Van Creveld Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands.
Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.
J Thromb Haemost. 2018 Apr;16(4):689-698. doi: 10.1111/jth.13952. Epub 2018 Feb 1.
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.
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.
光透射比浊法（LTA）是诊断血小板功能障碍（PFD）最常用的检测方法，但对轻度 PFD 的敏感性较低。已经推荐使用流式细胞术来辅助 PFD 的诊断，但尚未将其标准化为诊断检测。我们开发了一种标准化的流式细胞术血小板功能分析方案，该方案通过测定纤维蛋白原结合和血小板激活标志物 P-选择素的表达来评估血小板对激动剂刺激的反应。 目的： 评估流式细胞术血小板功能检测在排除血管性血友病和凝血因子缺乏症的疑似 PFD 患者中的附加价值。 方法： 对 107 例疑似 PFD 的患者进行了流式细胞术和 LTA 检测，评估了血小板功能。比较了两种检测方法在诊断 PFD 患者方面的一致性和判别能力。 结果： 在 107 例患者中，51 例患者的出血评分升高；62.7%的患者存在异常的流式细胞术血小板功能，54.2%的患者存在异常的 LTA 血小板功能。LTA 和流式细胞术之间存在中等程度的一致性（κ=0.32）。在出血评分升高的患者中，流式细胞术分析的判别能力良好（AUC 0.82，0.74-0.90），而 LTA 的判别能力为中等（AUC 0.70，0.60-0.80）。两种检测方法联合使用具有更好的判别能力（AUC 0.87，0.80-0.94）。 结论： 对于不明原因出血倾向的患者，流式细胞术分析血小板功能在 PFD 的诊断中有附加价值。
