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Published on: February 14, 2017
Platelet function testing: Current practice among clinical centres in Northern Europe
Timea Szanto1,2, Eva Zetterberg3, Sofia Ramström4,5
1Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
Insights
Northern European centers show significant variability in diagnosing inherited platelet function defects (IPFD). Harmonization is needed to align practices with international guidelines and improve patient care for bleeding disorders.
Area of Science:
- Hematology
- Clinical Diagnostics
- Medical Practice Variation
Background:
- Platelet function tests are crucial for diagnosing inherited platelet function defects (IPFD).
- Acquired platelet dysfunction due to drugs or comorbidities must be ruled out before testing.
- Standardized diagnostic approaches are essential for accurate IPFD assessment.
Purpose of the Study:
- To survey and identify current practices for platelet function testing across Northern European clinical centers.
- To assess the harmonization of diagnostic protocols for inherited platelet function defects in the region.
Main Methods:
- A survey questionnaire was distributed to 14 clinical centers in six Northern European countries.
- Data collected included preanalytical procedures, diagnostic work-up components, and molecular genetic testing availability.
- The study captured practices serving approximately 29.5 million people.
Main Results:
- Significant variability exists in diagnostic work-up, with only 42.8% of centers being comprehensive treatment centers.
- Bleeding assessment tools and family history are commonly used, but structured preanalytical instructions are less frequent (35.7%).
- Platelet aggregometry is universal, but other methods like flow cytometry (71.4%) and molecular diagnostics (50%) show varied adoption.
Conclusions:
- The current practices for diagnosing IPFD in Northern Europe are highly variable.
- Harmonization of diagnostic strategies is urgently needed, referencing international registers like EUHASS and guidelines from ISTH and EHA.
- Standardized protocols will improve consistency and accuracy in IPFD diagnosis and management.
Introduction:
Platelet function tests are used to screen and diagnose patients with possible inherited platelet function defects (IPFD). Some acquired platelet dysfunction may be caused by certain drugs or comorbidities, which need to be excluded before testing.
Aims:
To identify current practice among centres performing platelet function tests in Northern Europe.
Methods:
A total of 14 clinical centres from Sweden (six), Finland (two), Denmark (two), Norway (one), Estonia (two) and Iceland (one) completed the survey questionnaire, the population capture area of about 29.5 million.
Results:
Six of the 14 (42.8%) centres providing platelet function assessment represent comprehensive treatment centres (EUHANET status). A Bleeding score (BS) or ISTH bleeding assessment tool (ISTH BAT score) is evaluated in 11/14 (78.6%) centres and family history in all. Five/14 centres (35.7%) use structured preanalytical patient instructions, and 10/14 (71.4%) recorded questionnaire on the preassessment of avoidance of any drugs or natural products affecting platelet functions. Preliminary investigations of screening tests of coagulation are performed in 10/14 (71.4%), while in 4/14 (28.6%), the diagnostic work-up of IPFD and von Willebrand disease (VWD) is performed simultaneously. The work-up of IPFD includes peripheral blood smear in 10/14 (71.4%), platelet aggregometry in all, flow cytometry in 10/14 (71.4%) and Platelet Function Analysis (PFA) in 3/11 (28.6%). Molecular genetic diagnosis is available in 7/14 (50%) centres.
Conclusions:
The considerable variability in the current practice illustrates the need for harmonization between the Northern European centres according to the international registers (i.e. EUHASS) and IPFD guidelines (ISTH, EHA).
