PLATELET DYSFUNCTION Provisional Investigation
Document sites, duration and amount of bleeding especially epistaxis, menorrhagia and mucosal bleeding, History of systemic illness, medications, family history. Examine and document bleeding and signs of systemic disease
CBC and smear, PTT, PT, TT Normal platelet count and morphology
New onset bleeding
PTT FVIII,vWF Ag,vWF:RCo
Other investigation Diagnosis Management
Normal
No
Repeat Liver & Renal tests Abnormal
Recurrent infection, Eczema, lymphoreticular Malignancies, males
Specific morphologic abnormality
Uremia Drug-induced Liver disease Underlying Platelet dysfunction Manage Underlying disease
Abnormal No
Yes
No
Yes
Von Willebrand’s disease
Normal Normal Abnormal CBC and Blood smear
Stop drug If possible
Normal to slightly Low platelet count And large size
Lifelong bleeding
Platelet inhibiting drugs Yes
Normal to slightly low Platelet count and small Platelet size
Platelet aggregation studies
Normal Abnormal Abnormal
Intrinsic platelet MDS Dysfunction Glanzmann BMA BMB
vW multimer assay
X-linked thrombocytopenia Amegakaryocytosis
WiskottAldrich
Brenard-Soulier: Very large platelets Abnormal ristocetin aggregation May-Hegglin: Large platelets+Dohle bodies Gray platelet syndrom: Large, pale platelets
Type I vWD Type 2A,2B, 3, DDAVP Splenectomy may Platelet type---vWF replacement. reduce bleeding Rarely platelet DDAVP Challenge Platelet transfusion for latter transfusion BMT
ITP,Other macrothrombocytopenias
Platelet dysfunction Can be seen in ITP But low count is more important