is more sensitive to the most common disorders, which are characterized by abnormalities of platelet secretion. LTA (or lumiaggregometry) is useful as a first screening test of patients with the clinical suspicion of defects of platelet function because it helps to provide an interim diagnostic hypothesis, which can then be confirmed or discounted using appropriate and specific tests.

REFERENCES

• 1 Cattaneo M. Inherited platelet-based bleeding disorders.  J Thromb Haemost. 2003;  1 1628-1636
  CrossrefPubMedGoogle Scholar
• 2 Harrison P, Mumford A. Screening tests of platelet function: update on their appropriate uses for diagnostic testing.  Semin Thromb Hemost. 2009;  35 150-157
  Article in Thieme ConnectPubMedGoogle Scholar
• 3 McGlasson D L, Fritsma G A. Whole blood platelet aggregometry and platelet function testing.  Semin Thromb Hemost. 2009;  35 168-180
  Article in Thieme ConnectPubMedGoogle Scholar
• 4 Born G V. Aggregation of blood platelets by adenosine diphosphate and its reversal.  Nature. 1962;  194 927-929
  PubMedGoogle Scholar
• 5 O'Brien J R. Platelet aggregation: part II, some results from a new method of study.  J Clin Pathol. 1962;  15 452-455
  PubMedGoogle Scholar
• 6 Huang E M, Detwiler T C. Stimulus-response coupling mechanisms. In: Phillips DR, Schuman MA Biochemistry of Platelets. Orlando, FL; Academic Press 1986: 1-50
  Google Scholar
• 7 Mustard J F, Perry D W, Kinlough-Rathbone R L, Packham M A. Factors responsible for ADP-induced release reaction of human platelets.  Am J Physiol. 1975;  228 1757-1765
  PubMedGoogle Scholar
• 8 Cattaneo M, Gachet C, Cazenave J-P, Packham M A. Adenosine diphosphate (ADP) does not induce thromboxane A2 generation in human platelets.  Blood. 2002;  99 3868-3869
  CrossrefPubMedGoogle Scholar
• 9 Falcon C R, Cattaneo M, Ghidoni A, Mannucci P M. The in vitro production of thromboxane B2 by platelets of diabetic patients is normal at physiological concentrations of ionized calcium.  Thromb Haemost. 1993;  70 389-392
  PubMedGoogle Scholar
• 10 Born G V, Cross M J. The aggregation of blood platelets.  J Physiol. 1963;  168 178-195
  PubMedGoogle Scholar
• 11 Cattaneo M, Lecchi A, Zighetti M L, Lussana F. Platelet aggregation studies: autologous platelet-poor plasma inhibits platelet aggregation when added to platelet-rich plasma to normalize platelet count.  Haematologica. 2007;  92 694-697
  CrossrefPubMedGoogle Scholar
• 12 Mani H, Luxembourg B, Kläffling C et al.. Use of native or platelet count adjusted platelet rich plasma for platelet aggregation measurements.  J Clin Pathol. 2005;  58 747-750
  CrossrefPubMedGoogle Scholar
• 13 Linnemann B, Schwonberg J, Mani H et al.. Standardization of light transmittance aggregometry for monitoring antiplatelet therapy: an adjustment for platelet count is not necessary.  J Thromb Haemost. 2008;  6 677-683
  CrossrefPubMedGoogle Scholar
• 14 Sixma J J. Methods for platelet aggregation in platelet function and thrombosis.  Adv Exp Med Biol. 1972;  34 79-95
  PubMedGoogle Scholar
• 15 Zucker M B. Tests of platelet adhesion, aggregation and release.  Thromb Diath Haemorrh. 1970;  34(Suppl) 1-12
  PubMedGoogle Scholar
• 16 Friedlander I, Cook I JY, Hawkey C, Symons C. A laboratory study of spontaneous platelet aggregation.  J Clin Pathol. 1971;  24 323-327
  CrossrefPubMedGoogle Scholar
• 17 The British Society for Haematology BCSH Haemostasis and Thrombosis Task Force . Guidelines forplatelet function testing.  J Clin Pathol. 1988;  41 1322-1330
  CrossrefPubMedGoogle Scholar
• 18 Moffat K A, Ledford-Kraemer M R, Nichols W L et al.. Variability in clinical laboratory practice in testing for disorders of platelet function: results of two surveys of the North American Specialized Coagulation Laboratory Association.  Thromb Haemost. 2005;  93 549-553
  PubMedGoogle Scholar
• 19 Duncan E M, Bonar R, Rodgers S E, Favaloro E J, Marsden K. Methodology and outcomes of platelet aggregation testing in Australia, New Zealand and the Asia-Pacific region: results of a survey from the Royal College of Pathologists of Australasia Haematology Quality Assurance Program.  Int J Lab Hematol. 2008;  , March 25 (Epub ahead of print)
  PubMedGoogle Scholar
• 20 Jennings I, Woods T AL, Kitchen S, Walzer I D. Platelet function testing: practice among UK National External Quality Assessment Scheme for Blood Coagulation participants, 2006.  J Clin Pathol. 2008;  61 950-954
  CrossrefPubMedGoogle Scholar
• 21 Zhou L, Schmaier A H. Platelet aggregation testing in platelet-rich plasma. Description of procedures with the aim to develop standards in the field.  Am J Clin Pathol. 2005;  123 172-183
  CrossrefPubMedGoogle Scholar
• 22 Clinical and Laboratory Standards Institute (CLSI) .Platelet Function Testing by Aggregometry; Approved Guideline. CLSI document H58-A. Wayne, PA; Clinical and Laboratory Standards Institute 2008
  Google Scholar
• 23 Pai M, Hayward C. Diagnostic assessment of platelet disorders: what are the challenges to standardization?.  Semin Thromb Hemost. 2009;  35 xx
  PubMedGoogle Scholar
• 24 Favaloro E J. Internal quality control and external quality assurance of platelet function tests.  Semin Thromb Hemost. 2009;  35 xx
  PubMedGoogle Scholar
• 25 Michelson A D, Cattaneo M, Eikelboom J W et al.. Aspirin resistance: position paper of the Working Group on Aspirin Resistance.  J Thromb Haemost. 2005;  3 1309-1311
  CrossrefPubMedGoogle Scholar
• 26 Hayward C PM, Pai M, Moffat K A et al.. Diagnostic utility of light transmission platelet aggregometry: results from from a prospective study of individuals referred for bleeding disorders assessment.  J Thromb Haemost. 2009;  7 676-684
  CrossrefPubMedGoogle Scholar
• 27 Favaloro E J. Phenotypic identification of platelet type-von Willebrand disease and its discrimination from type 2B von Willebrand disease: a question of 2B or not 2B? A story of nonidentical twins? Or two-sides of a multidenominational or multifaceted primary hemostasis coin?.  Semin Thromb Hemost. 2008;  34 113-127
  Article in Thieme ConnectPubMedGoogle Scholar
• 28 Nieuwenhuis H K, Akkerman J W, Sixma J J. Patients with a prolonged bleeding time and normal aggregation tests may have storage pool deficiency: studies on one hundred six patients.  Blood. 1987;  70 620-623
  PubMedGoogle Scholar
• 29 Diamandis M, Veljkovic D K, Maurer-Spurej E et al.. Quebec platelet disorder: features, pathogenesis and treatment.  Blood Coagul Fibrinolysis. 2008;  19 109-119
  CrossrefPubMedGoogle Scholar

Prof. Marco Cattaneo

Unità di Medicina III, Ospedale San Paolo, Università di Milano

Via di Rudinì 8, 20142 Milano, Italy

Email: marco.cattaneo@unimi.it