Platelet aggregation test

Definition:

A test of the ability of platelets to clump together (aggregate) and cause blood clotting.

How the test is performed:

Adult or child:
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a tourniquet (an elastic band) or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the tourniquet to distend (fill with blood). A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the tourniquet is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

Infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.

The platelet aggregation test measures the rate and degree to which dispersed platelets in a sample of plasma form clumps after the addition of a material that normally stimulates aggregation. This may include ADP (adenosine diphosphate), epinephrine, arachidonic acid, collagen, or ristocetin. Clumping of platelets causes the sample to be more clear (less turbid). A machine measures the changes in turbidity (cloudiness) and prints a graphic recording of the results.

How to prepare for the test:

Consult with the health care provider if you are taking any medications that may alter test results (see "special considerations"). The list of medications that may affect test results is increasing rapidly; notify your health care provider of any medications (including over-the-counter preparations) that you have taken within the preceding 2 weeks.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

infant test or procedure preparation (birth to 1 year)
toddler test or procedure preparation (1 to 3 years)
preschooler test or procedure preparation (3 to 6 years)
schoolage test or procedure preparation (6 to 12 years)
adolescent test or procedure preparation (12 to 18 years)

How the test will feel:

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed:

This test is most often indicated when there is a bleeding tendency qualitatively similar to low-platelet bleeding despite normal platelet count (normal number of platelets).

Platelets (thrombocytes) are small cells in the bloodstream that are part of the blood clotting process. They are manufactured in the bone marrow. When bleeding occurs, platelets clump together at the site, swell, and stick to the injured area, acting as a plug to reduce the bleeding.

Platelet aggregation tests help to diagnose diseases of platelet dysfunction and distinguish between inherited bleeding problems (such as hemophilia or von Willebrand disease) and acquired bleeding problems (those that occur because of such things as another disorder or medication).

Normal Values:

(Note: The normal time it takes to cause clumping is temperature dependent and may vary from laboratory to laboratory. The shape of the vial is also important.)

Response to the different "aggregation stimulators" can help to distinguish various platelet defects. In particular, the difference between the response to ristocetin and the other products is important, because ristocetin triggers aggregation through a different mechanism than the other products. The time and pattern of platelet aggregation also varies between stimulators.

What abnormal results mean:

Congenital disorders that cause decreased platelet aggregation:

Glanzmann's thrombasthenia (a rare inherited platelet disorder)
- Platelets fail to aggregate in response to normal stimulation but do clump normally in response to ristocetin
Bernard-Soulier syndrome (rare inherited disorder in which platelets are unable to respond to von Willebrand factor)
- Platelets aggregate normally in response to most stimulation but do not aggregate in response to ristocetin. The response to collagen is blunted.
Storage pool disease (a group of disorders characterized by defective stimulation by materials, especially ADP, which trigger platelet aggregation)
- variable abnormalities of platelet aggregation
von Willebrand's disease ( inherited lack of von Willebrand factor or ristocetin cofactor)
- aggregation with ristocetin is usually abnormal in type I disease and increased in type II

Acquired conditions that cause decreased platelet aggregation:

use of platelet inhibiting medications (see special considerations)
autoimmune disorders that produce antibodies against platelets
myeloproliferative disorders
uremia (result of kidney failure)
- mechanism that causes bleeding is uncertain
acquired storage pool disorder (platelets are no longer effective because of temporary damage, such as in response to cardiopulmonary (heart and lungs) bypass or vasculitis)
fibrin degradation products

What the risks are:

excessive bleeding
fainting or feeling light-headed
hematoma (blood accumulating under the skin)
infection (a slight risk any time the skin is broken)
multiple punctures to locate veins

Note: This test is often performed because the patient has a bleeding problem. Bleeding may be more of a risk for this person than for people without bleeding problems.

Special considerations:

Medications that may alter test results include:

aspirin
aspirin compounds
nonsteroidal anti-inflammatory drugs
tricyclic antidepressants
antihistamines
some antibiotics

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Review Date: 10/28/2001
Reviewed By: Rebecca Elstrom, M.D., Division of Hematology-Oncology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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