Diagnosis of Inherited Platelet Function Disorders using two different Diagnostic Approaches

Authors

  • Muhammad waleed Ahmed Department of Haematology, Armed Forces Institute of Pathology Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Saeed Akhtar Khan Khattak Department of Haematology, Pakistan Navy Station Shifa Karachi Pakistan
  • Saima Zahir Department of Haematology, Armed Forces Institute of Pathology Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Sumaira Zahoor Department of Haematology, Armed Forces Institute of Pathology Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Umar Department of Haematology, Armed Forces Institute of Pathology Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Nazish Tahir Department of Haematology, Armed Forces Institute of Pathology Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i1.11217

Keywords:

Flow cytometry; Functional and molecular analysis; Inherited platelet disorder; Light transmission aggregometry; Platelet aggregation.

Abstract

Objective: To compare the effectiveness of immunophenotyping by flow cytometry (FC) and light transmission aggregometry (LTA) in diagnosing inherited platelet function disorders (IPFDs) i.e., Glanzmann thrombasthenia (GLT) and Bernard-Soulier syndrome (BSS).

Study Design: Prospective longitudinal study.

Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi, Pakistan from Jul 2020 to Jun 2022.

Methodology: A total of 76 patients were included in the study based on their clinical presentation and elevated bleeding time, as assessed using the ISTH-SSC Bleeding Assessment Tool severity score. Flow cytometry was performed on blood samples collected in EDTA anticoagulant to detect platelet membrane glycoproteins (CD41, CD61, CD42a, and CD42b). In contrast, LTA was used to record platelet responses to collagen, epinephrine, ADP, and Ristocetin, with platelet-rich plasma prepared from blood specimens collected in citrate anticoagulant.

Results: A total of 76 patients were included in the study based on their clinical presentation and increased bleeding time. Amongst them 42(58.0%) were males, while the mean age was 10.61±8.74 years. Chronic history of epistaxis was the presenting symptom in majority of the patients; 26(32%). Flow cytometry revealed a total of 16 patients suffering from IPFDs (GLT=10; BSS=06) whereas LTA confirmed the diagnosis of platelet dysfunction among 14 cases (GLT=10; BSS=04). Both showed concurrent positive results in 76.5% subjects (κ=0.84) while flow cytometry showed a relatively higher value of sensitivity, specifically in patients with low platelet

Conclusion: Both LTA and flow cytometry show a significant level of mutual diagnostic agreement.

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References

Wu J, Heemskerk JWM, Baaten CCFMJ. Platelet membrane receptor proteolysis: Implications for platelet function. Front Cardiovasc Med 2021;7:608391

https://doi.org/10.3389/fcvm.2020.608391

Boeckelmann D, Glonnegger H, Sandrock-Lang K, Zieger B. Pathogenic Aspects of Inherited Platelet Disorders. Hamostaseologie 2021;41(6):460-468.

https;//doi: 10.1055/a-1665-6249

Le Blanc J, Mullier F, Vayne C, Lordkipanidzé M. Advances in platelet function testing—light transmission aggregometry and beyond. J Clin Med 2020 ;9(8):2636

https://doi.org/10.3390/jcm9082636

Podda G, Femia EA, Cattaneo M. Current and emerging approaches for evaluating platelet disorders. Int J Lab Hematol 2016;38(S1):50–58.

http://doi.org/10.1111/ijlh.12539

Rubak P, Nissen PH, Kristensen SD, Hvas A-M. Investigation of platelet function and platelet disorders using flow cytometry. Platelets 2016;27(1):66-74.

https://doi.org/10.3109/09537104.2015.1032919

Hvas AM, Grove EL. Platelet Function Tests: Preanalytical Variables, Clinical Utility, Advantages, and Disadvantages. Methods Mol Biol 2017;1646:305-320.

https://doi.org/10.1007/978-1-4939-7196-1_24

Lambert MP. Updates in diagnosis of the inherited platelet disorders. Curr Opin Hematol 2020;27(5):333–340.

Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P, et al. ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. J Thromb Haemost 2010;8(9):2063–2065.

https://doi.org/10.1111/j.1538-7836.2010.03975.x

Navred K, Martin M, Ekdahl L, Zetterberg E, Andersson NG, Strandberg K, et al. A simplified flow cytometric method for detection of inherited platelet disorders—A comparison to the gold standard light transmission aggregometry. PLoS One 2019;14(1):e0211130.

https://doi.org/10.1371/journal.pone.0211130

Sharma P, Sachdeva MUS, Kumar N, Bose S, Bose P, Uppal V, et al. A comparative study between light transmission aggregometry and flow cytometric platelet aggregation test for the identification of platelet function defects in patients with bleeding. Blood Res 2021;56(2):109–118.

https://doi.org/10.5045/br.2021.2020232

Huskens D, Li L, Florin L, de Kesel P, de Laat B, Roest M, et al. Flow cytometric analysis of platelet function to improve the recognition of thrombocytopathy. Thromb Res 2020 ;194:183–189. https://doi.org/10.1016/j.thromres.2020.06.037

Van Asten I, Schutgens REG, Baaij M, Zandstra J, Roest M, Pasterkamp G, et al. Validation of flow cytometric analysis of platelet function in patients with a suspected platelet function defect. J Thromb Haemost 2018;16(4):689–698.

https://doi.org/10.1111/jth.13952

Sun P, McMillan-Ward E, Mian R, Israels SJ. Comparison of light transmission aggregometry and multiple electrode aggregometry for the evaluation of patients with mucocutaneous bleeding. Int J Lab Hematol 2019;41(1):133–140.https://doi.org/10.1111/ijlh.12937

Lambert MP. Inherited platelet disorders. Hematol Oncol Clin North Am 2019;33(3):471–87.

https://doi.org/10.1016/j.hoc.2019.01.008

Naz A, Jamal MY, Amanat S, Din ujjan I, Najmuddin A, Patel H, et al. Autosomal recessive inherited bleeding disorders in Pakistan: a cross-sectional study from selected regions. Orphanet J Rare Dis 2017;12(66):06206

http://doi.org/10.1186/s13023-017-0620-6

Irum S, Robert HM, Mahmood A, Mahmood R, Khurshid A, Ishaq M. Frequency inherited platele function disorders–Armed Forces Institute of Pathology experience. Pak Armed Force Med J 2020;70(1):22–26.

Kim B. Diagnostic workup of inherited platelet disorders. Blood Res 2022;57(S1):S11–19.

http://doi.org/10.5045/br.2022.2021223

Palma-Barqueros V, Revilla N, Sánchez A, Zamora Cánovas A, Rodriguez-Alén A, Marín-Quílez A, et al. Inherited platelet disorders: An updated overview. Int J Mol Sci 2021;22(9):4521. http://doi.org/10.3390/ijms22094521

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Published

28-02-2025

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Original Articles

How to Cite

1.
Ahmed M waleed, Khattak SAK, Zahir S, Zahoor S, Umar M, Tahir N. Diagnosis of Inherited Platelet Function Disorders using two different Diagnostic Approaches. Pak Armed Forces Med J [Internet]. 2025 Feb. 28 [cited 2025 Mar. 14];75(1):103-7. Available from: https://pafmj.org/PAFMJ/article/view/11217