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Semin Thromb Hemost
DOI: 10.1055/a-2622-3545
Review Article

Automation in Platelet Function Testing: Current Challenges and Future Directions

Federico Boggio 
1   Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Juri A. Giannotta
2   Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
,
Anna Lecchi
2   Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
› Institutsangaben
Funding The study was partially supported by the Italian Ministry of Health – Bando Ricerca Corrente. The Hemostasis & Thrombosis Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico is a member of the European Reference Network on Rare Haematological Diseases, EuroBloodNet-Project ID No. 101157011. ERN-EuroBloodNet is partly co-funded by the European Union within the framework of the Fourth EU Health Program.
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Abstract

Platelet function testing is essential for diagnosing and managing platelet function disorders, but faces significant challenges due to complex protocols and variability in results. While light transmission aggregometry remains the gold standard for assessing platelet aggregation, it suffers from several limitations, including labor-intensive protocols, variability in reagents, and poor standardization. Over the decades, improvements such as lumi-aggregometry, which integrates granule secretion testing, and impedance whole-blood aggregometry, which simplifies sample handling, have addressed some of these challenges. Advanced granule secretion assays, including high-performance liquid chromatography and flow cytometry, have further enhanced diagnostic capabilities, although these techniques still depend on specialized expertise and expensive equipment. Recently, significant advancements have been made with automated aggregometers, such as the Sysmex CS series, and high-throughput 96-well plate assays, which improve consistency, throughput, and reproducibility. Nonetheless, further refinement in standardized reagents and consensus-driven protocols is required. Microfluidic technologies, exemplified by systems like the Total Thrombus Analysis System (T-TAS), incorporate physiological shear conditions and real-time thrombus formation assessment, providing enhanced diagnostic insights into platelet behavior. Despite their automation and clinical feasibility, these flow-based systems still require broader validation for routine clinical implementation. Further developments should prioritize integrating complementary assays, enhancing automation, and advancing miniaturization to improve standardization and diagnostic accuracy. Future technologies combined with artificial intelligence-based data interpretation hold the promise to transform platelet diagnostics, enabling personalized patient care. However, achieving widespread clinical adoption requires ongoing collaboration between clinicians, laboratories, industry, and regulatory bodies.

Keywords

platelet function tests (aggregometry, flow cytometry, other) - automation - microfluidics - platelet disorders/pathology/inherited, acquired - platelet aggregometry - laboratory hemostasis diagnostics - point-of-care testing (hemostasis or thrombosis) - bleeding disorder—diagnosis

Authors' Contributions

F.B. provided original ideas, wrote, edited, and approved the final version of the manuscript. J.A.G. reviewed and approved the manuscript. A.L. wrote the first draft, coordinated the project, reviewed, and approved the subsequent corrections and improvements.




Publikationsverlauf

Eingereicht: 15. März 2025

Angenommen: 26. Mai 2025

Accepted Manuscript online:
27. Mai 2025

Artikel online veröffentlicht:
17. Juni 2025

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