Platelet Function Defects: A Clinical Review

Abstract

Platelet dysfunction, especially acquired forms, are common causes of hemorrhage, especially in association with trauma and surgery. Although the hereditary platelet function defects are generally quite rare, hereditary storage pool disease is common enough to be suspected in an individual, usually a child, with characteristic historical and clinical findings. The acquired platelet function defects, especially those resulting from drugs, are very common and should promptly be suspected in patients developing easy and spontaneous bruising, mild to moderate mucosal membrane hemorrhage, or unexplained bleeding associated with trauma or surgery. The template bleeding time is generally useful as a screening test of platelet function, but a normal template bleeding time, in the presence of a suggestive history, suggestive clinical findings, or in the patient frankly bleeding, is not reliable and platelet aggregation or lumi-aggregation should be done in appropriate clinical situations. The mainstay of therapy for essentially all these defects, if bleeding is significant, is the liberal infusion of appropriate numbers of platelet concentrates. The acquired platelet function defects, of course, should also be managed by attempts to treat or control the underlying disease, if possible, and offending drugs or potentially offending drugs should promptly be discontinued.

RETRACTED ARTICLE: Does continuous heparinization influence platelet function in the intensive care patient?

“…Activation or release of various potent inflammatory mediators or cytotoxic substances appears to participate in platelet injury in this situation [1,17]. It is not clear from the present data whether the reduced platelet function in the sepsis group was further induced or strenghened by continuous heparinization.…”

“…Many factors associated with severe illness may (directly or indirectly) affect platelet function, e. g., pH, drugs (especially antibiotics), and plasma factor abnormalities [17]. Changes in the internal environment of the platelets indicate the presence of hyperfunctional or hypersensitive platelets, which are prone to active aggregation.…”

“…Moreover, it has not been established whether platelets have a role in the pathogenesis of organ injury. There are many indicators of platelet abnormalities, including survival time, morphology, adhesiveness, size and volume, aggregation rate and sensitivity, and release of various substances [17,18]. Platelet aggregation was used in the present study because platelet dysfunction can be well expressed as a diminished sensibility to triggering agonists such as ADP, collagen, and epinephrine [19,20].…”

RETRACTED ARTICLE: Volume therapy in the intensive care patient – we are still confused, but...

“…Many factors may directly or indirectly affect platelet function in this situation, including pH, temperature, plasma coagulation abnormalities, and hormonal responses. Various drugs routinely used in intensive care patients can additionally interfere with platelet function [78]. After large doses of HMW HES platelets appeared swollen, and platelet adhesion was reduced.…”

Prognostic Factors in Septic Shock Patients on Arrival at Emergency Department

“…Platelet counts, activated partial thromboplastin time, INR, antithrombin, fibrinogen, and D-dimer reflect coagulopathy in critical illness. The platelet dysfunction in critical illness is of a multifactorial origin that is platelet membrane damage, release of platelet granule contents, fibrin degradation products, and others 19,20) . The platelet count that is included in the SOFA score predicts ICU mortality based on laboratory results and clinical data.…”