Technical considerations for platelet aggregation and related problems.

Platelet aggregation generally is ordered by the physician to evaluate platelet function in hemorrhagic or thrombotic disorders. Malfunction of the platelet may be the result of an intrinsic congenital defect or an acquired problem induced by drugs or certain circulating plasma factors. It is necessary to obtain information from the patient with respect to family history, drug ingestion, physical or mental stress. In addition, other laboratory studies should be obtained to rule out general coagulation disorders affecting the plasma factors. A bleeding time will be helpful in establishing the severity of any platelet dysfunction. Technical considerations with regard to the preparation of the samples are of primary importance in determining platelet aggregation. Aggregating studies require the use of a variety of binding agents. (Studies on shape change, adhesion of platelets, release of platelet granule substance, and or lysis with extrusion of cytoplasmic constituents may be helpful in certain cases.) Instrumentation for platelet aggregation presently is available in many hospitals. The technical factors to be considered for routine aggregation studies include the type and strength of anticoagulant, centrifugation technique used in preparing the platelet-rich and platelet-poor plasma, platelet concentration, time of storage of the sample after venipuncture and after centrifugation, temperature, and the mixing of the sample. In general, critical concentrations of each reagent should be employed to improve the discrimination capability of the assay. Small differences in response may be obliterated by using excessive concentrations of a given reagent. Comparison in response to the test platelets with control platelets is best done at the same time by performing the aggregation in a dual instrument so that handling procedures will be identical and artifactual differences eliminated.